Abstract
Surgical site infection may cause graft failure and limb loss following infrainguinal
vascular surgery. Chronic renal impairment (CRI) is associated with defective host
immunity and a poor long-term outcome after revascularisation. Our aim in this study
was to evaluate whether CRI is associated with surgical site infection in patients
undergoing infrainguinal revascularisation. We performed a matched case-control, retrospective
study of patients undergoing infrainguinal revascularisation in the Vascular and Endovascular
Surgery Centre which serves the Northern Ireland Regional Nephrology Service. Patients
with CRI were matched for age, sex, and anatomical bypass site, to patients with normal
renal function. Surgical site infection was evaluated in each group according to US
centers for Disease Control and the Society for Vascular Surgery/International Society
for Cardiovascular Surgery (SVS/ISCS) reporting standards. A multivariate logistic
regression model was used to evaluate the effect of renal impairment on the risk of
surgical site infection following infrainguinal revascularisation. One hundred ninety-two
patients underwent infrainguinal revascularisation between 1999 and 2001. Twenty-four
patients with CRI were identified and matched to an equal number of controls. Surgical
site infection was more common in patients with chronic renal impairment (10/24 vs.
3/24, P < 0.05). Pre-existing ulceration and chronic renal impairment were independent risk
factors for the development of infection (P < 0.005 and P < 0.05, respectively). The odds ratio for developing a surgical site infection in
chronic renal impairment was 7.06 (95% confidence intervals 1.18–42.22).
Chronic renal impairment is associated with the development of surgical site infection
in patients undergoing infrainguinal revascularisation.
