Giles Kristina A, Hamdan Allen D, Pomposelli Frank B, Wyers Mark C, Siracuse Jeffrey J, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Ann Vasc Surg. 2010 Jan;24(1):48-56. doi: 10.1016/j.avsg.2009.05.003. Epub 2009 Jul 19.
Patients undergoing lower extremity bypass are at high risk for surgical site infections (SSI). We examined lower extremity bypasses by graft origin and body mass index (BMI) classification to analyze differences in postoperative mortality and SSI occurrence.
The 2005-2007 National Surgical Quality Improvement Program (NSQIP), a multi-institutional risk-adjusted database, was queried to compare perioperative mortality (30-day), overall morbidity, and SSIs after lower extremity arterial bypass for peripheral arterial disease. Bypass was stratified by graft origin as aortoiliac, femoral, or popliteal. Patient demographics, comorbidities, operative, and postoperative occurrences were analyzed.
There were 7,595 bypasses performed (1,596 aortoiliac, 5,483 femoral, and 516 popliteal). Mortality was similar regardless of bypass origin (2.8%, 2.4%, and 2.7%; p = 0.57). SSIs occurred in 11% of overall cases (10%, 11%, and 11%; p = 0.47). Graft failure was significantly associated with postoperative SSI occurrence (odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.9-3.1, p < 0.001), as was postoperative sepsis (OR = 6.5, 95% CI 5.1-8.3, p < 0.001). Independent predictors of mortality were age, aortoiliac bypass origin, underweight, normal weight, morbid obesity (compared to overweight and obese), end-stage renal disease, poor preoperative functional status, preoperative sepsis, chronic obstructive pulmonary disease, hypoalbuminemia, and cardiac disease. Independent predictors of SSI were obesity, diabetes, poor preoperative functional status, a history of smoking, and female gender.
SSIs occur frequently after lower extremity bypass regardless of bypass origin and are associated with early graft failure and sepsis. Obesity predicts postoperative SSI. Mortality risk was greatest in the underweight, followed by morbidly obese and normal-weight patients, while overweight and mild to moderate obesity were associated with the lowest mortality.
接受下肢搭桥手术的患者发生手术部位感染（SSI）的风险很高。我们通过移植物来源和体重指数（BMI）分类对下肢搭桥手术进行了研究，以分析术后死亡率和SSI发生率的差异。
查询2005 - 2007年国家外科质量改进计划（NSQIP）这一多机构风险调整数据库，比较因外周动脉疾病行下肢动脉搭桥术后的围手术期死亡率（30天）、总体发病率和SSI情况。搭桥手术按移植物来源分为腹主动脉 - 髂动脉、股动脉或腘动脉进行分层。对患者的人口统计学特征、合并症、手术情况及术后发生的情况进行了分析。
共进行了7595例搭桥手术（腹主动脉 - 髂动脉搭桥1596例、股动脉搭桥5483例、腘动脉搭桥516例）。无论搭桥手术的来源如何，死亡率相似（分别为2.8%、2.4%和2.7%；p = 0.57）。总体病例中11%发生了SSI（分别为10%、11%和11%；p = 0.47）。移植物失败与术后SSI的发生显著相关（比值比[OR]=2.4，95%置信区间[CI]为1.9 - 3.1，p < 0.001），术后脓毒症也是如此（OR = 6.5，95%CI为5.1 - 8.3，p < 0.001）。死亡率的独立预测因素包括年龄、腹主动脉 - 髂动脉搭桥来源、体重过轻、正常体重、病态肥胖（与超重和肥胖相比）、终末期肾病、术前功能状态差、术前脓毒症、慢性阻塞性肺疾病、低白蛋白血症和心脏病。SSI的独立预测因素包括肥胖、糖尿病、术前功能状态差、吸烟史和女性性别。
无论搭桥手术的来源如何，下肢搭桥术后SSI发生率都很高，且与早期移植物失败和脓毒症相关。肥胖是术后SSI的预测因素。体重过轻患者的死亡风险最高，其次是病态肥胖和正常体重患者，而超重和轻度至中度肥胖患者的死亡率最低。
