Predictors of surgical site infection after open lower extremity revascularization

Davis, Frank M.; Sutzko, Danielle C.; Grey, Scott F.; Mansour, M. Ashraf; Jain, Krishna M.; Nypaver, Timothy J.; Gaborek, Greg; Henke, Peter K.

doi:10.1016/j.jvs.2016.11.053

Cited by 53 publications

(39 citation statements)

References 57 publications

(55 reference statements)

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“…26 Although no study has directly studied SSI following EVAR, the study by Davis et al did identify renal failure as a significant risk factor for SSI in their study of 3,033 patients following open lower extremity bypasses (OR 4.35; 95% CI: 2.74-6.72, p < 0.001). 27 O'Hare et al also revealed higher wound infections in patients with severe renal failure (on dialysis) following NSQIP-documented lower extremity revascularization. 28 The association of COPD with wound complications following oEVAR was also an expected finding due to its previous association with SSI in other types of vascular surgery such as lower extremity bypass.…”

Section: Discussionmentioning

confidence: 97%

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

et al. 2019

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We identified factors that would lead to wound complications after open femoral exposure for endovascular abdominal aortic aneurysm repair (oEVAR).Using the National Surgical Quality Improvement Program dataset (2005–2014), we examined the patients who underwent oEVAR. Patients were stratified on whether they developed postoperative wound complications. Comparisons were made between group with wound complications and those without and adjusted analyses performed to identify variables that independently increased the risk of wound complications.There were 14,868 patients in the study cohort and 2.6% (384 patients) developed wound complications after EVAR. Among those with wound complications, 94% (360 patients) of patients had superficial and deep surgical site infection. Patients who had wound complication were likely to be younger (72.6 vs. 73.7 years old (p = 0.02), functionally dependent (5.4 vs. 2.5%) (p < 0.05), smoker (3 vs. 2.4%, p =0.03), female (4 vs. 2.2%), with significantly higher body mass index (31 vs. 28), and more commonly had diabetes (4 vs. 2.4%, p < 0.001) or renal failure (12 vs. 3%, p < 0.001). Although perioperative survival was similar, patients who had wound complications had significantly longer hospital length of stay (LOS) (7.3 ± 12 vs. 3.4 ± 5 days, p < 0.001).Up to 3% patients developed wound complications after open femoral exposure during EVAR with significantly higher LOS and therefore cost utilization.

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Section: Discussionmentioning

confidence: 97%

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

et al. 2019

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“…A high rate of foot ulcer infection and wound infection can in fact be found in HD patients and this can be assumed to be the cause of the subsequent TCC infection. In particular, a study by Davis et al 17 on 3033 patients who underwent major surgery for peripheral arterial disease showed that HD patients had a four times higher risk for surgical site infection, which was in turn associated with reoperation and amputation.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream infections and patient survival with tunneled-cuffed catheters for hemodialysis: A single-center observational study

et al. 2020

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Background: In hemodialysis patients, a tunneled-cuffed permanent catheter is mandatory when the arteriovenous fistula is not feasible. The major risks of the use of tunneled-cuffed permanent catheter are bloodstream infections. The aim of this study is to analyze bloodstream infections from tunneled-cuffed permanent catheter in hemodialysis patients. Methods: An observational prospective study was carried out and 79 hemodialysis patients with tunneled-cuffed permanent catheter were enrolled. Patients were divided into those with bloodstream infections from tunneled-cuffed permanent catheter and those without. Their clinical and laboratory characteristics were compared. An original tunneled-cuffed permanent catheter lock therapy sequence was carried out combined with systemic antibiotic therapy. In case of antibiotic resistance, the tunneled-cuffed permanent catheter was removed. Results: The patients affected by bloodstream infections from tunneled-cuffed permanent catheter were 16/79 (20.3%). The bloodstream infection from tunneled-cuffed permanent catheter’s incidence rate was 0.52 per 1000 catheter days. Twenty-three bloodstream infections from tunneled-cuffed permanent catheter were found in 16/79 patients who used tunneled-cuffed permanent catheter. Staphylococcus aureus was the cause of bloodstream infection from tunneled-cuffed permanent catheter in 35% of the cases and Staphylococcus epidermidis in 30% of the cases. Risk factors were infection located in other organs and the presence of peripheral obstructive arterial disease. Conclusion: The enrolled cohort showed a reduced bloodstream infection from tunneled-cuffed permanent catheter incidence rate in comparison with the reference value (1 per 1000 catheter days). To reduce the number of bloodstream infections from tunneled-cuffed permanent catheter, hand hygiene and asepsis management of the tunneled-cuffed permanent catheter during the connection to the extracorporeal circuit and an original tunneled-cuffed permanent catheter lock therapy sequence seem to be the most efficient measures. Infections of other organs and the presence of peripheral obstructive arterial disease are the most important risk factors for bloodstream infections from tunneled-cuffed permanent catheter.

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“…35 He received 40 cc of CaSO 4 (Stimulan; Biocomposites, Staffordshire, England), which constitutes 4 packages of the product. 35 It is therefore important for providers to be cognizant of their patient's clinical status and the risk of elevating serum calcium when using high volumes of CaSO 4 .…”

Section: Safetymentioning

confidence: 99%

“…1 Higher rates are reported in traumatic injuries (20%-50%) or in some elective populations, including high-risk vascular surgery patients (15% or greater). 2-6 Surgical site infection can significantly increase cost and morbidity. 1 Morbidity, however, can be magnitudes higher when it involves prosthetic material.…”

Section: Introductionmentioning

confidence: 99%

A Scoping Review on the Use of Antibiotic-Impregnated Beads and Applications to Vascular Surgery

McGuinness

Ali

Phillips

et al. 2019

Vasc Endovascular Surg

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Introduction: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. Methods: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. Conclusions: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.

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Predictors of surgical site infection after open lower extremity revascularization

Cited by 53 publications

References 57 publications

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

Bloodstream infections and patient survival with tunneled-cuffed catheters for hemodialysis: A single-center observational study

A Scoping Review on the Use of Antibiotic-Impregnated Beads and Applications to Vascular Surgery

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