P-137 - PROSPECTIVE COMPARISON OF WOUND COMPLICATION RATES AFTER ELECTIVE OPEN PERIPHERAL VASCULAR SURGERY - ENDOVASCULAR VS OPEN VASCULAR SURGEONS A PROPENSITY SCORE ADJUSTED ANALYSIS

TOPIC:
Wound healing
AUTHORS:
Nyman J. (Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital ~ Malmö ~ Sweden) , Acosta S. (Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital ~ Malmö ~ Sweden) , Svensson-Björk R. (Department of Clinical Sciences, Lund University ~ Malmö ~ Sweden) , Monsen C. (Department of Clinical Sciences, Lund University ~ Malmö ~ Sweden) , Hasselmann J. (Department of Clinical Sciences, Lund University ~ Malmö ~ Sweden)
Introduction:
Skill and experience of surgeons are likely to influence the incidence of surgical wound complications (SWC) after open lower limb revascularization. Differences in SWC between surgeons with predominantly endovascular or open vascular surgical profiles could be expected. The aim of this study was to compare SWC rates after elective open vascular surgery between primarily endovascular and primarily open vascular surgeons.
Methods:
Prospectively data in patients undergoing elective surgery for peripheral artery disease (PAD) was collected between 2013 and 2019 (1). Senior surgeons were assigned to the OPEN-surgeon (threshold>20% open surgical procedures/all operations) or the ENDO-surgeon group. SWC was measured by their clinical impact scale (grade 1-outpatient treatment to grade 6-death) (2). Surgical site infection (SSI) was defined by ASEPSIS criteria. Propensity score adjusted analysis (PSAA) was used to account for differences in baseline and perioperative characteristics and expressed as odds ratios (OR) with 95% confidence intervals (CI).
Results:
The proportion of chronic limb-threatening ischemia (p=0.001), ipsilateral foot wound (p=0.012) and femoro-popliteal bypass procedures (p<0.001) were higher in the OPEN-surgeon group. A lower incidence of SWC according to ASEPSIS criteria (25.6% versus 38.6%, respectively, p=0.042) and SWC grade≥1 (33.7% versus 51.0%, respectively, p=0.010) was found in the ENDO-surgeon group (n=86) compared to the OPEN-surgeon group (n=153). These differences disappeared after PSAA (OR 0.63, 95% CI 0.27 - 1.44, and OR 0.60, 95% CI 0.27 - 1.33, respectively).
Conclusion:
Patients operated by ENDO-surgeons had less advanced PAD and lower incidence of SWC compared to those treated by OPEN-surgeons. No difference in SWC remained after PSAA.
References:
1. Hasselmann J, Björk J, Svensson-Björk R, Acosta S. Inguinal Vascular Surgical Wound Protection by Incisional Negative Pressure Wound Therapy: A Randomized Controlled Trial-INVIPS Trial. Ann Surg. 01 2020;271(1):48-53. doi:10.1097/SLA.0000000000003364 2. Hasselmann J, Björk J, Svensson-Björk R, Butt T, Acosta S. Proposed Classification of Incision Complications: Analysis of a Prospective Study on Elective Open Lower-Limb Revascularization. Surg Infect (Larchmt). May 2020;21(4):384-390. doi:10.1089/sur.2019.144