Alireza Daryapeyma1, Ollie Östlund2, Carl Wahlgren1
1Karolinska Institute, Stockholm, Sweden; 2Uppsala University, Uppsala, Sweden.
OBJECTIVES: To elucidate the incidence of health care associated infections and related risk factors in elective lower extremity vascular interventions.
METHODS: A retrospective nationwide survey of all postoperative infections among patients who have undergone elective open and endovascular surgery for lower extremity arterial disease between 2005-2010 (n=10547). Data were retrieved from the National Vascular Surgery Registry and cross-matched with the National Patient and Cause of Death registries.
RESULTS: Patients (claudication 27%; critical limb ischemia (CLI) 17% and gangrene 56%) were treated with endovascular intervention (n=6,262; 59%), thromboendarterectomy (TEA) (n=1061; 10%) or bypass surgery (n=3,224; 31%). The total incidence of postoperative infection (<30-d) was 9.7%. Skin and soft tissue infection (n=735; 6.9%), including surgical site infection and graft infection dominated. This was followed by urinary tract infection (n=168; 1.6%), pneumonia (n=114; 1.1%) and sepsis (n=91; 0.9%). Infection was significantly associated with both operative method and indication for treatment (TEA vs. endo in claudicants [OR 6.7 (95% CI 3.9 - 11.6]) and CLI [OR 2.0 (95% CI 1.1 - 3.7)]; bypass vs. endo in claudicants [OR 8.4 (95% CI 5.0 - 14)] and CLI [OR 3.4 (95% CI 2.3 - 5.1)]. Risk factors associated with infection were diabetes, renal insufficiency, heart and lung disease (p< 0.05). There was a significant increase in the 1-year amputation rate (11.8% vs. 5.6%) and 30-day mortality (4.2% vs. 2.5%) for patients with postoperative infection within 30 days (p<0 .001).
CONCLUSIONS: The risk of infection varies depending on method of treatment and the extent of comorbidities. Open surgery in claudicants confers a 7-fold increased risk compared to endovascular treatment. Early postoperative infection is significantly associated with an increased rate of amputation and mortality.
AUTHOR DISCLOSURES: A. Daryapeyma: Nothing to disclose; C. Wahlgren: Nothing to disclose; O. Östlund: Nothing to disclose.
Posted April 2013