JAMA Logo Colectomy is a standardized procedure to remove the colon either partially or fully. This procedure may help avert postoperative infections known as surgical site infection (SSI). A recent study now suggests that obese individuals subjected to colon surgery have higher chances of developing SSI.

While conducting the study, scientists evaluated SSI rates among obese and non-obese colectomy patients through data collected from members of eight different Blue Cross Blue Shield (BCBS) insurance plans. A total of 7,020 patients between 18 and 64 years of age subjected to either a segmental or total colectomy for colon cancer, diverticulitis or inflammatory bowel disease were examined. These patients underwent treatment for colon cancer between January 1, 2002 and December 31, 2008.

Investigators quote, “We conclude that patients undergoing colorectal surgery who develop SSIs, many of whom are obese, tax the health care system. Pay-for-performance policies in surgery should account for the increased risk of infection and cost of caring for this population. Failure to consider these differences could lead to perverse incentives that may penalize surgeons who care for obese patients and may even affect obese patients’ access to colorectal surgery.”

From these patients, 1,243 were identified as obese, while 5,777 were classified as non-obese. The overall rate of SSI appeared 10.3 percent, with 14.5 percent obese patients and 9.5 percent non-obese patients experiencing a higher rate of SSI. Experts believe that obesity was the strongest predictor of SSI after adjusting for laparoscopy, diagnosis, sex and age. On completion of the study, obese patients reported a 60 percent increase in odds of SSI as compared to non-obese patients. Elizabeth C. Wick, M.D., of the Johns Hopkins School of Medicine, Baltimore, and colleagues mention that on average, developing a postoperative SSI was linked with increased cost of the procedure, hospital stay and a higher rate of hospital readmission.

The study is posted online and will appear in the September issue of Archives of Surgery, one of the JAMA/Archives journals.