Wound Complications Predict Early Lower Extremity Bypass Failure: a National Analysis
Brian F. Gilmore, M.D., Megan C. Turner, M.D., Uttara Nag, M.D., Brian Ezekian, M.D., Kevin Southerland, M.D., Mitchell W. Cox, M.D., Chandler Long, M.D., Leila Mureebe, M.D..
Duke University, Durham, NC, USA.
OBJECTIVE: Multiple studies have examined the factors that predict surgical site infection (SSI) after infrainguinal bypass (BPG). The influence of SSI on early graft failure after BPG remains incompletely understood. The objective of this study was to use contemporary national data to examine the influence of SSI on early lower extremity bypass failure.
METHODS: The 2011 - 2015 National Surgical Quality Improvement Project (NSQIP) Participant Data Use File (PUF) was queried for patients undergoing infrainguinal bypass. The Targeted Data of NSQIP includes several additional variables augmenting the base PUF. Only patients with targeted data were included in this study. BPG graft failure was defined by stenosis requiring revision within 30 day or thrombosis. Patients were stratified by the presence or absence of post-operative SSI. Rates of BPG failure within 30 days were compared using Pearson’s Chi Square. A multivariable logistic regression was performed to identify factors independently associated with graft failure.
RESULTS: 10745 infrainguinal bypass procedures were identified. 8,689 patients had complete data available. 710 (4.7%) or procedures were complicated by BPG failure within 30 days. A total of 1,395 (12.9%) patients suffered a wound complication within 30 days. The risk of early BPG failure in patients with a wound complication was 7.16%, compared to 4.3% in patients without a wound complication (Pearson chi square=19.6, Cramer’s V=0.05, p<0.001). Regression using best variables subset selection and post-estimation using Akaike's and Schwarz's Bayesian information criteria identified that the only factor that was consistently associated with early bypass graft failure in both post-estimation models was post-operative wound complication (95% CI 0.04 - 0.3, p = 0.01).
CONCLUSIONS: SSI following infrainguinal BPG is associated with early BPG failure. Our findings further focus on reducing the incidence of SSI after infrainguinal BPG. We hypothesis that systemic inflammation related to the SSI leads to this increased risk for BPG failure. Additional prospective studies regarding the management of lower extremity wounds and the implementation of SSI prevention bundles are necessary to improve the patency rate for patients undergoing this complex procedure.
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