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Vascular Graft Infection: Incidence and Potential Risk Factors
Catherine R Ratliff1, David Strider, Tanya Flohr
1Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. David Strider, RN, ACNP, DNP, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Tanya Flohr, MD, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Danielle Moses, MS, PA-C, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Virginia Rovnyak, PhD, School of Nursing, University of Virginia, Charlottesville, Virginia. Julie Armatas, RN, ACNP, MSN, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Jennifer Johnson, RN, University of Virginia Health System, Charlottesville, Virginia. Alison Okerlund, RN, BSN, University of Virginia Health System, Charlottesville, Virginia. Mary Baldwin, BS, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Marian Lawson, RN, MSN, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Suzanne Fuhrmeister, RN, MSN, University of Virginia Health System, Charlottesville, Virginia. Margaret C. Tracci, MD, JD, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Gilbert R. Upchurch Jr, MD, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Kenneth J. Cherry, MD, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Purpose:
The purpose of this study was to identify factors that increase the risk of vascular graft infections (VGI) in patients following abdominal or lower extremity revascularization surgery.
Design:
Retrospective, descriptive study.
Methods:
We reviewed the electronic health records of 223 patients who had undergone abdominal or lower extremity revascularization procedures from July 2012 to November 2014, looking for factors associated with VGI. We reviewed 28 preoperative, intraoperative, and post-operative factors. Descriptive statistics (mean, range, and standard deviation) were used to describe the sample; χ was used to determine correlations between the risk factors and subsequent VGIs. The level of significance was determined at P = .05, with a confidence level of 95%.
Results:
We identified 33 cases of VGIs for the 223 charts reviewed, yielding an incidence rate of 15%. Seventeen of the 33 patients with VGI (51.5%) were male. The average age of patients who experienced VGI was 60.9 years (standard deviation, 12.2 years, range, 29-81 years). Preoperative factors that were shown to show statistical significance for the development of VGI were sequential procedures (P = .003), diabetes mellitus (P = .002), hemoglobin A1c more than 7.0 (P = .0002), blood glucose more than 180 mg/dL (P = .0006), and lack of mobility (0.0097). Intraoperative factors associated with VGI were hemostatic agents applied to the surgical field intraoperatively (P = .003) and perioperative hypoxemia (P = .027). Postoperative factors associated with VGI were discharge from the hospital to skilled nursing facility or acute rehabilitation facility (P = .005) and unscheduled clinic visits (P = .008).
Conclusion:
We measured a 15% incidence of VGI and identified multiple pre-, intra-, and postoperative associated factors. Vigilance is required to prevent VGI and knowledge of specific risk factors is important.
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