title: Wound Disruption after Lower Extremity Bypass Surgery is a Predictor of Subsequent Development of Wound Infection.
abstract: BACKGROUND
  Despite advances in endovascular surgery, lower extremity arterial bypass (LEB) remains the gold standard treatment for severe, symptomatic Peripheral Arterial Disease. With recent changes in health care, there has been an increasing emphasis on reducing the hospital length of stay (LOS). The purpose of this study was to identify the postoperative complications, which occur after discharge from hospital and to find risk factors for developing such complications.
  
  
  METHODS
  The 2013 lower extremity revascularization-targeted American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing LEB were assessed. Postoperative complications were identified and their relationship to the median discharge date. Univariate and multivariable analyses were performed to identify the risk factors associated with developing these complications. A prediction model was then created to accurately predict the risk of developing such complications.
  
  
  RESULTS
  A total of 2,646 patients (65% male and 35% female) were identified in the NSQIP database that underwent LEB during the year 2013. Median LOS was 6 days. Most common significant complications after hospital discharge were wound infection/complication (13.7%, mean days from operation [MDAO] = 15 days), wound disruption/dehiscence (1.6%, MDAO = 15 days), and organ space surgical site infections (0.6%, MDAO = 16 days). Multivariable analysis showed the following factors associated with wound infection: wound disruption/dehiscence (odds ratio [OR]: 16, confidence interval [CI]: 7.09-36.07, P < 0.001), organ space infection (OR: 9.63, CI: 2.71-34.25, P < 0.001), unplanned reoperation (OR: 3.86, CI: 2.85-5.24, P < 0.001), urinary tract infection (OR: 2.79, CI: 1.28-6.05, P = 0.010), body mass index ≥40 vs. <25 (OR: 2.28, CI: 1.18-4.39, P < 0.001), postoperative bleeding requiring a transfusion (OR: 2.03, CI: 1.49-2.78, P < 0.001), operation time >300 min vs. 0-170 min (OR: 1.98, CI: 1.32-2.96, P = 0.008), prior ipsilateral percutaneous intervention involving currently treated segment vs. prior ipsilateral bypass involving currently treated segment (OR: 1.98, CI: 1.30-3.01, P = 0.004), history of chronic obstructive pulmonary disease (OR: 1.73, CI: 1.21-2.48, P = 0.003) and total LOS ≥28 vs. <7 days (OR: 1.21, CI: 0.60-2.48, P = 0.014). The risk prediction model for developing wound infection was developed.
  
  
  CONCLUSIONS
  Wound infection is the most common complication after LEB. Most of these complications occur after discharge from hospital. Patients with risk factors for developing wound infections should be followed and closely monitored after discharge from the hospital.
authors.affiliation: Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA. Electronic address: faziz@hmc.psu.edu.
authors.forename: Faisal
authors.initials: F
authors.lastname: Aziz
authors.affiliation: Office of Medical Education, Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Bohr
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000009:adverse effects*