VESS06. Strategies to Reduce Wound Complications in Below-Knee Amputation

Abstract

Wound complications, including surgical site infections (SSI) and wound dehiscence (WD), are seen often after below-knee amputation (BKA) of the leg. Since 2015, our group has implemented several strategies intended to reduce the incidence of these wound complications. The objective of this study was to assess the impact of these strategies. A single-center, retrospective cohort study was conducted among patients who underwent BKA procedures. At our center, we have implemented strategies to reduce postoperative wound complications, including (1) decreasing the use of incisional skin staples, (2) increasing the use of negative pressure wound therapy dressings, and (3) implementing an outpatient elective decontamination protocol for methicillin-resistant Staphylococcus aureus. To examine the effect of these strategies, we defined pre-eras and post-eras. The pre-era included procedures completed between January 2009 and December 2013, before the implementation of infection control strategies. The post-era was between January 2015 and October 2018. Procedures completed in 2014 were excluded to account for a period of uptake in strategies. The primary outcome was a composite of 30-day wound complications (SSI, WD, or both). Multivariable logistic regression was used to model associations between the primary outcome, eras, preoperative comorbidities, and infection control strategies. A total of 182 BKAs were performed: 110 (60.4%) in the pre-era and 72 (39.6%) in the post-era. Patient characteristics between the two eras did not differ significantly in the univariable analysis. The proportion of SSI or WD between periods did not significantly decrease (infection: pre-era = 14%, post-era = 11% [P = .60]; WD: pre-era = 9%, post-era = 7% [P = .60]). After risk adjustment, the use of staples compared with sutures (odds ratio [OR], 0.35; P = .05) was associated with a decreased risk of developing the composite end point. One or more drain placements were associated with an increased risk of SSI/WD incidence (OR, 4.12; P = .04). Procedures completed in the post-era were associated with a decreased risk of composite end point development in the adjusted model; however, this was not significant (OR, 0.48; P = .15). After BKA, skin closure with staples was associated with a decreased adjusted-risk of wound complications, and drain placement was associated with an increased risk of wound complications.