Predictors of surgical site infection after open lower extremity revascularization

OBJECTIVE: Surgical site infection (SSI) after open lower extremity bypass (LEB) is a serious complication leading to an increased rate of graft failure, hospital readmission, and health care costs. This study sought to identify predictors of SSI after LEB for arterial occlusive disease and also potential modifiable factors to improve outcomes. METHODS: Data from a statewide cardiovascular consortium of 35 hospitals were used to obtain demographic, procedural, and hospital risk factors for patients undergoing elective or urgent open LEB between January 2012 and June 2015. Bivariate comparisons and targeted maximum likelihood estimation were used to identify independent risk factors of SSI. Adjusted odds ratios (ORs) were calculated for patient demographics, comorbidities, operative details, and hospital-level factors. RESULTS: Our study population included 3033 patients who underwent 703 femoral-femoral bypasses, 1431 femoral-popliteal bypasses, and 899 femoral-distal vessel bypasses. An SSI was diagnosed in 320 patients (10.6%) ≤30 days after the index operation. Adjusted patient and procedural predictors of SSI included renal failure currently requiring dialysis (OR, 4.35; 95% confidence interval [CI], 3.45-5.47; P \u3c .001), hypertension (OR, 4.29; 95% CI, 2.74-6.72; P \u3c .001), body mass index ≥25 kg/m2 (OR, 1.78; 95% CI, 1.23-2.57; P = .002), procedural time \u3e240 minutes (OR, 2.95; 95% CI, 1.89-4.62; P \u3c .001), and iodine-only skin preparation (OR, 1.73; 95% CI, 1.02-2.91; P = .04). Hospital factors associated with increased SSI included hospital size \u3c500 beds (OR, 2.22; 95% CI, 1.09-4.55; P = .028) and major teaching hospital (OR, 1.66; 95% CI, 1.07-2.58; P = .024). SSI resulted in increased risk of major amputation and surgical reoperation (P \u3c .01), but did not affect 30-day mortality. CONCLUSIONS: SSI after LEB is associated with an increase in rate of amputation and reoperation. Several patient, operative, and hospital-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve vascular patient outcomes

Radar Perspective of the Aristarchus Pyroclastic Deposit and Implications for Future Missions

The Aristarchus plateau represents one of the most complex volcanic provinces on the lunar surface and is host to the largest pyroclastic deposit on the Moon. Lunar pyroclastic deposits offer a window into the Moon’s interior and represent a valuable resource to support a sustained human presence. We present a new analysis of the Aristarchus pyroclastic deposit using Mini-RF bistatic radar data at wavelengths of 4.2 and 12.6 cm. Building on previous Earth-based Arecibo Observatory radar studies at 12.6 and 70 cm, we place further constraints on the spatial extent of the pyroclastic deposit and investigate the clast size distribution and provenance of foreign material distributed within the formation. Concentrations of blocky material >0.5 cm in diameter and suspended within the upper decimeters of the pyroclastic deposit are associated with potential buried mare flows along the rim of Vallis Schröteri and discrete pockets of primary material ejected by the Aristarchus impact. Unraveling the deposit from nonpyroclastic materials and the surrounding landscape creates new constraints with which to reconstruct the volcanic history of the region. From a future mission perspective, the identification of primary Aristarchus material distributed across the plateau offers an opportunity to sample diverse volcanic lithologies within an area that could be sampled by a single Commercial Lunar Payload Services mission. In terms of lunar resource in situ utilization, such ejected material also represents a contaminant; thus, radar data provide an invaluable tool to identify pristine pyroclastic material for mission planners