Risk Factors For Surgical Site Infections After Lower Extremity Open Revascularization
Sungshin Amy Na, PharmD1, Natale Mazzaferro2, Weiyi Xia2, William Beckerman, MD1.
1Robert Wood Johnson Medical School, New Brunswick, NJ, USA, 2Rutgers School of Public Health, New Brunswick, NJ, USA.
OBJECTIVES: Surgical site infection (SSI) is a serious complication of lower extremity open revascularization and is associated with increased healthcare costs, decreased postoperative quality of life and increased length of stay. The objective of this study was to determine factors associated with increased risk of developing post-operative SSI in patients undergoing lower extremity revascularization.
METHODS: Patients who underwent lower extremity open revascularization from 2014-2017 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression analysis was used to determine risk factors associated surgical site infections within 30 days of the operation. Odds ratios were adjusted for demographics, pre-operative comorbidities, procedure type, and intra-operative variables. RESULTS: 8,423 patients who underwent lower extremity revascularization were identified, with a mean age of 67.24 and of whom 5,636 (66.9%) were male. Out of the 8,423 patients, 1,419 (16.8%) had an SSI within 30 days of the operation. Risk factors associated with developing a SSI included BMI 25-29.9 (odds ratio [OR], 1.34; 95% CI, 1.08-1.67), BMI≥30 (OR, 2.12; 95% CI, 1.71-2.62), history of severe COPD (OR, 1.47; 95% CI, 1.18-1.84), preprocedural beta-blocker use (OR, 1.25; CI 95%, 1.05-1.49) and procedure time >214 minutes (OR, 1.44; 95% CI,1.22-1.70). Factors associated with a decreased risk of developing SSI included male gender (OR, 0.71; 95% CI, 0.60-0.84), popliteal-distal bypass (OR, 0.65; 95% CI, 0.47-0.89) and black or African American race (OR, 0.79; 95% CI, 0.63-0.99).
CONCLUSIONS: There are various patient-related and operative factors that increase the likelihood of developing an SSI after lower extremity open revascularization. These findings indicate that addressing modifiable peri-operative SSI risk factors may be beneficial in decreasing rates of SSI and improving post-operative outcomes.
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