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Search for Modifiable Risk Factors to Improve Bypass Results Pays Off
"Predictors of surgical site infection after open lower extremity revascularization.” Journal of Vascular Surgery, June, 2017.
CHICAGO, Illinois, June, 2017 – During lower extremity revascularization, high-risk surgical patients experience significant rates of wound infection, prolonged hospital stay and readmission, as well as graft failure and limb loss.
A large study of the outcomes of 3,033 patients undergoing lower extremity bypass found a 10.6 percent infection rate and identified procedural risk factors. As reported in the June edition of the Journal of Vascular Surgery, vascular surgeon Dr. Peter Henke and researchers from the University of Michigan used data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Vascular Intervention Collaborative (BMC2 VIC).
Previous studies have found that risk factors are obesity, dialysis dependence, hypertension and the use of antiplatelet medications. This study found the following procedural risk factors also contributing to adverse outcomes:
• procedural length (>240 minutes)
• peak glucose (>180 mg/dL)
• iodine-based skin preparation at the time of surgery
“Although some factors such as patient co-morbidities are not modifiable, others represent areas of target for quality improvement for at risk patients,” noted Dr. Frank Davis, first author on the study. “Diligence should be devoted to decreasing operative length, controlling intraoperative glucose levels and avoiding iodine-only skin preparation.”
Patients with critical limb ischemia often require surgical bypass when endovascular procedures are not possible or unsuccessful. Since autologous vein provides the best outcomes for graft patency, vein harvest, along with exposure of the femoral artery, puts this difficult patient population at risk for groin incision complications, noted to be as high as 23 percent.
Identification of modifiable risk factors, particularly those involving operative technique, may provide further opportunity to improve patient outcomes and reduce hospital costs. Ultimately the care of these complex patients comes down to attention to detail. And doing so provides us with quality, less costly outcomes from which we all benefit.
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CME credit is available for this article. CME credits are available for one year. CME exams are posted here: http://www.jvascsurg.org/cme/home. Anyone can take the exam, which is free for JVS subscribers and $10 for non-subscribers.
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The Society for Vascular Surgery® (SVS) is a 5,600-member, not-for-profit professional medical society, composed primarily of specialty-trained vascular surgeons, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.
The Journal of Vascular Surgery (JVS) is dedicated to the science and art of vascular surgery and aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. The goal of the journal is to improve the management of patients with vascular diseases by publishing relevant papers that report important medical, surgical and endovascular advances, test new hypotheses and address current controversies