Department of Anesthesiology, Maine Medical Center, Portland, Me; Spectrum Medical Group, Portland, Me.
Department of Vascular Surgery, Maine Medical Center, Portland, Me.
J Vasc Surg. 2018 Jan;67(1):287-293. doi: 10.1016/j.jvs.2017.05.130. Epub 2017 Aug 16.
Lower extremity bypass (LEB) operations have high rates of surgical site infections (SSI). Phenylephrine is a commonly used vasoconstrictor which may reduce skin blood flow and increase the likelihood of SSI in these patients. We studied the potential effect of phenylephrine infusion during LEB surgery on SSI.
LEB cases and their demographic data were identified through the Vascular Quality Initiative registry. SSI in this population was identified using the hospital epidemiology surveillance database. Phenylephrine use in this population was identified through chart review.
We identified 699 patients who underwent LEB; 82 (11.7%) developed an SSI, and 244 of 698 (35.0%) were treated with phenylephrine infusion. In bivariate analysis, higher body mass index (28.8 kg/m vs 27.3 kg/m; P = .034), diabetes (14.6% vs 9.4%; P = .035), hypertension (12.6% vs 4.7%; P = .038), groin incision (13.2 vs 5.4%; P = .013) and longer procedure times (17.1% for >220 minutes and 8.9% for ≤220 minutes; P = .003) were associated with higher rates of SSI. Whereas phenylephrine infusion exhibited a trend toward a higher rate (14.8% vs 9.9%; P = .057). In the logistic regression model, diabetes (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.2; P = .032), total procedure time (OR, 1.85; 95% CI, 1.1-3.1; P = .026) and vertical groin incision (OR, 2.6; 95% CI, 1.1-6.5; P = .035) were independent predictors of increased SSI rates, whereas body mass index (OR, 1.04; 95% CI, 0.99-1.08; P = .09), hypertension (OR, 2.5; 95% CI, 0.6-10.9; P = .22), and phenylephrine infusion (OR, 1.08; 95% CI, 0.63-1.85; P = .78) were not independent predictors of increased SSI rates.
Phenylephrine infusion did not increase the risk of SSI in patients who underwent LEB.
下肢旁路（LEB）手术的手术部位感染（SSI）发生率较高。去氧肾上腺素是一种常用的血管收缩剂，可能会减少皮肤血流量，并增加这些患者发生 SSI 的可能性。我们研究了 LEB 手术期间去氧肾上腺素输注对 SSI 的潜在影响。
通过血管质量倡议登记处确定接受 LEB 的病例及其人口统计学数据。通过医院流行病学监测数据库确定该人群中的 SSI。通过图表审查确定该人群中去氧肾上腺素的使用情况。
我们确定了 699 例接受 LEB 的患者；82 例（11.7%）发生 SSI，698 例中有 244 例（35.0%）接受去氧肾上腺素输注。在单变量分析中，较高的体重指数（28.8kg/m 与 27.3kg/m；P=0.034）、糖尿病（14.6%与 9.4%；P=0.035）、高血压（12.6%与 4.7%；P=0.038）、腹股沟切口（13.2%与 5.4%；P=0.013）和较长的手术时间（220 分钟以上的发生率为 17.1%，而 220 分钟以下的发生率为 8.9%；P=0.003）与 SSI 发生率较高相关。而去氧肾上腺素输注呈 SSI 发生率较高的趋势（14.8%与 9.9%；P=0.057）。在逻辑回归模型中，糖尿病（比值比 [OR]，1.8；95%置信区间 [CI]，1.0-3.2；P=0.032）、总手术时间（OR，1.85；95%CI，1.1-3.1；P=0.026）和垂直腹股沟切口（OR，2.6；95%CI，1.1-6.5；P=0.035）是 SSI 发生率增加的独立预测因素，而体重指数（OR，1.04；95%CI，0.99-1.08；P=0.09）、高血压（OR，2.5；95%CI，0.6-10.9；P=0.22）和去氧肾上腺素输注（OR，1.08；95%CI，0.63-1.85；P=0.78）不是 SSI 发生率增加的独立预测因素。
在接受 LEB 的患者中，去氧肾上腺素输注并未增加 SSI 的风险。
