Chronic renal impairment and surgical site infection in patients undergoing infrainguinal revascularisation: Results of a matched case-control study

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.