Preceding Wound Complications as Drivers of Surgical Site Infection after Bypass for Chronic Limb-Threatening Ischemia.

OBJECTIVES: Surgical site infection (SSI) remains a serious complication following bypass surgery for chronic limb-threatening ischemia (CLTI). This study aimed to characterize wound complications (WCs) preceding SSI and to identify predictors of SSI in a Japanese CLTI cohort with a high prevalence of dialysis. METHODS: A single-center retrospective study was conducted in patients undergoing infra-inguinal bypass with saphenous vein grafts (2012-2021). WCs and subsequent SSI within 3 months were evaluated. Predictors of SSI were examined using the Mann-Whitney U test for continuous variables and the χ2 tests for categorical variables. RESULTS: Among 148 patients, the incidence of SSI was 8.7% (n = 13). Preceding WCs included lymphorrhea/lymphocele (n = 7), hematoma (n = 4), and edema (n = 2). Hematoma had the highest conversion rate to SSI (25.0%). Staphylococcus aureus was the predominant pathogen. Univariate analysis identified female sex as a potential predictor of SSI (p = 0.03), while dialysis dependence (43.9% of the cohort) was not associated with SSI risk. CONCLUSIONS: SSI following bypass surgery in CLTI predominantly arises from preceding WCs, characterized by edema or inadequate drainage of blood or lymph. Targeted management to prevent these preceding WCs may be a crucial strategy to reduce SSI.