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. 2022 Oct;76(4):1014-1020.
doi: 10.1016/j.jvs.2022.04.040. Epub 2022 Jun 11.

Surgical site infection after open lower extremity revascularization associated with doubled rate of major limb amputation

Micah J Pherson  1 , Paula D Strassle  1 , Victoria J Aucoin  2 , Corey A Kalbaugh  3 , Katharine L McGinigle  4
Affiliations

Surgical site infection after open lower extremity revascularization associated with doubled rate of major limb amputation

Micah J Pherson et al. J Vasc Surg. 2022 Oct.

Abstract

Objective: Surgical site infection (SSI) after open lower extremity revascularization is a relatively common complication associated with increased hospital stays, graft infection, and in severe cases, graft loss. Although the short-term effects of SSI can be significant, it has not been considered a complication that increases major limb amputation. The purpose of this study was to determine the association of SSI with outcomes in patients undergoing surgical revascularization for peripheral arterial disease.

Methods: We analyzed nationwide Vascular Quality Initiative (VQI) data from the infrainguinal bypass module from 2003 to 2017. The cohort included adults who underwent open lower extremity bypass for symptomatic peripheral arterial disease and had at least one follow-up record. Weighted Kaplan-Meier curves and Cox proportional hazards regression were used to assess the association between SSI and 1-year mortality and major limb amputation. Inverse-probability of treatment weights were used to account for differences in demographics and patient characteristics and allow for 'adjusted' Kaplan-Meier curves.

Results: The analysis included 21,639 patients, and 1155 (5%) had a reported SSI within 30 days of surgery. Patients with SSI were more likely be obese (41% vs 30%), but there were no other clinically relevant differences between demographics, comorbidities, and bypass details. After weighting, patients with SSI were almost twice as likely to undergo major amputation by 6 months (hazard ratio, 1.84; 95% confidence interval, 1.07-3.17). The association with SSI and increased amputation rates persisted at 1 year. The association of SSI on amputation was no different based on preoperative Rutherford class (P = .91). The association between SSI and 1-year mortality rate was not statistically significant (hazard ratio, 1.15; 95% confidence interval, 0.91-1.46).

Conclusions: SSI is more common in obese patients, and patients who develop an SSI are observed to have a significantly increased rate of limb amputation after open lower extremity revascularization.

Keywords: Lower extremity bypass; Major limb amputation; Surgical site infection.

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Conflict of interest statement

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Figures

Fig 1.
Fig 1.
Figure depicts the crude (A) and weighted (B) incidence of major amputation stratified by postoperative surgical site infection (SSI) status. The crude and weighted cumulative incidence demonstrate an increased rate of major amputation in those patients that develop an SSI.
Fig 2.
Fig 2.
Figure demonstrates the crude (A) and weighted (B) incidence of all-cause mortality with respect to development of a postoperative surgical site infection (SSI).
See this image and copyright information in PMC

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