{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T10:10:05Z","timestamp":1781518205151,"version":"3.54.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to explore the relationship between visceral fat area (VFA) and the risk of surgical site infection (SSI) after thoracolumbar posterior surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on 1,491 patients who had undergone posterior thoracolumbar surgery from January 1, 2022, through May 30, 2023. Inclusion criteria were age \u226518 years, undergoing thoracolumbar posterior surgery, and having complete clinical data with a follow-up duration exceeding 1 year. Exclusion criteria included minimally invasive surgery, preoperative infections, traumatic skin injuries, combined tumors, and patients with long-term steroid use or immune system diseases. VFA was measured using CT scans, and patients were categorized based on VFA \u2265100\u2005cm<jats:sup>2<\/jats:sup> as having visceral fat obesity. The incidence of SSI was assessed according to the CDC criteria. Logistic regression analysis was used to identify risk factors for SSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of SSI was 2.4% (36 out of 1,491 patients). Multivariate logistic regression analysis showed that VFA was the most significant predictor of SSI [<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001; Exp(B)\u2009=\u20091.026; 95% CI, 1.013\u20131.040], indicating a 2.6% increased infection risk per 1 cm<jats:sup>2<\/jats:sup> increase in VFA. Other significant risk factors included BMI [<jats:italic>P<\/jats:italic>\u2009=\u20090.024; Exp(B)\u2009=\u20091.138; 95% CI, 1.018\u20131.273]. Patients with visceral fat obesity had a significantly higher infection rate (5.7% vs. 1.2%, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>VFA is a significant risk factor for SSI following thoracolumbar posterior surgery. Preoperative assessment of VFA can help identify high-risk patients and guide preventive measures to reduce SSI incidence and improve surgical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1606944","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T05:24:48Z","timestamp":1752557088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Visceral fat: the hidden culprit behind thoracolumbar surgery infections"],"prefix":"10.3389","volume":"12","author":[{"given":"Dan","family":"Su","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jucai","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingling","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3171\/2013.10.SPINE1364","article-title":"Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases","volume":"20","author":"Chaichana","year":"2014","journal-title":"J Neurosurg Spine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"292","DOI":"10.3171\/2019.8.SPINE19479","article-title":"Risk factors for deep surgical site infection following thoracolumbar spinal surgery","volume":"32","author":"Deng","year":"2020","journal-title":"J Neurosurg Spine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1093\/neuros\/nyz405","article-title":"Persistent postoperative hyperglycemia as a risk factor for operative treatment of deep wound infection after spine surgery","volume":"87","author":"Pennington","year":"2020","journal-title":"Neurosurgery"},{"key":"B4","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00586-007-0559-8","article-title":"The diagnosis and management of infection following instrumented spinal fusion","volume":"17","author":"Collins","year":"2008","journal-title":"Eur Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1007\/s00586-010-1421-y","article-title":"Risk factors for deep surgical site infections after spinal fusion","volume":"19","author":"Schimmel","year":"2010","journal-title":"Eur Spine J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1007\/s11999-014-3933-y","article-title":"Incidence of surgical site infection after spine surgery: what is the impact of the definition of infection?","volume":"473","author":"Nota","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s00586-021-06978-y","article-title":"Management and outcome of spinal implant-associated surgical site infections in patients with posterior instrumentation: analysis of 176 cases","volume":"31","author":"Hickmann","year":"2022","journal-title":"Eur Spine J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"239","DOI":"10.55519\/JAMC-02-11179","article-title":"Efficacy of prophylactic intrawound application of vancomycin powder in preventing surgical site infections in spinal instrumentation surgery","volume":"35","author":"Khalid","year":"2023","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"B9","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1007\/s00701-022-05128-7","article-title":"Medicosurgical management of deep wound infections after thoracolumbar instrumentation: risk factors of poor outcomes","volume":"164","author":"Frechon","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1089\/sur.2021.271","article-title":"Increased surgical site subcutaneous fat thickness is associated with infection after posterior cervical fusion","volume":"23","author":"Donnally","year":"2022","journal-title":"Surg Infect (Larchmt)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1124","DOI":"10.3928\/01477447-20160819-05","article-title":"Fat thickness as a risk factor for infection in lumbar spine surgery","volume":"39","author":"Lee","year":"2016","journal-title":"Orthopedics"},{"key":"B12","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1097\/MCO.0000000000000485","article-title":"How to best assess abdominal obesity","volume":"21","author":"Fang","year":"2018","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"B13","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1038\/hr.2010.271","article-title":"Visceral adiposity, not abdominal subcutaneous fat area, is associated with high blood pressure in Japanese men: the ohtori study","volume":"34","author":"Koh","year":"2011","journal-title":"Hypertens Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"486","DOI":"10.4093\/dmj.2021.0095","article-title":"Sex differences of visceral fat area and visceral-to-subcutaneous fat ratio for the risk of incident type 2 diabetes Mellitus","volume":"46","author":"Kim","year":"2022","journal-title":"Diabetes Metab J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1002\/oby.21724","article-title":"Metabolites distinguishing visceral fat obesity and atherogenic traits in individuals with overweight","volume":"25","author":"Baek","year":"2017","journal-title":"Obesity (Silver Spring)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12944-025-02482-0","article-title":"Association between visceral fat area and metabolic syndrome in individuals with normal body weight: insights from a Chinese health screening dataset","volume":"24","author":"Sun","year":"2025","journal-title":"Lipids Health Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1002\/oby.24040","article-title":"Age and BMI have different effects on subcutaneous, visceral, liver, bone marrow, and muscle adiposity, as measured by CT and MRI","volume":"32","author":"Wang","year":"2024","journal-title":"Obesity (Silver Spring)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.diabres.2019.06.008","article-title":"Change in CT-measured abdominal subcutaneous and visceral but not thigh fat areas predict future insulin sensitivity","volume":"154","author":"Liu","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"20170968","DOI":"10.1259\/bjr.20170968","article-title":"Fully automated segmentation and quantification of visceral and subcutaneous fat at abdominal CT: application to a longitudinal adult screening cohort","volume":"91","author":"Lee","year":"2018","journal-title":"Br J Radiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"20160662","DOI":"10.1259\/bjr.20160662","article-title":"Validation of a semi-automated technique to accurately measure abdominal fat distribution using CT and MRI for clinical risk stratification","volume":"90","author":"Waduud","year":"2017","journal-title":"Br J Radiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"495084","DOI":"10.1155\/2014\/495084","article-title":"Development of automatic visceral fat volume calculation software for CT volume data","volume":"2014","author":"Nemoto","year":"2014","journal-title":"J Obes"},{"key":"B22","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee","volume":"27","author":"Mangram","year":"1999","journal-title":"Am J Infect Control"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e5118","DOI":"10.1097\/MD.0000000000005118","article-title":"Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: a retrospective case-control study","volume":"95","author":"Tominaga","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"17534","DOI":"10.1038\/s41598-018-35809-2","article-title":"Obesity and type 2 diabetes mellitus induce lipopolysaccharide tolerance in rat neutrophils","volume":"8","author":"Kuwabara","year":"2018","journal-title":"Sci Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/j.jdiacomp.2015.12.017","article-title":"Diabetes medications: impact on inflammation and wound healing","volume":"30","author":"Salazar","year":"2016","journal-title":"J Diabetes Complications"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1007\/s00586-013-2783-8","article-title":"Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients","volume":"22","author":"Satake","year":"2013","journal-title":"Eur Spine J"},{"key":"B27","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/s0094-1298(02)00066-4","article-title":"Wound healing and diabetes mellitus","volume":"30","author":"Greenhalgh","year":"2003","journal-title":"Clin Plast Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1097\/BRS.0000000000000506","article-title":"Complication rates following elective lumbar fusion in patients with diabetes: insulin dependence makes the difference","volume":"39","author":"Golinvaux","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2800","DOI":"10.1007\/s00586-013-2890-6","article-title":"Body mass index and risk of surgical site infection following spine surgery: a meta-analysis","volume":"22","author":"Abdallah","year":"2013","journal-title":"Eur Spine J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jocn.2015.05.056","article-title":"Do obese patients have worse outcomes after direct lateral interbody fusion compared to non-obese patients?","volume":"25","author":"Adogwa","year":"2016","journal-title":"J Clin Neurosci"},{"key":"B31","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s00776-014-0669-1","article-title":"Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and\/or lumbar spinal surgery in adults","volume":"20","author":"Ogihara","year":"2015","journal-title":"J Orthop Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1055\/s-0035-1570750","article-title":"The effects of obesity on spine surgery: a systematic review of the literature","volume":"6","author":"Jackson","year":"2016","journal-title":"Global Spine J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1007\/s11999-013-3346-3","article-title":"Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis","volume":"472","author":"Jiang","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.spinee.2019.09.013","article-title":"Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary","volume":"20","author":"Tan","year":"2020","journal-title":"Spine J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1097\/BRS.0b013e318241b186","article-title":"2012 Young investigator award winner: the distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections","volume":"37","author":"Mehta","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"B36","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.jamcollsurg.2011.04.008","article-title":"Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy","volume":"213","author":"Lee","year":"2011","journal-title":"J Am Coll Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"821","DOI":"10.4103\/1119-3077.183237","article-title":"Surgical site infection in posterior spine surgery","volume":"19","author":"Ojo","year":"2016","journal-title":"Niger J Clin Pract"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1097\/BRS.0b013e3182407859","article-title":"Is surgical case order associated with increased infection rate after spine surgery?","volume":"37","author":"Gruskay","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1016\/j.arth.2023.02.048","article-title":"Visceral fat as a risk factor for periprosthetic joint infection after total hip and knee arthroplasty","volume":"38","author":"Blackburn","year":"2023","journal-title":"J Arthroplasty"},{"key":"B40","doi-asserted-by":"publisher","first-page":"111808","DOI":"10.1016\/j.nut.2022.111808","article-title":"Association between visceral fat and osteoporotic vertebral compression refractures","author":"Zhang","year":"2022","journal-title":"Nutrition"},{"key":"B41","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1186\/s13018-023-04376-2","article-title":"Association of central sensitization, visceral fat, and surgical outcomes in lumbar spinal stenosis","volume":"18","author":"Ogon","year":"2023","journal-title":"J Orthop Surg Res"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1606944\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T05:24:49Z","timestamp":1752557089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1606944\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":41,"alternative-id":["10.3389\/fsurg.2025.1606944"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1606944","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"article-number":"1606944"}}