How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence

Zhao, Adam Hanting; Kwok, Chi Ho Ricky; Jansen, Shirley

doi:10.1016/j.avsg.2021.06.045

Cited by 9 publications

(7 citation statements)

References 99 publications

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“…Surgical site infections (SSIs) are frequent, costly complications of lower limb revascularization surgery for peripheral artery disease (PAD) that are associated with significant morbidity and mortality 1,2 . Development of an SSI after these surgeries increases risk of limb loss and raises the cost per procedure by ~$10,500 to 38,000 US dollars 3 .…”

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“…Although randomized controlled trials (RCTs) have evaluated a number of different strategies intended to prevent SSI after lower limb revascularization surgery, interpretation of their results is difficult for several reasons 1,8 . These studies have different risks of bias and frequently included a mixture of patients with and without chronic limb-threatening ischemia (CLTI) who underwent a variety of different lower limb revascularization surgeries 1,8 . This is important because PAD patients with CLTI have been reported to have a significantly higher risk of SSI compared with those undergoing lower limb revascularization for non-CLTI-related indications (eg, intermittent claudication or peripheral aneurysms) 9,10 .…”

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“…(Ann Surg 2023;278:e447-e456) S urgical site infections (SSIs) are frequent, costly complications of lower limb revascularization surgery for peripheral artery disease (PAD) that are associated with significant morbidity and mortality. 1,2 Development of an SSI after these surgeries increases risk of limb loss and raises the cost per procedure by ~$10,500 to 38,000 US dollars. 3 SSIs involving prosthetic (and sometimes autologous) bypass grafts may also require urgent or emergent reoperation, graft excision, and complex additional arterial bypasses to prevent catastrophic hemorrhage.…”

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“…1,8 These studies have different risks of bias and frequently included a mixture of patients with and without chronic limb-threatening ischemia (CLTI) who underwent a variety of different lower limb revascularization surgeries. 1,8 This is important because PAD patients with CLTI have been reported to have a significantly higher risk of SSI compared with those undergoing lower limb revascularization for non-CLTI-related indications (eg, intermittent claudication or peripheral aneurysms). 9,10 Further, lower limb revascularization surgeries that require groin or periaxillary incisions have a higher associated risk of SSI than those that do not.…”

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Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery

et al. 2023

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Objective: The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery. Background: SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty. Results: Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11–0.57; n=4 studies; I 2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38–0.78; n=5 studies; I 2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26–0.73; n=2 studies; I 2=0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33–1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097–1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44–1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42–1.03; n=1 study) (low certainty for all). Conclusions: Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.

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