van der Slegt Jasper, Kluytmans Jan A J W, Mulder Paul G H, Veen Eelco J, Ho Gwan H, van der Laan Lijckle
1 Department of Surgery, Amphia Hospital , Breda, The Netherlands .
Surg Infect (Larchmt). 2014 Dec;15(6):752-6. doi: 10.1089/sur.2013.253.
Patients with peripheral arterial disease (PAD) are at risk for revision surgery in the groin and therefore at potential risk for surgical site infections (SSIs). In an observational study, a cohort of patients with peripheral arterial disease was followed to examine the effect of different incision intervals on SSI-free survival.
Patients, needing peripheral vascular surgery because of PAD, were retrieved from a prospectively collected database on SSIs after vascular surgery between March 2009 and January 2012, the group consisting of 720 patients. Of these, 255 patients were selected (age 71.9±10.4 y). Cox proportional hazards models were used for event-history analyses. The effect of incision interval was estimated with adjustment for a number of potential confounders. Effects were quantified by means of hazard ratios (HRs) with 95% confidence intervals (CIs).
No significant effect on the incision interval on SSI-free survival was observed. After separating incisional SSIs into superficial- and deep-seated, a significant linear trend effect of the groin incision interval on deep-incisional SSI development was observed: the shorter the interval, the higher the event rate (HR 1.5 per category, 95% CI 1.1-2.1, p=0.22). Besides the incision interval, the Rutherford classification was a significant risk factor for SSI development (HR 3.0; 95% CI 2.1-4.2; p<0.0005).
Revision surgery in the groin puts patients at risk for deep-incisional SSI. No effect on superficial incisional SSI development was observed. Besides the incision interval, the Rutherford classification was a significant risk factor for both superficial- and deep-incisional SSI. Quality improvement and better risk stratification schemes are suggested.
外周动脉疾病（PAD）患者存在腹股沟翻修手术风险，因此有手术部位感染（SSI）的潜在风险。在一项观察性研究中，对一组外周动脉疾病患者进行随访，以检查不同切口间隔对无SSI生存的影响。
从2009年3月至2012年1月前瞻性收集的血管手术后SSI数据库中检索因PAD需要进行外周血管手术的患者，该组由720名患者组成。其中，选择了255名患者（年龄71.9±10.4岁）。采用Cox比例风险模型进行事件史分析。通过对一些潜在混杂因素进行调整来估计切口间隔的影响。效应通过风险比（HR）及其95%置信区间（CI）进行量化。
未观察到切口间隔对无SSI生存有显著影响。将切口SSI分为浅表和深部后，观察到腹股沟切口间隔对深部切口SSI发生有显著的线性趋势效应：间隔越短，事件发生率越高（每类别HR 1.5，95%CI 1.1-2.1，p=0.22）。除切口间隔外，卢瑟福分类是SSI发生的显著危险因素（HR 3.0；95%CI 2.1-4.2；p<0.0005）。
腹股沟翻修手术使患者有深部切口SSI的风险。未观察到对浅表切口SSI发生有影响。除切口间隔外，卢瑟福分类是浅表和深部切口SSI的显著危险因素。建议进行质量改进和更好的风险分层方案。
