title: Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: an analysis of 1404 operations for critical limb ischemia.
abstract: BACKGROUND
  Infrainguinal bypass (IB) surgery is an effective means of improving arterial circulation to the lower extremity for patients with critical limb ischemia (CLI). However, wound complications (WC) of the surgical incision following IB can impart significant morbidity.
  
  
  METHODS
  A retrospective analysis of WC from the 1404 patients enrolled in a multicenter clinical trial of vein bypass grafting for CLI was performed. Univariate and multivariable regression models were used to determine WC predictors and associated outcomes, including graft patency, limb salvage, quality of life (QoL), resource utilization (RU), and mortality.
  
  
  RESULTS
  A total of 543 (39%) patients developed a reported WC within 30 days of surgery, with infections (284, 52%) and hematoma/hemorrhage (121, 22%) being the most common type. Postoperative anticoagulation (odds ratio [OR], 1.554; 95% confidence interval [CI] 1.202 to 2.009; P = .0008) and female gender (OR, 1.376; 95% CI, 1.076 to 1.757; P = .0108) were independent factors associated with WC. Primary, primary-assisted, and secondary graft patency rates were not influenced by the presence of WC; though, patients with WC were at increased risk for limb loss (hazard ratio [HR], 1.511; 95% CI 1.096 to 2.079; P = .0116) and higher mortality (HR, 1.449; 95% CI 1.098 to 1.912; P = .0089). WC was not significantly associated with lower QoL at 3 months (4.67 vs 4.79, P = .1947) and 12 months (5.02 vs 5.13, P = .2806). However, the subset of patients with serious WC (SWC) demonstrated significantly lower QoL at 3 months compared with patients without WC, (4.43 vs 4.79, respectively, P = .0166), though this difference was not seen at 12 months (4.94 vs 5.13, P = .2411). Patients with WC had higher RU than patients who did not have WC. Mean index length of hospital stay (LOS) was 2.3 days longer, mean cumulative 1-year LOS was 8.1 days longer, and mean number of hospitalizations was 0.5 occurrences greater for patients with WC compared with patients without WC (all P < .0001).
  
  
  CONCLUSIONS
  WC is a frequent complication of IB for CLI, associated with increased risk for major amputation, mortality, and greater RU. Further detailed investigation into the link between female gender and oral anticoagulation use with WC may help identify causes of WC and perhaps prevent or lessen their occurrence.
authors.affiliation: Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. llnguyen@partners.org
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
authors.forename: Soma
authors.initials: S
authors.lastname: Brahmanandam
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Bandyk
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Clowes
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Moneta
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006406:Hematoma / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009656:North America; D016017:Odds Ratio; D009841:Oligonucleotides / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D014680:Veins / Q000637:transplantation
chemical_list: D000925:Anticoagulants; D002317:Cardiovascular Agents; D009841:Oligonucleotides; C502518:edifoligide