PMID- 37926138
OWN - NLM
STAT- MEDLINE
DCOM- 20240122
LR  - 20240201
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 99
DP  - 2024 Feb
TI  - Risk Analysis and Clinical Outcomes in Chronic Limb-threatening Ischemia Patients 
      with Surgical Site Infection after Distal Bypass.
PG  - 33-40
LID - S0890-5096(23)00750-1 [pii]
LID - 10.1016/j.avsg.2023.09.091 [doi]
AB  - BACKGROUND: A recent randomized control study showed that long-term outcomes 
      after surgical revascularization were superior to those after endovascular 
      treatment for cases with chronic limb-threatening ischemia (CLTI) with an 
      appropriate single-segment great saphenous vein. However, surgical site infection 
      (SSI) in CLTI cases after infrapoplital bypass also resulted in a prolonged 
      hospital stay and poor outcomes, including graft disruption. The aim of the 
      current study was to analyze risk factors for SSI in CLTI patients after distal 
      bypass and to compare outcomes in patients with and without SSI. METHODS: A total 
      of 515 cases that underwent distal bypass at a single center between 2009 and 
      2022 were analyzed retrospectively. Comparisons were made between patients with 
      and without SSI after distal bypass. The primary end point was limb salvage after 
      distal bypass. RESULTS: Of the 515 cases that underwent distal bypass, 79 (15%) 
      had SSI. The risk factors for SSI were preoperative antibacterial drug use 
      (P = 0.001), pedal bypass (P = 0.001), and prolonged operation time (>/=150 min) 
      (P = 0.010). The median hospital stay in SSI cases was longer than that in 
      non-SSI cases (P < 0.001). Of 515 distal bypasses, 7 (1.3%) bypass grafts 
      ruptured postoperatively due to SSI, and of these 7 cases, 6 ruptured during the 
      day, 5 cases occurred within 1 month postoperatively, and 2 patients (29%) are 
      alive without amputation. The mean follow-up period was 34 +/- 30 months. During 
      follow-up, 62 limbs (SSI cases, 19; non-SSI cases, 43) required major amputation 
      and there were 234 deaths (SSI cases, 46; non-SSI cases, 188). The 1-, 3-, and 
      5-year limb salvage rates of 82%, 71%, and 62%, respectively, in SSI cases were 
      significantly lower than those in non-SSI cases (P < 0.001). The 5-year survival 
      rate of 29% in SSI cases showed a tendency to be lower than that in non-SSI cases 
      (P = 0.058). CONCLUSIONS: The limb salvage rate in SSI cases was lower than in 
      non-SSI cases after distal bypass. Graft rupture due to SSI occurred at a rate of 
      1.3% and resulted in poor outcomes in most cases. SSIs adversely affect outcomes 
      and further study is needed to identify methods to avoid SSI following distal 
      bypass.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Kobayashi, Taira
AU  - Kobayashi T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima, Japan. Electronic address: ja-t-coba@hotmail.co.jp.
FAU - Hamamoto, Masaki
AU  - Hamamoto M
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima, Japan.
FAU - Okazaki, Takanobu
AU  - Okazaki T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima, Japan.
FAU - Okusako, Ryo
AU  - Okusako R
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima, Japan.
FAU - Hasegawa, Misa
AU  - Hasegawa M
AD  - Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, 
      Hatsukaichi-shi, Hiroshima, Japan.
FAU - Takahashi, Shinya
AU  - Takahashi S
AD  - Department of Cardiovascular Surgery, Hiroshima University Hospital, Minami-ku, 
      Hiroshima, Japan.
LA  - eng
PT  - Journal Article
DEP - 20231103
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Humans
MH  - *Chronic Limb-Threatening Ischemia
MH  - Treatment Outcome
MH  - Surgical Wound Infection/diagnosis/etiology
MH  - Retrospective Studies
MH  - Lower Extremity/blood supply
MH  - Vascular Patency
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Risk Assessment
MH  - Risk Factors
MH  - Limb Salvage/adverse effects
MH  - Ischemia/diagnostic imaging/surgery/etiology
EDAT- 2023/11/06 00:41
MHDA- 2024/01/22 06:43
CRDT- 2023/11/05 19:12
PHST- 2023/06/30 00:00 [received]
PHST- 2023/08/23 00:00 [revised]
PHST- 2023/09/18 00:00 [accepted]
PHST- 2024/01/22 06:43 [medline]
PHST- 2023/11/06 00:41 [pubmed]
PHST- 2023/11/05 19:12 [entrez]
AID - S0890-5096(23)00750-1 [pii]
AID - 10.1016/j.avsg.2023.09.091 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2024 Feb;99:33-40. doi: 10.1016/j.avsg.2023.09.091. Epub 2023 Nov 
      3.