J. T. Wiseman1, S. Fernandes-Taylor1, K. C. Kent1 1University Of Wisconsin,Wisconsin Surgical Outcomes Research Program,Madison, WI, USA
Objective: Surgical site infection (SSI) is a major cause of morbidity after open abdominal aortic aneurysm repair (AAA). Incidence of SSI can lead to ventral hernia, graft infection, hospital readmission, increased costs, and in certain cases mortality. Identification of SSI risk factors at the time of open AAA repair may facilitate selection of patients at high-risk for SSI development, allowing for a higher level of in-hospital wound surveillance and subsequent implementation of appropriate transitional care interventions. The objective of this study is to describe the incidence and risk factors for SSI after open AAA repair using national data.
Methods: Patients who underwent open AAA repair from 2005-2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files. Multivariable logistic regression was performed using patient demographics, preoperative health characteristics and comorbidities, and operative variables to predict SSI.
Results: Of the 8,192 patients who underwent open AAA repair, 386 (4.3%) were diagnosed with SSI within 30 days of surgery. On multivariate analysis, patient preoperative health characteristics and comorbidities that predicted SSI included obesity vs. normal BMI (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.6-2.7), overweight vs. normal BMI (OR: 1.4; 95% CI: 1.0-1.8), an existing open wound or wound infection (OR: 2.2; 95% CI: 1.2-3.9), dyspnea (OR: 1.5; 95% CI: 1.2-1.9), and smoking (OR: 1.3; 95% CI: 1.1-1.7). Operative factors that predicted SSI included emergency operation (OR: 1.8; 95% CI: 1.3-2.4) and operative time >5 hours vs. 3-5 hours (OR: 1.6; 95% CI: 1.3-2.1).
Conclusions: SSI after open AAA repair is a common post-operative complication. Our data suggest that there are readily identifiable patient and operative characteristics known prior to and at completion of open AAA repair that significantly predict increased risk of SSI, suggesting that targeted in-hospital wound surveillance and subsequent transitional care efforts may improve outcomes in this patient population.