Risk Of Wound Complications Following Lower Extremity Revascularization
Ke Xu, BA1, Loreski Collado, MD1, Brenda Lin, MD2, Joseph Raffetto, MD2, James T. McPhee, MD2.
1Boston University School of Medicine, Boston, MA, USA, 2VA Boston Healthcare, Boston, MA, USA.
OBJECTIVES:To create a simple risk score to identify factors associated with wound complications after infrainguinal revascularization to inform operative decision making.
METHODS: The Veterans Affairs Surgical Quality Improvement Program national data set was queried from 2005 to 2021 to identify 22,114 patients undergoing elective open revascularization for PAD (Claudication, rest pain, tissue loss) or peripheral aneurysm. Emergency and trauma cases were excluded. The data set was divided into a two-thirds derivation set and one-third validation set for to create a risk prediction model. The primary end point was wound complication (wound dehiscence, superficial/deep wound surgical site infection). Eight independent risk factors for wound complication resulted from the model and were assigned whole number integer risk scores. Summary risk scores were collapsed into categories and defined as low (0-5 points), moderate (6-10 points), high (11-15), and very high (>15).
RESULTS: The wound complication rate in the derivation data set was 9.7% (n = 1,428). By multivariable generalized linear modeling, as shown in Table 1 predictors of wound complication (odds ratio [95% confidence limits]) included age <= 73 (1.3 [1.1-1.5]), BMI greater than 35 Kg/M2 (2.0 [1.7-2.4]), non-Hispanic white (vs others 1.6 [1.4-1.8]), diabetes (1.2 [1.1-1.4]), WBC count > 9,900/mm3 (1.2 [1.0-1.3]), operation prior to 2012 (1.6 [1.5-1.8]), operative time > 6 hours (1.2 [1.1-1.4]), and undergoing a femoral endarterectomy in conjunction with bypass (1.3 [1.1-1.6]). In both the derivation and validation sets, wound complications correlated with risk category. Among the defined categories in the derivation set, wound complication rates were 4.3% for low-risk patients, 9.0% for moderate-risk patients, 13.7% for high-risk patients, and 27.2% for very-high risk patients, with similar results for the internal validation data set (Table 2/Figure 1). Operative indication did not independently associate with wound complications. Patients with wound complications had higher rates of reoperation and graft failure.
CONCLUSIONS:This risk prediction model uses easily obtainable clinical metrics that allow for informed discussion of wound complication risk for patients undergoing open infrainguinal revascularization.
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