Association Between Post-Operative Infection and Bypass Graft Failure
brian gilmore, md, tracy truong, MS, cynthia K. shortell, md, leila mureebe, md, mph.
duke university medical center, Durham, NC, USA.
OBJECTIVES Post-operative infection occurs in up to 18% of lower extremity bypass grafts (LEBPG). Sequelae of infection include amputation, increased cost of care, and reoperation. Most research has focused on outcomes and predictors of infection. We hypothesize that peri-operative infection increases bypass graft failure.METHODSThe Society for Vascular Surgery Vascular Quality Initiatives Lower Extremity Bypass module from January 2003 through December 2017 was queried for this study. 54,020 procedures in 35,646 patients across 218 centers were available. Merging procedure data (n = 35,646) with follow-up data (n = 21,301) left a total of 18,711 procedures. After excluding missing post-op wound infection, 18,677 lower extremity bypass grafts were available for final analysis.RESULTSAmong these patients, 613 (3.3%) had post-op wound infections. In univariate analysis, factors correlated with infection (p < .05) included gender, body-mass index, insurer, diabetes, chronic obstructive pulmonary disease, dialysis, diabetes mellitus and beta blocker use. Patency was directly correlated with the occurrence of post-operative infection (p < .0001). After excluding covariates with missing values, 12,809 observations were included in the survival analysis. From the Fine-Gray model, the estimated rate of subdistribution hazard ratios and 95% confidence interval for post-op wound infection was 1.41 (1.07 - 1.86) with p-value of 0.01 after controlling for confounders. Cumulative incidence plot for time to graft failure within one year and the competing event, death within one year is illustrated in figure 1.CONCLUSIONSPost-op wound infection was associated with a 41% increase in the rate of graft failure within one year in patients who were either event-free or who had a competing event, death.
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