title: Predictors of surgical site infection after open lower extremity revascularization.
abstract: OBJECTIVE
  Surgical site infection (SSI) after open surgery for lower extremity revascularization is a serious complication that may lead to graft infection, prolonged hospitalization, and increased cost. Rates of SSI after revascularization vary widely, with most studies reported from single institutions. The objective of this study was to describe the rate and predictors of SSI after surgery for arterial occlusive disease using national data, and to identify any association between SSI and length of hospital stay, reoperation, graft loss, and mortality.
  
  
  METHODS
  Patients who underwent lower extremity arterial bypass or thromboendarterectomy from 2005-2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files. Multivariate logistic regression identified predictors of SSI. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. The association between SSI and other 30-day outcomes such as mortality and graft failure was determined.
  
  
  RESULTS
  Of 12,330 patients who underwent revascularization, 1367 (11.1%) were diagnosed with an SSI within 30 days. Multivariate predictors of SSI included female gender (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3-1.6), obesity (OR, 2.1; 95% CI, 1.8-2.4), chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 1.0-1.5), dialysis (OR, 1.5; 95% CI, 1.1-2.1), preoperative hyponatremia (OR, 1.2; 95% CI, 1.0-1.4), and length of operation >4 hours (OR, 1.4; 95% CI, 1.2-1.6). SSI was associated with prolonged (>10 days) hospital stay (OR, 1.8; 95% CI, 1.4-2.1) and higher rates of 30-day graft loss (OR, 2.3; 95% CI, 1.7-3.1) and reoperation (OR, 3.7; 95% CI, 3.1-4.6). SSI was not associated with increased 30-day mortality.
  
  
  CONCLUSIONS
  SSI is a common complication after open revascularization and is associated with a more than twofold increased risk of early graft loss and reoperation. Several patient and operation-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve outcomes in this patient population.
authors: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors: David Yu
authors: DY
authors: Greenblatt
authors: Victoria
authors: V
authors: Rajamanickam
authors: Matthew W
authors: MW
authors: Mell
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D019992:Databases as Topic; D004691:Endarterectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery*; D019984:Quality Indicators, Health Care; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014680:Veins / Q000637:transplantation*