Obesity Decreases Perioperative Tissue Oxygenation
Open accessAbstract
Background: Obesity is an important risk factor for surgical site infections. The incidence of surgical wound infections is directly related to tissue perfusion and oxygenation. Fat tissue mass expands without a concomitant increase in blood flow per cell, which might result in a relative hypoperfusion with decreased tissue oxygenation. Consequently, the authors tested the hypotheses that perioperative tissue oxygen tension is reduced in obese surgical patients. Furthermore, they compared the effect of supplemental oxygen administration on tissue oxygenation in obese and nonobese patients. Methods: Forty-six patients undergoing major abdominal surgery were assigned to one of two groups according to their body mass index: body mass index less than 30 kg/m2 (nonobese) or 30 kg/m2 or greater (obese). Intraoperative oxygen administration was adjusted to arterial oxygen tensions of approximately 150 mmHg and approximately 300 mmHg in random order. Anesthesia technique and perioperative fluid management were standardized. Subcutaneous tissue oxygen tension was measured with a polarographic electrode positioned within a subcutaneous tonometer in the lateral upper arm during surgery, in the recovery room, and on the first postoperative day. Postoperative tissue oxygen was also measured adjacent to the wound. Data were compared with unpaired two-tailed t tests and Wilcoxon rank sum test; P < 0.05 was considered statistically significant. Results: Intraoperative subcutaneous tissue oxygen tension was significantly less in the obese patients at baseline (36 vs. 57 mmHg; P = 0.002) and with supplemental oxygen administration (47 vs. 76 mmHg; P = 0.014). Immediate postoperative tissue oxygen tension was also significantly less in subcutaneous tissue of the upper arm (43 vs. 54 mmHg; P = 0.011) as well as near the incision (42 vs. 62 mmHg; P = 0.012) in obese patients. In contrast, tissue oxygen tension was comparable in each group on the first postoperative morning. Conclusion: Wound and tissue hypoxia were common in obese patients in the perioperative period and most pronounced during surgery. Even with supplemental oxygen tissue, oxygen tension in obese patients was reduced to levels that are associated with a substantial increase in infection risk.
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Adipose tissue is poorly oxygenated in the obese state in humans.
“This has been verified by recent clinical observations in humans, which suggest that AT is poorly oxygenated in the obese state (20,21).”
From Adipose tissue remodeling and obesity (2011) · cites this paper as [20]
Compared to brown AT, white AT is not particularly well vascularized.
“Compared to brown AT, white AT is not particularly well vascularized (4,20)”
From Adipose tissue remodeling and obesity (2011) · cites this paper as [20]
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- Authors
- Kabon, B., Nagele, A., Reddy, D., Eagon, C., Fleshman, J. W., Sessler, D. I., & Kurz, A.
- Affiliations
- University of Bern (CH)
- Venue
- Anesthesiology
- Published
- 2004-02-01
- Volume
- 100
- Issue
- 2
- Pages
- 274-280
- ISSN
- 0003-3022 (ISSN-L)
- PMC
- PMC1395476
- OpenAlex
- W2125674863
- Cited by
- 376
- References
- 32
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 19 · 2021: 16 · 2020: 19 · 2019: 24 · 2018: 18 · 2017: 16 · 2016: 18 · 2015: 20 · 2014: 18 · 2013: 24 · 2012: 23
- FWCI
- 15.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01gm058273-04)
- National Institute of General Medical Sciences (GM061655, R01GM061655, GM58273)
- Topics
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- obesity, tissue oxygen tension, tissue hypoxia, surgical site infection, supplemental oxygen, abdominal surgery, perioperative period, tissue perfusion, wound healing
- MeSH terms
- Abdomen, Adult, Blood Pressure, Female, Humans, Intraoperative Period, Male, Middle Aged, Obesity, Oxygen, Oxygen Consumption, Postoperative Period, Risk Factors, Body Mass Index
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