Risk factor analysis for surgical site infections in 750 vascular surgery patients

Abstract

Objective: To perform a risk factor analysis following determination of surgical site infection (SSI) rates in vascular surgery procedures. Methods: All patients receiving vascular surgery (thoraco-abdominal, abdominal, retroperitoneal, iliaco-femoral, femoral, femoro-distal, endostents) from Jan 2002–Dec 2005 were included. SSI were determined according to CDC definitions. Risk factor analysis was performed. Results: In 750 patients, 73 thoraco-abdominal, 276 abdominal, 24 retroperitoneal, 172 femoral and 53 femoro-distal, 99 endovascular procedures and 112 thrombo-embolectomies were performed (combined procedures included). 42 (5.6%) patients developed SSI in average 11.5 (5–33) days following surgery. 28 (3.7%) superficial, 10 (1.3%) deep SSI and 4 (0.5%) organ space infections occurred. S.aureus (13 (31%), out of which 8 (19%) were MRSA, CoNS (17 (40%)), enterococci (14 (33%)), and P.aeruginosa (7 (17%)) were the most prevalent pathogens (other (21 (26%)). Femoral access (RR2.3, 95%CI 1.6; 3.4,p<0.001), operative revisions (RR 1.2, 95%CI 1.1; 1.4, p<0.001), peripheral vascular disease class FontaineIII (OR 3.5,95%CI 1.5; 8.2, p=0.002), and the use of autologous vessels (RR2.0, 95%CI 1.3; 3.3, p=0,008) increased the infection risk significantly. Elective aneurysm repair (OR 0.4; 95%CI 0.21; 0.77, p=0.008) and endovascular procedures (RR nd, p=0.01) were associated with a decreased infection risk. Conclusion: In vascular surgery postoperative SSI occur frequently. The choice of surgical access, graft material and the grade of peripheral vascular disease at the time of surgery were found crucial risk factors for the development of SSI. Future studies should address modifications of surgical access, graft materials, and whether the decision for an endovascular procedure or an intervention in earlier stages of peripheral vascular disease would prevent SSI.