Risk Factors for Surgical Site Infections After Lower Extremity Open Revascularization

Background: Surgical site infection (SSI) is a serious complication of lower extremity open revascularization and is associated with increased morbidity, increased healthcare costs, and decreased postoperative quality of life. The objective of this study was to determine factors associated with an increased risk of developing postoperative SSI in patients undergoing lower extremity revascularization. Associations between SSI and postoperative complications were also identified. Methods: Patients who underwent lower extremity open revascularization from 2014–2017 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). A multivariate logistic regression analysis was used to determine risk factors associated with SSIs within 30 days of the operation and postoperative complications. Odds ratios (ORs) were adjusted for demographics, preoperative comorbidities, procedure type, and intraoperative variables. Results: Ten thousand nine hundred ten patients who underwent lower extremity open revascularization were identified, with a mean age of 67.24 years and of whom 7,318 (67%) were male. Of the 10,910 patients, 922 (8.45%) had an SSI within 30 days of the operation. Risk factors associated with developing SSI included body mass index 25–29.9 (OR, 1.34; 95% confidence interval [CI], 1.08–1.67), body mass index ≥ 30 (OR, 2.12; 95% CI, 1.71–2.62), history of severe chronic obstructive pulmonary disease (OR, 1.47; 95% CI, 1.18–1.84), preprocedural beta-blocker use (OR, 1.25; CI 95%, 1.05–1.49), procedure time > 214 minutes (OR, 1.44; 95% CI, 1.22–1.70), and creatinine > 1.2 (OR 1.03; 95% CI, 0.87–1.21). One factor associated with a decreased risk of developing SSI was male gender (OR, 0.71; 95% CI, 0.60–0.84). Patients who developed an SSI were more likely to have adverse outcomes such as myocardial infarction/stroke, major amputation, bleeding requiring transfusion or secondary procedure, or require a reintervention in the treated segment. Conclusions: There are various patient-related and operative factors that increase the likelihood of developing an SSI after lower extremity open revascularization. These findings indicate that addressing modifiable perioperative SSI risk factors may be beneficial in decreasing rates of SSI and improving postoperative outcomes.