title: Interventions on the superficial venous system for chronic venous insufficiency by surgeons in the modern era: an analysis of ACS-NSQIP.
abstract: OBJECTIVE
  To evaluate patient characteristics, practice patterns, and outcomes for patients treated for chronic venous insufficiency (CVI).
  
  
  BACKGROUND
  Chronic venous insufficiency is a common problem treated using open or endovascular methods by physicians from a number of surgical and nonsurgical specialties.
  
  
  METHODS
  Patients treated for CVI in the American College of Surgeons National Surgical Quality Improvement Program data set (2005-2011) were identified. Analyses were based on open surgical treatment (open surgery of varicose vein [OSVV]) versus endovenous ablation (EVA), specialty of treating surgeon, and by the presence of venous ulceration (VU). Preoperative patient characteristics and intraoperative measures were examined, and multivariate logistic regression analyses were performed for the postoperative outcomes of superficial surgical site infection (sSSI) and deep venous thrombosis (DVT).
  
  
  RESULTS
  A total of 4366 patients were identified. Patients undergoing EVA were older (53.3 vs 51.8 years; P < .001), had higher body mass index (BMI; 29.9 vs 29.0; P < .001), and more commonly presented with VU (20.9% vs 13.3%; P < .001). Vascular surgeons were more likely than general surgeons to treat patients with VU (17.0% vs 13.4%; P = .017). Patients with VU had higher BMI (32.2 vs 28.8; P < .001), were older (57.9 vs 51.4 years; P < .001), and more likely to be diabetic (9.0% vs 4.7%; P < .001). Factors associated with sSSI were OSVV (adjusted odds ratio [AOR] 2.56; 95% confidence interval [CI] 1.19-5.50; P = .016), obesity (AOR 2.16; 95% CI 1.10-4.24; P = .025), and VU (AOR 2.56; 95% CI 1.19-5.50; P = .016). Patients undergoing OSVV had significantly lower odds of DVT when compared to EVA (AOR 0.52; 95% CI 0.28-0.97; P = .040).
  
  
  CONCLUSIONS
  The OSVV, obesity, and VU increase the odds of sSSI after procedures treating CVI. Patients in these categories should be monitored closely for signs of infection in the perioperative period. Patients undergoing EVA have higher odds of postoperative DVT, suggesting that routine screening after EVA for DVT may be justified.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA Division of Vascular Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA tcarruthers@lifespan.org.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Carruthers
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D013038:Specialization; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014481:United States; D014647:Varicose Ulcer / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014689:Venous Insufficiency / Q000175:diagnosis / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology
keywords: chronic venous insufficiency; deep venous thrombosis; laser ablation; phlebectomy; radiofrequency ablation; saphenous vein stripping; surgical site infection; varicose veins; venous ablation