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Surgical Site Infection Following Infrainguinal Bypass Procedures
Tiffany Y. Wu, M.D.1, Fred Weaver, M.D.2, Steven G. Katz, M.D.3.
1Huntington Hospital, Pasadena, CA, USA, 2University of Southern California, Los Angeles, CA, USA, 3University of Southern California, Pasadena, CA, USA.
OBJECTIVES: With aging of the adult population, a significant increase in the number of procedures performed for lower extremity ischemia has occurred. Surgical site infection (SSI) following infrainguinal bypass surgery can lead to markedly increased patient morbidity and hospital cost. The ability to identify risk factors leading to these events may allow for modification of treatment strategy or perhaps select patients better served by alternative methods of revascularization.
METHODS: The National Surgical Quality Improvement Program (NSQIP) database from 2005-2011 was queried. Patients undergoing infrainguinal revascularization by open bypass were identified. Wound infection was classified as superficial if it included only skin or subcutaneous tissue. Deep infection was noted if it involved the deep soft tissues, fascia, muscle layers, or graft. Preoperative risk factors and patient demographics were compared. Those factors found to be significant were placed in a step-wise multivariate Cox proportional hazards regression model to determine their individual significance.
RESULTS: During the period of study, 20,505 infrainguinal bypass operations were identified, and SSI was found to complicate 2363 (11.6%). In 1469 cases (7.2%), the SSI was found to be superficial and in 894 (4.4%) it was found to be deep. On multivariate analysis, hypertension was a significant predictor of superficial wound infection (p < 0.05). Emergency operation, dialysis dependence, previous coronary intervention, and female sex were significant predictors of deep wound infection (p<0.05 for each). The presence of diabetes, shortness of breath, and operative time greater than four hours was predictive of both (p<0.05 for each).
CONCLUSIONS: A number of peri-operative risk factors are associated with an increased risk of SSI following infrainguinal bypass operations. While the length of operation may be subject to modification, the majority of risk factors are not. In patients with co-morbidities predictive of an increased risk of SSI, alternative methods of revascularization may be preferable.
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