Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience

Abdullah A AlFawaz 1 2, Ali H Safar 3, Ali Al-Mukhaizeem 3, Emad Kamal 2, Mohammed Alloush 2, Ebrahim Hanbal 2

Affiliations

01 January 2022

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doi: 10.1159/000525158

Abstract

Introduction: Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications.

Methods: This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher's exact test and two-tailed t test were used where appropriate.

Results: 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142-33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960-4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349-4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305-4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181-6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients.

Conclusion: Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.

Keywords: Arterial aneurysms; Peripheral arterial disease; Post-operative complications; Vascular surgery; Wound infection.

Conflict of interest statement

All authors listed on this manuscript have no affiliation with, or involvement in, any organization or entity with financial or nonfinancial interests in the subject matter or materials discussed in the manuscript.

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References

  1.  
    1. Piednoir E, Robert-Yap J, Baillet P, Lermite E, Christou N. The socioeconomic impact of surgical site infections. Front Public Health. 2021;9:712461. - PMC - PubMed
  2.  
    1. Goldstone J, Moore WS. Infection in vascular prostheses. Clinical manifestations and surgical management. Am J Surg. 1974;128:225–33. - PubMed
  3.  
    1. Szilagyi DE, Smith RF, Elliott JP, Vrandecic MP. Infection in arterial reconstruction with synthetic grafts. Ann Surg. 1972;176:321–33. - PMC - PubMed
  4.  
    1. Cox TR. Vascular infections: exceeding the threshold. Mil Med. 1995;160:609–11. - PubMed
  5.  
    1. Josephs LG, Cordts PR, DiEdwardo CL, LaMorte WW, Menzoian JO. Do infected inguinal lymph nodes increase the incidence of postoperative groin wound infection? J Vasc Surg. 1993;17:1077–2. - PubMed
  6.  
    1. Edwards WH, Jr, Kaiser AB, Kernodle DS, Appleby TC, Edwards WH, Sr, Martin RS, 3rd, et al. Cefuroxime versus cefazolin as prophylaxis in vascular surgery. J Vasc Surg. 1992;15:35–2. - PubMed
  7.  
    1. Naylor AR, Hayes PD, Darke S. A prospective audit of complex wound and graft infections in Great Britain and Ireland: the emergence of MRSA. Eur J Vasc Endovasc Surg. 2001;21:289–94. - PubMed
  8.  
    1. Newington DP, Houghton PW, Baird RN, Horrocks M. Groin wound infection after arterial surgery. Br J Surg. 1991;78:617–9. - PubMed
  9.  
    1. Nicolle LE, Huchcroft SA, Cruse PJ. Risk factors for surgical wound infection among the elderly. J Clin Epidemiol. 1992;45:357–64. - PubMed
  10.  
    1. Coit DG, Peters M, Brennan MF. A prospective randomized trial of perioperative cefazolin treatment in axillary and groin dissection. Arch Surg. 1991;126:1366–2. - PubMed
  11.  
    1. Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27–40. - PubMed
  12.  
    1. Gordon SM, Serkey JM, Barr C, Cosgrove D, Potts W. The relation ship between glycosylated hemoglobin (HgA1c) levels and postoperative infections in patients undergoing primary coronary artery bypass surgery (CABG) Infect Control Hosp Epidemiol. 1997;18((58)):29.
  13.  
    1. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–61. - PubMed
  14.  
    1. Terranova A. The effects of diabetes mellitus on wound healing. Plast Surg Nurs. 1991;11:20–5. - PubMed
  15.  
    1. Mobin-Uddin K. Exposure of femoral vessels by a suprainguinal incision. J Vasc Surg. 1992;15:1079–80. - PubMed
  16.  
    1. Blankensteijn JD, Gertler JP, Petersen MJ, Brewster DC, Cambria RP, La Muraglia GM, et al. Avoiding infrainguinal bypass wound complications in patients with chronic renal insufficiency: the role of the anatomic plane. Eur J Vasc Endovasc Surg. 1996;11:98–104. - PubMed
  17.  
    1. Branchereau A, Ondo N'Dong F, La Selve L. Antibioprevention in reconstructive arterial surgery. A double-blind study. Presse Med. 1987;16:1633–5. - PubMed
  18.  
    1. Hall JC, Christiansen KJ, Goodman M, Lawrence-Brown M, Prendergast FJ, Rosenberg P, et al. Duration of antimicrobial prophylaxis in vascular surgery. Am J Surg. 1998;175:87–90. - PubMed
  19.  
    1. Kester RC, Antrum R, Thornton CA, Ramsden CH, Harding I. A comparison of teicoplanin versus cephradine plus metronidazole in the prophylaxis of post-operative infection in vascular surgery. J Hosp Infect. 1999;41:233–43. - PubMed
  20.  
    1. Garibaldi RA. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect. 1988;11(Suppl B):5–9. - PubMed
  21.  
    1. Paulson DS. Efficacy evaluation of a 4% chlorhexidine gluconate as a full-body shower wash. Am J Infect Control. 1993;21:205–9. - PubMed
  22.  
    1. Bandyk DF. Infection in prosthetic vascular grafts. In: Rutherford RB, editor. Vascular surgery. 5th ed. Vol. 47. W.B Saunders; 2000. pp. 733–51.
  23.  
    1. Kikta MJ, Goodson SF, Bishara RA, Meyer JP, Schuler JJ, Flanigan DP. Mortality and limb loss with infected infrainguinal bypass grafts. J Vasc Surg. 1987;5:566–71. - PubMed
  24.  
    1. Ascer E, Gennaro M, Pollina RM, Ivanov M, Yorkovich WR, Ivanov M, et al. Complementary distal arteriovenous fistula and deep vein interposition: a five-year experience with a new technique to improve infrapopliteal prosthetic bypass patency. J Vasc Surg. 1996;24:134–43. - PubMed
  25.  
    1. Misare BD, Pomposelli FB, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW. Infrapopliteal bypasses to severely calcified, unclampable outflow arteries: two-year results. J Vasc Surg. 1996;24:6–16. - PubMed
  26.  
    1. Faries PL, Arora S, Pomposelli FB, Pulling MC, Smakowski P, Rohan DI, et al. The use of arm vein in lower-extremity revascularization: results of 520 procedures performed in eight years. J Vasc Surg. 2000;31:50–9. - PubMed
  27.  
    1. Lantis JC, Conte MnS, Belkin M, Whittemore AD, Mannick JA, Donaldson MC. Infrainguinal bypass grafting in patients with end-stage renal disease: improving outcomes? J Vasc Surg. 2001;33:1171–8. - PubMed
  28.  
    1. Kreienberg PB, Darling RC, Chang BB, Paty PS, Lloyd WE, Shah DM. Adjunctive techniques to improve patency of distal prosthetic bypass grafts: polytetrafluoroethylene with remote arteriovenous fistulae versus vein cuffs. J Vasc Surg. 2000;31:696–701. - PubMed
  29.  
    1. Whittemore AD, Kent KC, Donaldson MC, Couch NP, Mannick JA. What is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction? J Vasc Surg. 1989;10:299–305. - PubMed
  30.  
    1. Johnson BL, Glickman MH, Bandyk DF, Esses GE. Failure of foot salvage in patients with end-stage renal disease after surgical revascularization. J Vasc Surg. 1995;22:280–6. - PubMed
  31.  
    1. Belkin M, Knox J, Donaldson MC, Mannick JA, Whittemore AD. Infrainguinal arterial reconstruction with nonreversed greater saphenous vein. J Vasc Surg. 1996;24:957–62. - PubMed

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