Predictors of surgical site infection after open lower extremity revascularization

David Yu Greenblatt, Victoria Rajamanickam, Matthew Mell

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Objectives: Surgical site infection (SSI) after open surgery for lower extremity revascularization is a serious complication that may lead to graft infection, prolonged hospitalization, and increased cost. Rates of SSI after revascularization vary widely, with most studies reported from single institutions. The objective of this study was to describe the rate and predictors of SSI after surgery for arterial occlusive disease using national data, and to identify any association between SSI and length of hospital stay, reoperation, graft loss, and mortality. Methods: Patients who underwent lower extremity arterial bypass or thromboendarterectomy from 2005-2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files. Multivariate logistic regression identified predictors of SSI. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. The association between SSI and other 30-day outcomes such as mortality and graft failure was determined. Results: Of 12,330 patients who underwent revascularization, 1367 (11.1%) were diagnosed with an SSI within 30 days. Multivariate predictors of SSI included female gender (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3-1.6), obesity (OR, 2.1; 95% CI, 1.8-2.4), chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 1.0-1.5), dialysis (OR, 1.5; 95% CI, 1.1-2.1), preoperative hyponatremia (OR, 1.2; 95% CI, 1.0-1.4), and length of operation >4 hours (OR, 1.4; 95% CI, 1.2-1.6). SSI was associated with prolonged (>10 days) hospital stay (OR, 1.8; 95% CI, 1.4-2.1) and higher rates of 30-day graft loss (OR, 2.3; 95% CI, 1.7-3.1) and reoperation (OR, 3.7; 95% CI, 3.1-4.6). SSI was not associated with increased 30-day mortality. Conclusion: SSI is a common complication after open revascularization and is associated with a more than twofold increased risk of early graft loss and reoperation. Several patient and operation-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve outcomes in this patient population.

Original languageEnglish (US)
Pages (from-to)433-439
Number of pages7
JournalJournal of Vascular Surgery
Volume54
Issue number2
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

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Surgical Wound Infection
Lower Extremity
Odds Ratio
Confidence Intervals
Transplants
Reoperation
Length of Stay
Mortality
Perioperative Care
Arterial Occlusive Diseases
Endarterectomy
Hyponatremia
Quality Improvement
Chronic Obstructive Pulmonary Disease
Comorbidity
Dialysis
Hospitalization

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of surgical site infection after open lower extremity revascularization. / Greenblatt, David Yu; Rajamanickam, Victoria; Mell, Matthew.

In: Journal of Vascular Surgery, Vol. 54, No. 2, 01.08.2011, p. 433-439.

Research output: Contribution to journalArticle

Greenblatt, David Yu ; Rajamanickam, Victoria ; Mell, Matthew. / Predictors of surgical site infection after open lower extremity revascularization. In: Journal of Vascular Surgery. 2011 ; Vol. 54, No. 2. pp. 433-439.
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abstract = "Objectives: Surgical site infection (SSI) after open surgery for lower extremity revascularization is a serious complication that may lead to graft infection, prolonged hospitalization, and increased cost. Rates of SSI after revascularization vary widely, with most studies reported from single institutions. The objective of this study was to describe the rate and predictors of SSI after surgery for arterial occlusive disease using national data, and to identify any association between SSI and length of hospital stay, reoperation, graft loss, and mortality. Methods: Patients who underwent lower extremity arterial bypass or thromboendarterectomy from 2005-2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files. Multivariate logistic regression identified predictors of SSI. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. The association between SSI and other 30-day outcomes such as mortality and graft failure was determined. Results: Of 12,330 patients who underwent revascularization, 1367 (11.1{\%}) were diagnosed with an SSI within 30 days. Multivariate predictors of SSI included female gender (odds ratio [OR], 1.4; 95{\%} confidence interval [CI], 1.3-1.6), obesity (OR, 2.1; 95{\%} CI, 1.8-2.4), chronic obstructive pulmonary disease (OR, 1.2; 95{\%} CI, 1.0-1.5), dialysis (OR, 1.5; 95{\%} CI, 1.1-2.1), preoperative hyponatremia (OR, 1.2; 95{\%} CI, 1.0-1.4), and length of operation >4 hours (OR, 1.4; 95{\%} CI, 1.2-1.6). SSI was associated with prolonged (>10 days) hospital stay (OR, 1.8; 95{\%} CI, 1.4-2.1) and higher rates of 30-day graft loss (OR, 2.3; 95{\%} CI, 1.7-3.1) and reoperation (OR, 3.7; 95{\%} CI, 3.1-4.6). SSI was not associated with increased 30-day mortality. Conclusion: SSI is a common complication after open revascularization and is associated with a more than twofold increased risk of early graft loss and reoperation. Several patient and operation-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve outcomes in this patient population.",
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