Abdominal Wall Thickness as a Predictor of Surgical Site Infections in Nonelective Colon Procedures.

INTRODUCTION: Surgical site infections (SSIs) remain a clinically important outcome in colon surgery. Prior work has demonstrated an association between abdominal wall thickness and SSI risk in emergency colon cases. We aimed to validate this association between anterior abdominal wall thickness and incisional (superficial and deep) SSIs after nonelective colon procedures. METHODS: We retrospectively reviewed 1344 nonelective colon procedures as defined by the National Healthcare Safety Network in a nine-hospital geographic network from 2019 to 2022. Regression models assessed the association between abdominal wall thickness and wound class with incisional SSIs. Subsequent regression analysis of the top 25% highest-risk subset evaluated for association between skin closure techniques with SSI. RESULTS: After excluding cases with missing data 1023 nonelective colon procedures remained. Abdominal wall thickness was significantly associated with incisional SSI risk, with each centimeter associated with 29% (P = 0.021) increased odds of SSI overall, and 101 increased odds (P < 0.001) in the high-risk subgroup. Wound class IV (dirty-infected) did not have a significantly higher SSI risk than class II in the overall cohort. CONCLUSIONS: Increased abdominal wall thickness is associated with increased incisional SSI in nonelective colon surgeries. Wound class IV patients may benefit from unique pathways given their increased risk. Future studies to elucidate individualized risk and skin closure techniques could improve SSI rates in high-risk colectomy patients.