title: Surgical site infections after lower extremity revascularization procedures involving groin incisions.
abstract: BACKGROUND
  We sought to evaluate the incidence, epidemiology, and factors associated with surgical site infections (SSIs) after lower extremity revascularization procedures involving groin incisions and determine outcomes based on SSI status.
  
  
  METHODS
  This is a single-institution, retrospective cohort study of 106 patients who underwent lower extremity revascularization procedures involving femoral artery exposure through a groin incision at a tertiary referral hospital. The primary outcome was occurrence of SSI at the groin wound. The duration of hospital stay, reoperation within 30 days, discharge disposition, and 30-day mortality were also evaluated. Independent variables included patient demographics and operative variables (i.e., procedure type, transfusion requirements, preoperative antibiotics, intraoperative vasopressors, and operative duration). Statistical analysis included chi-squared tests, t-tests, and multivariable regression analysis.
  
  
  RESULTS
  Of the 106 patients who underwent a lower extremity revascularization procedure with a groin incision for femoral artery exposure, 62% were male, and the mean age was 62 years. Comorbidities included hypertension (93%), dyslipidemia (65%), statin use (63%), active smoker (50%), diabetes (24%), and chronic obstructive pulmonary disease (23%). All patients received preoperative antibiotics, 50% required intraoperative pressors, 21% received a blood transfusion, and the mean operative time was 296 min. The overall duration of stay was 10.7 days, the 30-day reoperation rate was 18%, and the 30-day mortality rate was 12%. Overall, 22% developed a seroma or hematoma, and 31% developed a SSI. Patients who developed an SSI compared with those who did not were more likely to have a postoperative seroma or hematoma (55% vs 5%) and to receive a blood transfusion (33% vs 15%), but less likely to be treated with a statin (47% vs 69%) or carry a diagnosis of dyslipidemia (50% vs 72%), respectively, all P < 0.05. Patients with an SSI had a longer duration of stay (14.5 vs 8.7 days) and a higher reoperative rate (49% vs 4%), but had a lower 30-day mortality (0% vs 18%) than those who did not develop an SSI (all P < 0.05). On multivariable regression analysis adjusting for differences in patient and operative variables, the occurrence of a wound seroma or hematoma remained an independent predictor for SSI (odd ratio: 27.6; 95% confidence interval: 5.4-139.6).
  
  
  CONCLUSIONS
  The incidence of postoperative surgical site complications after lower extremity revascularization procedures involving a groin incision was 31% and was significantly associated with blood transfusion, postoperative seroma or hematoma, dyslipidemia, and statin usage. After adjusting for differences in patient and operative variables, postoperative seroma or hematoma was an independent predictor of SSI. Patients with a SSI have a longer duration of hospitalization and higher reoperative rate. Additional prospective cohort studies are warranted to delineate ways to decrease the rate of SSI.
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: SreyRam
authors.initials: S
authors.lastname: Kuy
authors.affiliation: Division of Vascular Surgery, University of Texas at Houston, Houston, TX.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Division of Vascular Surgery, University of Texas at Houston, Houston, TX.
authors.forename: Sapan
authors.initials: S
authors.lastname: Desai
authors.affiliation: School of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Arshish
authors.initials: A
authors.lastname: Dua
authors.affiliation: School of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Patel
authors.affiliation: University General Hospital, Houston, TX.
authors.forename: Nader
authors.initials: N
authors.lastname: Tondravi
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kellie R
authors.initials: KR
authors.lastname: Brown
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lewis
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: University General Hospital, Houston, TX.
authors.forename: SreyReath
authors.initials: S
authors.lastname: Kuy
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Rishi
authors.initials: R
authors.lastname: Subbarayan
authors.affiliation: Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: prossi@mcw.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011677:Punctures; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents