title: The impact of vascular surgery wound complications on quality of life.
abstract: OBJECTIVE
  In addition to traditional surgical outcomes, perioperative quality of life is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in context of postoperative wound complications (WCs). We hypothesized that WCs negatively affect quality of life.
  
  
  METHODS
  The EuroQol (EQ)-5D subjective health state data, comprising five domains with 1 (good) to 3 (poor) ordinal scoring, plus visual analog score, were collected at the day of surgery and at 2 and 4 weeks of follow-up in a study evaluating silver-eluting dressings in 500 patients at three centers. A preference-weighted index was calculated. Groups were defined by no complication (NC) or presence of one or more postoperative WCs.
  
  
  RESULTS
  Patients (72% male) were a mean age of 67.6 years. Primary indications included critical limb ischemia (41.4%), claudication (31.6%), and abdominal aortic aneurysm (11.2%; open groin access for endovascular aneurysm repair). At least one WC occurred in 148 patients (29.6%). Baseline demographics were similar except mean age (NC group, 67.9 years; WC group, 65.7 years; P = .042) and body mass index (NC group, 27.0 kg/m2; WC group, 28.2 kg/m2). WCs were associated with use of conduit for reconstruction (P = .002), below-knee incisions (P = .002), and incision length (P < .001). Compared with the NC group, there was a decrement in quality-of-life scores in the WC group at 2 weeks (mean change, -0.217; P = .001) but not at 4 weeks (mean change, +0.044; P = .065) postoperatively. Subgroup analysis showed quality-of-life change after WC was most significant in the claudication group (P = .008). The EQ-5D visual analog scale score was lowest in groups with rest pain (57.0) and tissue loss (55.1) and highest in the abdominal aortic aneurysm cohort (71.8).
  
  
  CONCLUSIONS
  EQ-5D identified a significantly decreased quality-of-life score 2 weeks after WCs in a cohort undergoing elective infrainguinal arterial surgery. This effect was not present 4 weeks postoperatively.
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: mcgilled@cmhc.org.
authors.forename: Edward A
authors.initials: EA
authors.lastname: McGillicuddy
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: C Keith
authors.initials: CK
authors.lastname: Ozaki
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Shah
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
authors.affiliation: Department of Surgery, Beth Israel Hospital, Boston, Mass.
authors.forename: Allen
authors.initials: A
authors.lastname: Hamdan
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Neal
authors.initials: N
authors.lastname: Barshes
authors.affiliation: Department of Surgery, Beth Israel Hospital, Boston, Mass.
authors.forename: Mark
authors.initials: M
authors.lastname: Wyers
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Louis
authors.initials: L
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000523:psychology*; D011788:Quality of Life; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing