Impact of body mass index and gender on wound complications after lower extremity arterial surgery

• Published in: Journal of vascular surgery 2017-06, Vol.65 (6), p.1713-1718.e1
• Main Authors: Arnaoutakis, Dean J., MD, MBA, Scully, Rebecca E., MD, Sharma, Gaurav, MD, Shah, Samir K., MD, Ozaki, C. Keith, MD, Belkin, Michael, MD, Nguyen, Louis L., MD, MBA, MPH
• Format: Article
• Language: English
• Subjects: Adiposity; Aged; Aged, 80 and over; Body Mass Index; Chi-Square Distribution; Female; Hematoma - diagnosis; Hematoma - etiology; Humans; Logistic Models; Lower Extremity - blood supply; Male; Middle Aged; Multicenter Studies as Topic; Multivariate Analysis; Odds Ratio; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - surgery; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Risk Factors; Seroma - diagnosis; Seroma - etiology; Sex Factors; Surgery; Surgical Wound Dehiscence; Surgical Wound Infection - diagnosis; Surgical Wound Infection - etiology; Surgical Wound Infection - microbiology; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Waist-Hip Ratio; Wound Healing
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.12.116

Abstract Objective Wound complications (WCs) after lower extremity arterial surgery (LEAS) are common, resulting in readmissions and reinterventions. Whereas diabetes and obesity are known risk factors for WCs, gender-specific variability in body fat distribution (android vs gynoid) may drive differential risks of WCs after LEAS. We analyzed the independent and synergistic effects of gender and body mass index (BMI) on WCs. Methods We performed a retrospective review of prospectively collected data from a published, randomized, multicenter trial assessing the incidence of WCs (dehiscence, surgical site infections, seroma, and hematoma) after LEAS. Postoperative outcomes were compared between genders. A multivariable regression model assessed the impact of gender and BMI on WCs. Subanalysis focused on the synergy of gender and body habitus, groin-only incisions, and clinical outcomes. Results There were 502 patients who underwent LEAS between October 2010 and September 2013. The cohort was elderly (67.6 ± 10.5 years), mostly male (72%), and overweight (BMI, 27.6 ± 5.7); 225 (45%) patients had a groin-only incision. In 171 patients (37.9%), a WC developed within 30 days, 85% of which were infectious in etiology. On multivariable regression, obesity (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.17-3.77), morbid obesity (OR, 2.87; 95% CI, 1.32-6.23), and female gender (OR, 1.17; 95% CI, 1.06-2.75) were independent predictors of infectious WCs at 30 days. When stratified by groin-only incision, BMI was no longer significant, but female gender (OR, 2.70; 95% CI, 1.24-5.87) was predictive of infectious WCs at 30 days. There was no synergistic effect of BMI and gender on WCs. Conclusions WCs are common after LEAS. BMI is an independent risk factor for the development of any WC. Female gender, a potential surrogate for high hip to waist ratio body habitus, is also an independent predictor of groin WCs, suggesting the clinical importance of gynoid vs android fat distribution.