Høgh Annette, Johannessen Andreas K, Dahl Marie, Dashnaw Birgit, Nicolajsen Chalotte W
Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.
J Vasc Surg. 2025 Oct;82(4):1412-1420.e3. doi: 10.1016/j.jvs.2025.05.017. Epub 2025 May 16.
Patients who undergo open infrainguinal surgical revascularization are at high risk of surgical wound complications. This study aimed to evaluate the effectiveness of introducing an optimized multicomponent surgical wound management strategy involving preoperative risk stratification of patients, perioperative optimized wound closure and dressing, and postoperative edema control.
This was a pragmatic pre-post study at a tertiary vascular surgery center. Consecutive patients who underwent surgery from November 2022 to the end of June 2023 (postintervention group) were compared with patients who underwent surgery between November 2021 and the end of June 2022 (preintervention group). The primary outcomes were surgical wound complications (a composite outcome based on prolonged lymphatic secretion or seroma, surgical site infection, bleeding or hematoma, and wound dehiscence) during primary admission and within 60 days after surgery. The outcomes are presented as total numbers, and comparisons among groups were performed via logistic regression; the results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Baseline and perioperative characteristics with potential confounding impacts were controlled for by means of propensity scores and the inverse probability of treatment weights.
In 122 (preintervention group) and 133 (postintervention group) patient cases, a total of 49 (40.8%) and 27 (20.6%) surgical wound complications, respectively, were observed during primary admission, corresponding to an adjusted OR of 0.43 (95% CI, 0.24-0.77). The length of stay was lower in the postintervention group, with an adjusted average of -1.19 days (95% CI, -2.6 days to 0.2 days). During the 60-day follow-up, 38 (31.1%) and 44 (33.1%) patients experienced surgical wound complications, with ORs of 1.18 (95% CI, 0.69-2.04). Among these, 11 (9%) and 12 (9%) had deep wound complications, with ORs of 0.95 (95% CI, 0.40-2.28), and 13 (10.7%) vs 18 (13.5%) were readmitted because of wound complications, with ORs of 1.26 (95% CI, 0.58-2.74).
Optimized peri- and postoperative surgical wound management was found to be associated with a reduced risk of surgical wound complications during primary admission, yet the risk of serious wound complications during follow-up remained high.
接受开放性腹股沟下手术血运重建的患者发生手术伤口并发症的风险很高。本研究旨在评估引入一种优化的多组分手术伤口管理策略的有效性，该策略包括患者术前风险分层、围手术期优化伤口闭合和敷料以及术后水肿控制。
这是一项在三级血管外科中心进行的实用前后对照研究。将2022年11月至2023年6月底接受手术的连续患者（干预后组）与2021年11月至2022年6月底接受手术的患者（干预前组）进行比较。主要结局是初次住院期间及术后60天内的手术伤口并发症（基于淋巴液分泌延长或血清肿、手术部位感染、出血或血肿以及伤口裂开的复合结局）。结局以总数呈现，组间比较通过逻辑回归进行；结果以比值比（OR）及95%置信区间（CI）表示。通过倾向评分和治疗权重的逆概率控制具有潜在混杂影响的基线和围手术期特征。
在122例（干预前组）和133例（干预后组）患者病例中，分别在初次住院期间观察到49例（40.8%）和27例（20.6%）手术伤口并发症，校正后的OR为0.43（95%CI，0.24 - 0.77）。干预后组的住院时间较短，校正后的平均住院时间为 - 1.19天（95%CI， - 2.6天至0.2天）。在60天的随访期间，38例（31.1%）和44例（33.1%）患者发生手术伤口并发症，OR为1.18（95%CI，0.69 - 2.04）。其中，11例（9%）和12例（9%）发生深部伤口并发症，OR为0.95（95%CI，0.40 - 2.28），因伤口并发症再次入院的患者分别为13例（10.7%）和18例（13.5%），OR为1.26（95%CI，0.58 - 2.74）。
优化的围手术期和术后手术伤口管理与初次住院期间手术伤口并发症风险降低相关，但随访期间严重伤口并发症的风险仍然很高。
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