PMID- 32889070 OWN - NLM STAT- MEDLINE DCOM- 20211011 LR - 20211011 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 73 IP - 4 DP - 2021 Apr TI - The association between preoperative length of stay and surgical site infection after lower extremity bypass for chronic limb-threatening ischemia. PG - 1340-1349.e2 LID - S0741-5214(20)31921-2 [pii] LID - 10.1016/j.jvs.2020.08.037 [doi] AB - OBJECTIVE: Surgical site infection (SSI) is an important complication of lower extremity bypass (LEB) and the rate of SSI after LEB varies widely in the existing literature, ranging from 4% to 31%. Prolonged length of stay (LOS) has been implicated in the occurrence of SSI across multiple surgical disciplines. The impact of preoperative LOS in patients with chronic limb-threatening ischemia (CLTI) undergoing LEB is unknown. We examined the association of preoperative LOS on SSI after LEB. METHODS: A retrospective analysis of the Society for Vascular Surgery Vascular Quality Initiative Infrainguinal Bypass Registry identified patients undergoing elective LEB for chronic limb-threatening ischemia from 2003 to 2019. Patients undergoing LEB for acute limb ischemia, urgent/emergent procedures, aneurysm, or who had concomitant suprainguinal bypass were excluded. The primary outcome measure was postoperative SSI. Multivariable forward stepwise logistic regression was then performed including all variables with a P value of less than .10 in both matched and unmatched cohorts to evaluate for demographic and perioperative predictors of SSI. Propensity score matching was used to create matched cohorts of patients for each LOS group. RESULTS: A total of 17,883 LEB procedures were selected for inclusion: 0 days (12,362 LEB), 1 to 2 days (1737 LEB), and 3 to 14 days (3784 LEB). Patients with the greatest preoperative LOS were more likely to have vein mapping (0 days preoperative LOS, 66.3%; 1-2 days, 65.2%; 3-14 days, 73.2%; P < .01) or computed tomography angiography/magnetic resonance angiography (0 days, 32.1%; 1-2 days, 34.4%; 3-14 days, 38.4%; P < .01). Patients with 3 or more days of preoperative LOS had longer procedure lengths (0 days, 244 minutes; 1-2 days, 243 minutes; 3-14 days, 255 minutes; P < .01) and were more likely to have completion angiogram (0 days, 27.1%; 1-2 days, 29.5%; 3-14 days, 31.6%; P = .02). Multivariable logistic regression demonstrated that preoperative LOS of 3 to 14 days was associated with increased rate of SSI (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.20-3.07; P = .01). Transfusion of 3 or more units (OR, 2.87; 95% CI, 1.89-4.36; P < .01) and prolonged procedure length (>220 minutes; OR, 1.86; 95% CI, 1.26-2.73; P < .01) were also significantly associated with postoperative SSIs. CONCLUSIONS: Many factors including preoperative comorbidities and operative complexity covary with preoperative LOS as risk factors for SSI. However, when patients are matched based on comorbidities and factors that would predict overall clinical complexity, preoperative LOS remains important in predicting SSI. CI - Copyright (c) 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Stewart, Luke M AU - Stewart LM AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Spangler, Emily L AU - Spangler EL AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Sutzko, Danielle C AU - Sutzko DC AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Pearce, Benjamin J AU - Pearce BJ AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - McFarland, Graeme E AU - McFarland GE AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Passman, Marc A AU - Passman MA AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Patterson, Mark A AU - Patterson MA AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Haverstock, Brent AU - Haverstock B AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Unger, Kenneth AU - Unger K AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Novak, Zdenek AU - Novak Z AD - University of Alabama at Birmingham, Birmingham, Ala. FAU - Beck, Adam W AU - Beck AW AD - University of Alabama at Birmingham, Birmingham, Ala. Electronic address: awbeck@uabmc.edu. LA - eng PT - Journal Article DEP - 20200901 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Chronic Disease MH - Comorbidity MH - Female MH - Humans MH - Ischemia/diagnostic imaging/*surgery MH - *Length of Stay MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnostic imaging/*surgery MH - Quality Indicators, Health Care MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Surgical Wound Infection/*etiology MH - Time Factors MH - Treatment Outcome MH - Vascular Grafting/*adverse effects OTO - NOTNLM OT - Infrainguinal bypass OT - Lower extremity bypass OT - Preoperative length of stay OT - SAVS OT - Surgical site infection EDAT- 2020/09/06 06:00 MHDA- 2021/10/12 06:00 CRDT- 2020/09/05 12:20 PHST- 2020/02/26 00:00 [received] PHST- 2020/08/01 00:00 [accepted] PHST- 2020/09/06 06:00 [pubmed] PHST- 2021/10/12 06:00 [medline] PHST- 2020/09/05 12:20 [entrez] AID - S0741-5214(20)31921-2 [pii] AID - 10.1016/j.jvs.2020.08.037 [doi] PST - ppublish SO - J Vasc Surg. 2021 Apr;73(4):1340-1349.e2. doi: 10.1016/j.jvs.2020.08.037. Epub 2020 Sep 1.