title: Healthcare-associated infections after lower extremity revascularization.
abstract: OBJECTIVE
  This population-based study aims to elucidate the incidence of healthcare-associated infections (HCAI) and related risk factors in non-emergent, open and endovascular lower extremity vascular procedures.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data from the Swedish National Vascular Surgery registry (Swedvasc), National Patient registry, and Cause of Death registry. A nationwide survey of all postoperative infections among patients who have undergone non-emergent open and endovascular surgery for lower extremity arterial disease between January 2005 to December 2010 (n = 10,547) has been performed. Data were retrieved from the National Vascular Surgery registry and cross-matched with the National Patient and Cause of Death registries. The primary purpose of the study was to identify the rate of 30-day postoperative infections and the associated risk factors for the different classes of lower extremity ischemia and operative procedures.
  
  
  RESULTS
  The study cohort included patients with claudication 27.0% (n = 2,827) and critical limb ischemia (CLI), consisting of rest pain 17.0% (n = 1,835) and ulceration/gangrene 56.0% (n = 5,885) undergoing endovascular intervention (n = 6,262; 59.0%), thromboendarterectomy (n = 1,061; 10.0%), or bypass surgery (n = 3,224; 31.0%). The total incidence of postoperative infection (<30-days) was 9.7% (n = 1,019), including skin and soft tissue infection (n = 735; 6.9%), urinary tract infection (n = 168; 1.6%), pneumonia (n = 114; 1.1%), and sepsis (n = 91; 0.9%). In claudicants, the risk of infection was increased eightfold for bypass surgery compared with endovascular intervention (odds ratio 8.4, 95% confidence interval 5.0-14). Risk factors associated with infection were degree of lower extremity ischemia, diabetes, renal insufficiency, and heart and lung disease (p < .05).
  
  
  CONCLUSIONS
  The postoperative rate of HCAI is associated with cardiovascular risk factors, operative method, and degree of lower extremity ischemia. This may be of assistance when deciding on the type of operative procedure for these patients.
authors.affiliation: Department of Vascular Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden. Electronic address: alireza.daryapeyma@Karolinska.se.
authors.forename: A
authors.initials: A
authors.lastname: Daryapeyma
authors.affiliation: Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Östlund
authors.affiliation: Department of Vascular Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: C-M
authors.initials: CM
authors.lastname: Wahlgren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Lower extremity; Postoperative infection; Revascularization