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Predicting wound complications following lower extremity revascularization.

Ke Xu1, Brenda Lin2, Loreski Collado2

  • 1Department of Surgery, Brigham and Women's Hospital, Boston, MA.

Journal of Vascular Surgery
|November 20, 2023
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A new risk score identifies factors for wound complications after infrainguinal revascularization. This tool helps predict and discuss risks for patients undergoing open bypass surgery.

Keywords:
Lower extremity revascularizationRisk predictionWound complication

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Area of Science:

  • Vascular Surgery
  • Surgical Outcomes Research
  • Health Informatics

Background:

  • Wound complications are a significant concern following infrainguinal revascularization procedures.
  • Predicting these complications is crucial for patient management and optimizing surgical outcomes.

Purpose of the Study:

  • To develop a straightforward risk score for identifying key factors associated with wound complications after open infrainguinal revascularization.
  • To enable better risk stratification and informed patient counseling.

Main Methods:

  • Utilized the Veterans Affairs Surgical Quality Improvement Program national data set (2005-2021) including 22,114 patients undergoing elective open infrainguinal revascularization.
  • Developed a risk prediction model using a two-thirds derivation set and validated it on a one-third set.
  • Identified eight independent risk factors and assigned integer scores to categorize patients into low, moderate, high, and very high-risk groups for wound complications.

Main Results:

  • The overall wound complication rate was 9.7% in the derivation set.
  • Identified risk factors include: older age (≤73), higher body mass index (≥35 kg/m²), non-Hispanic White ethnicity, diabetes, elevated white blood cell count (>9900/mm³), absence of coronary artery disease, longer operative time (>6 hours), and concurrent femoral endarterectomy.
  • Wound complication rates increased significantly with higher risk categories (4.5% low to 23.8% very high risk).
  • Wound complications were associated with increased rates of reoperation and graft failure.

Conclusions:

  • A simple, validated risk prediction model effectively identifies patients at higher risk for wound complications after open infrainguinal revascularization.
  • The model utilizes readily available clinical data, facilitating practical application in preoperative discussions and patient care planning.