The Association Between Preoperative Length of Stay and Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia.

Abstract Objective Surgical site infection (SSI) is an important complication of lower extremity bypass (LEB) and the rate of SSI after LEB varies widely in the existing literature, ranging from 4-31%. Prolonged length of stay (LOS) has been implicated in the occurrence of SSI across multiple surgical disciplines. The impact of preoperative LOS in patients with chronic limb-threatening ischemia (CLTI) undergoing LEB is unknown. We examined the association of preoperative LOS on SSI after LEB. Methods A retrospective analysis of the SVS Vascular Quality Initiative Infrainguinal Bypass Registry identified patients undergoing elective LEB for CLTI from 2003-2019. Patients undergoing LEB for acute limb ischemia, urgent/emergent procedures, aneurysm, or who had concomitant suprainguinal bypass were excluded. The primary outcome measure was postoperative SSI. Multivariable forward stepwise logistic regression was then performed including all variables with p Results A total of 17,883 LEB procedures were selected for inclusion: 0 days (12,362 LEB), 1-2 day (1,737 LEB), and 3-14 day (3,784 LEB). Patients with the greatest preoperative LOS were more likely to have vein mapping (0 days Preop LOS: 66.3%, 1-2 days: 65.2%, 3-14 days: 73.2%; p 220 min (OR=1.86, 95% CI: 1.26-2.73; p Conclusions Many factors including preoperative comorbidities and operative complexity co-vary with preoperative LOS as risk factors for SSI. However, when patients are matched based on comorbidities and factors that would predict overall clinical complexity, preoperative LOS remains important in predicting SSI.