When Infections Hurt More: Black Patients Experience More Severe Surgical Site Infections following Lower Extremity Bypass

Abstract

Background: Surgical site infections (SSIs) are common complications following lower extremity bypass (LEB). Previous studies have reported that recognition of SSIs may be delayed among patients with darker skin tones, leading to more severe presentations. We examined whether patients of Black race experienced increased severity of SSIs following LEB surgery.

Methods: A single-center, retrospective review of patients undergoing LEB surgery from January 2018 to December 2022 was performed. Patients were categorized as Black or non-Black. Postoperative SSI was stratified per Southampton wound score (grade 2-5), with severe SSI defined as grades four or five.

Results: Among 505 LEB patients, 216 (42.8%) self-identified as Black, and 289 (57.2%) were non-Black. Median age was 65 y (interquartile range [IQR] 59-72 y). Age, smoking status, and body mass index were similar between groups. Black patients more frequently underwent bypass for chronic limb-threatening ischemia compared with non-Black patients (57.4% vs 40.8% tissue loss, 25.5% vs 21.5% rest pain, p<0.001). Surgical technique and time to SSI diagnosis was similar between groups. Incidence of SSI was lower among Black patients (15.3% vs 28.7%, p<0.001). Black patients had more severe SSI at time of diagnosis (30.4% vs 18.3% grade four, 15.2% vs 6.1% grade five; p=0.03). Black race was independently associated with severe SSI (odds ratio 1.64, p=0.04).

Conclusion: Postoperative SSI is less frequent among Black patients undergoing LEB surgery, but presents with increased severity, which may reflect a delay in diagnosis. These findings underscore the importance of vigilance and early recognition in this patient population.

Keywords: Black race; lower extremity bypass; surgical site infection.