Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia

Background: Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limbthreatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery. Methods: We retrospectively queried electronic medical records for all LEB operations performed for CLTI. Multivariate logistic regression analysis was used to identify risk factors associated with postoperative SSI. Using these risk factors, subset analysis was performed to determine whether NPWT was associated with reduced SSI in high-risk patients. Results: From 2018 to 2022, a total of 367 patients underwent LEB surgery for CLTI. Mean patient age was 66 years. Postoperative groin SSI was diagnosed in 22.9% (n - 84) of patients. Patients suffering SSI were more frequently morbidly obese (6.0% vs 1.8%, P - 0.03) and had higher rates of chronic obstructive pulmonary disease (35.7% vs 23.3%, P - 0.02). Other comorbidities and demographic data were similar between groups. NPWT was utilized in 19.6% (n - 72) of patients, with no baseline differences between SSI and no SSI cohorts (15.5% vs 20.9%, P - 0.28). On multivariate analysis, female sex (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.06-3.35, P - 0.03), white race (OR 2.17, 95% CI 1.23-3.82, P - 0.007), morbid obesity (OR 3.67, 95% CI 0.93-14.4, P - 0.05), and active smoking (OR 4.07, 95% CI 1.20-13.8, P - 0.02) were independently associated with postoperative SSI. Subset analysis among patients at increased risk of SSI did not reveal any differences in wound infection with NPWT usage. Conclusions: In our experience, NPWT does not appear to be more effective than standard dressings in preventing groin SSI after LEB surgery for CLTI, even among populations at heightened risk for wound infection.