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PC60. Predictors of Surgical Site Infection After Infrainguinal Bypass in the ACS-NSQIP Targeted Vascular Module
JOURNAL OF VASCULAR SURGERY Volume 61, Number 6S
PC58. Postoperative Infections Are Associated With Increased Risk of Cardiac Events in Vascular Patients Tristen T. Chun1, Daithi S. Heffernan1, William G. Cioffi1, Jeffrey M. Slaiby2, Edward J. Marcaccio1, Manuel GarciaToca2. 1Rhode Island Hospital, Brown University, Providence, RI; 2University Surgical Associates, Brown University, Providence, RI Objectives: Despite advances in perioperative cardiac protection, the rate of cardiac events in vascular patients remains high. We have previously shown that infections in trauma patients are associated with higher rates of subsequent cardiac complications. This was believed to be due to the additive effect of a second hit of an infection after the trauma. Vascular patients are particularly susceptible to the effects of perioperative complications, including cardiac events. The aim of this study was to describe an association between postoperative infections and rates of subsequent cardiac events in vascular patients. Methods: This was a retrospective review of all vascular patients who underwent an operative intervention over a 5year period. Records were reviewed for demographics, operative interventions, open vs endovascular, medical comorbidities, all infections, and cardiac events. In patients with clinical suspicion of myocardial infarction (MI), cardiac damage was defined as troponin >0.15 ng/mL and MI as troponin >1 ng/mL. Pneumonia was diagnosed using bronchoalveolar lavage (BAL) and considered positive if BAL fluid culture contained >100,000 colony-forming units. A urinary tract infection (UTI) was diagnosed if the urine culture contained >100,000 colony-forming units. All other infections were diagnosed by Centers for Disease Control and Prevention criteria and culture data. Regression analysis was performed to assess risk of cardiac events as a function of infections adjusting for age, gender, and preoperative medical comorbidities. Results: Overall there were 1894 patients (66.7% male), with an average age of 65.7 years; of these, 49% of patients had hypertension and 18.6% had chronic obstructive pulmonary disease. The overall infection rate was 18.4%, UTI being most common (84%). The overall rate of cardiac damage was 12.6%, and the rate of MI was 5.2%. Comparing patients with and without infection, rates of cardiac damage (29.6% vs 8.8%; P < .001) and MI (12.6% vs 3.5%; P < .001) were both higher in patients with infections. Adjusting for age, gender, and comorbidities, patients with UTI were more likely to subsequently develop either cardiac damage (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.6) or MI (OR, 1.9; 95% CI, 1.04-3.4). A similar association was noted between any infection and either cardiac damage (OR, 2.2; 95% CI, 1.38-3.3) or MI (OR, 1.8; 95% CI, 1.04-3.1). Conclusions: Vascular patients remain at a significant risk of both infectious and cardiac complications. We herein describe an association between postoperative infections, most commonly UTIs, and subsequent cardiac events. Physicians should continue to focus on early ambulation, use of incentive spirometry, and discontinuation of indwelling catheters in order to reduce postoperative infections. This will be critical to enhancing cardioprotection in vulnerable patients during the perioperative period. Author Disclosures: T. T. Chun: Nothing to disclose; D. S. Heffernan: Nothing to disclose; W. G. Cioffi:
Abstracts 133S
Nothing to disclose; J. M. Slaiby: Nothing to disclose; E. J. Marcaccio: Nothing to disclose; M. Garcia-Toca: Nothing to disclose. PC60. Predictors of Surgical Site Infection After Infrainguinal Bypass in the ACS-NSQIP Targeted Vascular Module John C. McCallum1, Patric Liang1, Peter A. Soden1, Dominique B. Buck1, Sara L. Zettervall2, Raul J. Guzman1, Chantel Hile1, Marc L. Schermerhorn1. 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; 2Genesys Regional Medical Center Objectives: Prior studies of predictors of surgical site infection (SSI) after lower extremity bypass have conflicting results. With the release of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) targeted vascular module, we sought to analyze the new clinical variables to identify factors associated with SSI after bypass. Methods: We identified all patients in the targeted vascular ACS-NSQIP for 2011 to 2012 undergoing infrainguinal bypass who developed SSI within 30 days. Predictors of SSI on univariate analysis were included in a multivariable logistic regression model. Results: We identified 2967 bypass patients with a 10.1% rate of SSI (1961 critical limb ischemia, 11.3% SSI rate; 885 claudication, 7.8% SSI rate). Independent predictors of SSI were age <50 years (5.4% of patients; odds ratio [OR], 1.7; 95% CI, 1.2-2.4), female sex (35%; OR 1.5; 95% CI, 1.2-1.8), body mass index >30 kg/m2 (29%; OR, 2.3; 95% CI, 1.8-2.8), nonclean incision site (6.6%; OR 2.0; 95% CI, 1.4-2.9), transfusion or reoperation for bleeding (17%; OR 1.9; 95% CI, 1.4-2.5), and a 1-hour increase in operating time (OR 1.2; 95% CI, 1.2-1.3; Fig). Conclusions: Our findings support previously identified SSI risk factors of female sex, age, body mass index, and operating time. Additionally, we found that transfusion for bleeding, a recent addition to NSQIP in the targeted vascular module, is a strong predictor of SSI after bypass.
Fig.
Author Disclosures: J. C. McCallum: Nothing to disclose; P. Liang: Nothing to disclose; P. A. Soden: Nothing to disclose; D. B. Buck: Nothing to disclose; S. L. Zettervall: Nothing to disclose; R. J. Guzman: Nothing to disclose; C. Hile: Nothing to disclose; M. L. Schermerhorn: Cordis, Endologix, Cook, consulting fee.
PC58. Postoperative Infections Are Associated With Increased Risk of Cardiac Events in Vascular Patients Tristen T. Chun1, Daithi S. Heffernan1, William G. Cioffi1, Jeffrey M. Slaiby2, Edward J. Marcaccio1, Manuel GarciaToca2. 1Rhode Island Hospital, Brown University, Providence, RI; 2University Surgical Associates, Brown University, Providence, RI Objectives: Despite advances in perioperative cardiac protection, the rate of cardiac events in vascular patients remains high. We have previously shown that infections in trauma patients are associated with higher rates of subsequent cardiac complications. This was believed to be due to the additive effect of a second hit of an infection after the trauma. Vascular patients are particularly susceptible to the effects of perioperative complications, including cardiac events. The aim of this study was to describe an association between postoperative infections and rates of subsequent cardiac events in vascular patients. Methods: This was a retrospective review of all vascular patients who underwent an operative intervention over a 5year period. Records were reviewed for demographics, operative interventions, open vs endovascular, medical comorbidities, all infections, and cardiac events. In patients with clinical suspicion of myocardial infarction (MI), cardiac damage was defined as troponin >0.15 ng/mL and MI as troponin >1 ng/mL. Pneumonia was diagnosed using bronchoalveolar lavage (BAL) and considered positive if BAL fluid culture contained >100,000 colony-forming units. A urinary tract infection (UTI) was diagnosed if the urine culture contained >100,000 colony-forming units. All other infections were diagnosed by Centers for Disease Control and Prevention criteria and culture data. Regression analysis was performed to assess risk of cardiac events as a function of infections adjusting for age, gender, and preoperative medical comorbidities. Results: Overall there were 1894 patients (66.7% male), with an average age of 65.7 years; of these, 49% of patients had hypertension and 18.6% had chronic obstructive pulmonary disease. The overall infection rate was 18.4%, UTI being most common (84%). The overall rate of cardiac damage was 12.6%, and the rate of MI was 5.2%. Comparing patients with and without infection, rates of cardiac damage (29.6% vs 8.8%; P < .001) and MI (12.6% vs 3.5%; P < .001) were both higher in patients with infections. Adjusting for age, gender, and comorbidities, patients with UTI were more likely to subsequently develop either cardiac damage (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.6) or MI (OR, 1.9; 95% CI, 1.04-3.4). A similar association was noted between any infection and either cardiac damage (OR, 2.2; 95% CI, 1.38-3.3) or MI (OR, 1.8; 95% CI, 1.04-3.1). Conclusions: Vascular patients remain at a significant risk of both infectious and cardiac complications. We herein describe an association between postoperative infections, most commonly UTIs, and subsequent cardiac events. Physicians should continue to focus on early ambulation, use of incentive spirometry, and discontinuation of indwelling catheters in order to reduce postoperative infections. This will be critical to enhancing cardioprotection in vulnerable patients during the perioperative period. Author Disclosures: T. T. Chun: Nothing to disclose; D. S. Heffernan: Nothing to disclose; W. G. Cioffi:
Abstracts 133S
Nothing to disclose; J. M. Slaiby: Nothing to disclose; E. J. Marcaccio: Nothing to disclose; M. Garcia-Toca: Nothing to disclose. PC60. Predictors of Surgical Site Infection After Infrainguinal Bypass in the ACS-NSQIP Targeted Vascular Module John C. McCallum1, Patric Liang1, Peter A. Soden1, Dominique B. Buck1, Sara L. Zettervall2, Raul J. Guzman1, Chantel Hile1, Marc L. Schermerhorn1. 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; 2Genesys Regional Medical Center Objectives: Prior studies of predictors of surgical site infection (SSI) after lower extremity bypass have conflicting results. With the release of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) targeted vascular module, we sought to analyze the new clinical variables to identify factors associated with SSI after bypass. Methods: We identified all patients in the targeted vascular ACS-NSQIP for 2011 to 2012 undergoing infrainguinal bypass who developed SSI within 30 days. Predictors of SSI on univariate analysis were included in a multivariable logistic regression model. Results: We identified 2967 bypass patients with a 10.1% rate of SSI (1961 critical limb ischemia, 11.3% SSI rate; 885 claudication, 7.8% SSI rate). Independent predictors of SSI were age <50 years (5.4% of patients; odds ratio [OR], 1.7; 95% CI, 1.2-2.4), female sex (35%; OR 1.5; 95% CI, 1.2-1.8), body mass index >30 kg/m2 (29%; OR, 2.3; 95% CI, 1.8-2.8), nonclean incision site (6.6%; OR 2.0; 95% CI, 1.4-2.9), transfusion or reoperation for bleeding (17%; OR 1.9; 95% CI, 1.4-2.5), and a 1-hour increase in operating time (OR 1.2; 95% CI, 1.2-1.3; Fig). Conclusions: Our findings support previously identified SSI risk factors of female sex, age, body mass index, and operating time. Additionally, we found that transfusion for bleeding, a recent addition to NSQIP in the targeted vascular module, is a strong predictor of SSI after bypass.
Fig.
Author Disclosures: J. C. McCallum: Nothing to disclose; P. Liang: Nothing to disclose; P. A. Soden: Nothing to disclose; D. B. Buck: Nothing to disclose; S. L. Zettervall: Nothing to disclose; R. J. Guzman: Nothing to disclose; C. Hile: Nothing to disclose; M. L. Schermerhorn: Cordis, Endologix, Cook, consulting fee.