The majority of SSI following major vascular surgery only develop after discharge from hospital. Apart from the usual patient-related risk factors for SSI such as obesity, diabetes mellitus and smoking, with vascular surgery other factors such as female gender, a history of high blood pressure and/or coronary artery disease also appear to play an important role in the emergence of SSI.1 In terms of the type of surgery, vascular surgery on the aorta in particular is associated with an SSI rate of 2%–14%, which is considered a significant risk.1 Staphylococcus aureus is the leading cause of most postoperative wound infections in patients with occlusive diseases.1 Many studies therefore focus on preventive measures to reduce nasal and skin colonisation with Staphylococcus aureus.
Surgical-site infections (SSI) are a common cause of morbidity in patients after vascular surgery, and hyperglycaemia is a relevant risk factor for them. The glycaemic status can be used for risk stratification. Tight glycaemic control can have a positive effect on the incidence of SSI.
Inui T et al. 20153: A surgical-site infection (SSI) following an arterial intervention is a common nosocomial complication and a major cause of postoperative morbidity. Implementation of perioperative measures to reduce nasal and skin colonisation with Staphylococcus aureus in conjunction with an appropriate antibiotic prophylaxis, meticulous wound closure, and postoperative care to optimise host immunity (e.g. temperature regulation, adequate oxygenation, and blood glucose management) can minimise the occurrence of SSI.
Langenberg JCM et al. 20184: SSI cause significant morbidity and mortality in patients undergoing vascular surgery. Preoperative screening and subsequent treatment of nasal Staphylococcus aureus carriers with mupirocin and chlorhexidine reduce the risk of SSI in patients undergoing aortic surgery.
Langenberg JCM et al. 20205: SSI are frequently seen after vascular surgery on the aorta (2%–14%). Deep SSI are associated with graft infection, sepsis, and mortality. The SSI rate was 3% in the patient group with aneurysms and 10.3% in the group with occlusive disease. Also, infection-related re-admission (6.6% versus 0.9%) and re-intervention (4.2% versus 0.9%) were higher after arterial occlusion procedures than after aneurysm repair surgery. Staphylococcus aureus was found to be the most common causative pathogen, accounting for 64% of SSI in occlusive diseases versus 10% in aneurysmal diseases. In addition, data analysis showed that chronic kidney disease was associated with higher SSI rates.
Outpatient vascular surgery mostly involves varicose vein operations.6 The treatment of varicose veins increased by around 30% between 2010 and 2017. During this period, the number of varicose vein procedures carried out in hospitals fell by around 26%. At the same time, outpatient procedures of this type increased by around 78%.
For minor surgical procedures, it is often not necessary to admit the patients to the hospital as inpatients. This also means cost savings for health insurance carriers,” according to health insurer Debeka on the trend in outpatient procedures, according to a report in the Deutsches Ärzteblatt.6
There is essentially no difference between inpatient and outpatient varicose vein surgery in terms of indications, contraindications, procedures and follow-up care.7 It can therefore be concluded that for SSI risk assessment, it is more or less irrelevant whether an operation is performed on an outpatient or inpatient basis. Despite the relatively low infection rates in some areas, the focus should be on further reducing the SSI rate for outpatient procedures as well. The appropriate measures for this are identical to those for procedures with subsequent hospitalisation.
Prevention strategies are crucial to sustaining any reduction in infection rates. Most guidelines agree on recommendations, such as “antibiotic prophylaxis, preoperative full body wash, appropriate hand disinfection by the surgical team, sterile surgical gowns and gloves, postoperative infection monitoring and no dressing changes within the first 48 hours”.2 Although experts agree that it is not possible to reduce the infection rate to zero, SSI prevention is well worth the effort: For example, 40% of all nosocomial infections can be prevented by strict adherence to hand hygiene alone.8
As a leading provider of pioneering high-quality medical devices and hygiene products, Lohmann & Rauscher has made it its mission to support patients and healthcare professionals in SSI prevention – not only by offering appropriate solutions and products, but also by providing comprehensive information about SSI.
1) Gesundheitsberichterstattung des Bundes – gemeinsam getragen von RKI und DESTATIS. Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_PROC?_XWD_2/1/XWD_CUBE.DRILL/_XWD_30/D.390/43135 (Letzter Zugriff: Dezember 2024).
2) Prävention postoperativer Wundinfektionen: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 Apr;61(4):448-473
3) Inui T et al. Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg. 2015;28(3-4):201–207.
4) Langenberg JCM et al. Peri-Operative Nasal Eradication Therapy Prevents Staphylococcus aureus Surgical Site Infections in Aortoiliac Surgery. SurgInfect (Larchmt). 2018;19(5):510–515.
5) Langenberg JCM et al. Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease? Vasc Endovascular Surg. 2020;1538574420940098.
6) Deutsches Ärzteblatt (2019). Krampfadereingriffe immer häufiger ambulant. https://www.aerzteblatt. de/nachrichten/101667/Krampfadereingriffe-immerhaeufiger- ambulant (Letzter Zugriff: Dezember 2024)
7) Nüllen H et al. (1995). Ambulante Varizenchirurgie in der Praxis. In: Imig H, Schröder A (eds) Varizen – Poplitea-Aneurysmen. Steinkopff, Darmstadt
8) Kampf G., Löffler H., Gastmeier P. Händehygiene zur Prävention nosokomialer Infektionen. Dtsch Arztebl Int. 2009;106(40):649–655.
