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Proposed Classification of Incision Complications: Analysis of a Prospective Study on Elective Open Lower-Limb Revascularization.
- Source :
-
Surgical infections [Surg Infect (Larchmt)] 2020 May; Vol. 21 (4), pp. 384-390. Date of Electronic Publication: 2019 Dec 12. - Publication Year :
- 2020
-
Abstract
- Background: Incision complications (IC) have a significant impact on procedure-related morbidity after lower-limb revascularization. One of the most studied IC is surgical site infection (SSI). Reporting these complications in a uniform way is crucial to evaluate treatment approaches. The aim of this study was to propose a comprehensive classification of IC and apply it to compare SSI with other IC in a trial on elective open lower-limb revascularization procedures. Methods: Two hundred twenty-three eligible patients undergoing elective unilateral inguinal and infra-inguinal arterial vascular surgery were extracted from a randomized controlled trial on incisional negative-pressure wound therapy (NPWT) on inguinal vascular surgical incisions. The IC were classified by grades of severity (grade 0-6) that focused on IC-related consequences such as out-patient treatment (grade 1), prolonged in-patient treatment (grade 2), re-admission (grade 3), and re-operation (grade ≥4). An SSI was defined by the ASEPSIS score criteria. Results: An SSI was diagnosed in 63 patients (28.3%). Thirty-five of 160 patients (21.8%) not suffering from SSI underwent IC treatment. Treatment for IC was recorded for 25/144 patients (17.4%) with satisfactory site healing as judged by the ASEPSIS score. The median incision-related in-hospital stay in those with SSI (n = 79) and disturbed healing (n = 16) according to the ASEPSIS score was 13 days in both groups (p = 0.53). Five patients had peri-vascular SSI (IC grade 4 n = 4; grade 5 n = 1). The proposed classification of IC and the ASEPSIS score correlated highly (r = 0.77; p < 0.001). Inter-rater reliability for IC grading was substantial for three investigators with different levels of experience (k = 0.81, 0.71, and 0.70). Conclusions: The proposed incision classification suggests a comparable clinical significance of vascular IC in terms of IC-related in-patient stay, whether there was a surgical site infection or not. This classification system requires external validation.
- Subjects :
- Aged
Aged, 80 and over
Elective Surgical Procedures adverse effects
Female
Groin
Humans
Length of Stay
Male
Middle Aged
Negative-Pressure Wound Therapy methods
Prospective Studies
Reproducibility of Results
Risk Factors
Severity of Illness Index
Wound Healing physiology
Lower Extremity
Surgical Wound Infection classification
Surgical Wound Infection epidemiology
Vascular Surgical Procedures adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1557-8674
- Volume :
- 21
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Surgical infections
- Publication Type :
- Academic Journal
- Accession number :
- 31829833
- Full Text :
- https://doi.org/10.1089/sur.2019.144