Na Sungshin, Mazzaferro Natale, Xia Weiyi, Greenberg Patricia, Beckerman William
Division of Vascular Surgery and Endovascular Therapy, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ.
Ann Vasc Surg. 2023 Feb;89:251-260. doi: 10.1016/j.avsg.2022.09.052. Epub 2022 Oct 29.
Surgical site infection (SSI) is a serious complication of lower extremity open revascularization and is associated with increased morbidity, increased healthcare costs, and decreased postoperative quality of life. The objective of this study was to determine factors associated with an increased risk of developing postoperative SSI in patients undergoing lower extremity revascularization. Associations between SSI and postoperative complications were also identified.
Patients who underwent lower extremity open revascularization from 2014-2017 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). A multivariate logistic regression analysis was used to determine risk factors associated with SSIs within 30 days of the operation and postoperative complications. Odds ratios (ORs) were adjusted for demographics, preoperative comorbidities, procedure type, and intraoperative variables.
Ten thousand nine hundred ten patients who underwent lower extremity open revascularization were identified, with a mean age of 67.24 years and of whom 7,318 (67%) were male. Of the 10,910 patients, 922 (8.45%) had an SSI within 30 days of the operation. Risk factors associated with developing SSI included body mass index 25-29.9 (OR, 1.34; 95% confidence interval [CI], 1.08-1.67), body mass index ≥ 30 (OR, 2.12; 95% CI, 1.71-2.62), history of severe chronic obstructive pulmonary disease (OR, 1.47; 95% CI, 1.18-1.84), preprocedural beta-blocker use (OR, 1.25; CI 95%, 1.05-1.49), procedure time > 214 minutes (OR, 1.44; 95% CI, 1.22-1.70), and creatinine > 1.2 (OR 1.03; 95% CI, 0.87-1.21). One factor associated with a decreased risk of developing SSI was male gender (OR, 0.71; 95% CI, 0.60-0.84). Patients who developed an SSI were more likely to have adverse outcomes such as myocardial infarction/stroke, major amputation, bleeding requiring transfusion or secondary procedure, or require a reintervention in the treated segment.
There are various patient-related and operative factors that increase the likelihood of developing an SSI after lower extremity open revascularization. These findings indicate that addressing modifiable perioperative SSI risk factors may be beneficial in decreasing rates of SSI and improving postoperative outcomes.
手术部位感染（SSI）是下肢开放性血管重建术的一种严重并发症，与发病率增加、医疗费用增加及术后生活质量下降相关。本研究的目的是确定下肢血管重建术患者术后发生SSI风险增加的相关因素。还确定了SSI与术后并发症之间的关联。
使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）确定2014年至2017年接受下肢开放性血管重建术的患者。采用多因素逻辑回归分析确定手术30天内与SSI及术后并发症相关的危险因素。对人口统计学、术前合并症、手术类型和术中变量进行比值比（OR）调整。
确定了10910例接受下肢开放性血管重建术的患者，平均年龄67.24岁，其中7318例（67%）为男性。在这10910例患者中，922例（8.45%）在术后30天内发生了SSI。与发生SSI相关的危险因素包括体重指数25 - 29.9（OR，1.34；95%置信区间[CI]，1.08 - 1.67）、体重指数≥30（OR，2.12；95%CI，1.71 - 2.62）、严重慢性阻塞性肺疾病史（OR，1.47；95%CI，1.18 - 1.84）、术前使用β受体阻滞剂（OR，1.25；95%CI，1.05 - 1.49）、手术时间>214分钟（OR，1.44；95%CI，1.22 - 1.70）以及肌酐>1.2（OR 1.03；95%CI，0.87 - 1.21）。与发生SSI风险降低相关的一个因素是男性（OR，0.71；95%CI，0.60 - 0.84）。发生SSI的患者更有可能出现不良结局，如心肌梗死/中风、大截肢、需要输血或二次手术的出血，或需要对治疗节段进行再次干预。
下肢开放性血管重建术后，有多种与患者相关和手术相关的因素会增加发生SSI的可能性。这些发现表明，处理可改变的围手术期SSI危险因素可能有助于降低SSI发生率并改善术后结局。
