Phenylephrine infusion impact on surgical site infections after lower extremity bypass surgery

Abstract Objective Lower extremity bypass (LEB) operations have high rates of surgical site infections (SSI). Phenylephrine is a commonly used vasoconstrictor which may reduce skin blood flow and increase the likelihood of SSI in these patients. We studied the potential effect of phenylephrine infusion during LEB surgery on SSI. Methods LEB cases and their demographic data were identified through the Vascular Quality Initiative registry. SSI in this population was identified using the hospital epidemiology surveillance database. Phenylephrine use in this population was identified through chart review. Results We identified 699 patients who underwent LEB; 82 (11.7%) developed an SSI, and 244 of 698 (35.0%) were treated with phenylephrine infusion. In bivariate analysis, higher body mass index (28.8 kg/m 2 vs 27.3 kg/m 2 ; P  = .034), diabetes (14.6% vs 9.4%; P  = .035), hypertension (12.6% vs 4.7%; P  = .038), groin incision (13.2 vs 5.4%; P  = .013) and longer procedure times (17.1% for >220 minutes and 8.9% for ≤220 minutes; P  = .003) were associated with higher rates of SSI. Whereas phenylephrine infusion exhibited a trend toward a higher rate (14.8% vs 9.9%; P  = .057). In the logistic regression model, diabetes (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.2; P  = .032), total procedure time (OR, 1.85; 95% CI, 1.1-3.1; P  = .026) and vertical groin incision (OR, 2.6; 95% CI, 1.1-6.5; P  = .035) were independent predictors of increased SSI rates, whereas body mass index (OR, 1.04; 95% CI, 0.99-1.08; P  = .09), hypertension (OR, 2.5; 95% CI, 0.6-10.9; P  = .22), and phenylephrine infusion (OR, 1.08; 95% CI, 0.63-1.85; P  = .78) were not independent predictors of increased SSI rates. Conclusions Phenylephrine infusion did not increase the risk of SSI in patients who underwent LEB.