Multicomponent strategy for optimized peri- and postoperative wound care after open revascularization for peripheral atherosclerosis.

Abstract

Objective: Patients who undergo open infrainguinal surgical revascularization are at high risk of surgical wound complications. This study aimed to evaluate the effectiveness of introducing an optimized multicomponent surgical wound management strategy involving preoperative risk stratification of patients, perioperative optimized wound closure and dressing and postoperative edema control.

Methods: This was a pragmatic pre-post study at a tertiary vascular surgery center. Consecutive patients who underwent surgery from November 2022 to the end of June 2023 (postintervention group) were compared with patients who underwent surgery between November 2021 and the end of June 2022 (preintervention group). The primary outcomes were surgical wound complications (a composite outcome based on prolonged lymphatic secretion or seroma, surgical site infection, bleeding or hematoma and wound dehiscence) during primary admission and within 60 days after surgery. The outcomes are presented as total numbers, and comparisons among groups were performed via logistic regression; the results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Baseline and perioperative characteristics with potential confounding impacts were controlled for by means of propensity scores and the inverse probability of treatment weights.

Results: In 122 (preintervention group) and 133 (postintervention group) patient cases, a total of 49 (40.8%) and 27 (20.6%) surgical wound complications, respectively, were observed during primary admission, corresponding to an adjusted OR of 0.43 (95% CI 0.24 to 0.77). The length of stay was lower in the postintervention group, with an adjusted average of -1.19 days (95% CI -2.6 days to 0.2 days). During the 60-day follow-up, 38 (31.1%) and 44 (33.1%) patients experienced surgical wound complications, with ORs of 1.18 (95% CI 0.69 to 2.04). Among these, 11 (9%) and 12 (9%) had deep wound complications, with ORs of 0.95 (95% CI 0.40 to 2.28), and 13 (10.7%) versus 18 (13.5%) were readmitted because of wound complications, with ORs of 1.26 (95% CI 0.58 to 2.74).

Conclusion: Optimized peri- and postoperative surgical wound management was found to be associated with a reduced risk of surgical wound complications during primary admission, yet the risk of serious wound complications during follow-up remained high.