R. Kulkarni1, W. W. King1, S. Shah1, A. Longchamp1, M. Tao1, K. Ding1, C. K. Ozaki1, G. Sharma1 1Brigham And Women’s Hospital,Vascular And Endovascular Surgery,Boston, MA, USA
Introduction: Wound complication rates after vascular surgery may be as high as 30%, and represent a major cause of morbidity, mortality, and cost. The authors have previously demonstrated that local adipose tissue can exhibit an exacerbated inflammatory response to local surgical trauma. To date, however, links between human adipose phenotype and procedural outcomes such as wound complications have not been reported. We hypothesized that specific adipose-related biomarkers uniquely link to 30-day wound complication rates in patients undergoing open vascular surgical procedures.
Methods: Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected from patients undergoing carotid endarterectomy (CEA), lower extremity revascularization (LER), and lower extremity amputations (AMP) at the time of surgery. Nine adipose-associated biologic mediators (adiponectin, IL-1β, IL-6, IL-8, leptin, MCP-1, PAI-1, resistin, and TNF) were assayed in the adipose tissues and plasma. Wound complications were classified according to a previously published grading system. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution and data were compared using the Student’s t-test. All statistical analyses were conducted using SAS software,v9.3 (SAS Institute, Inc., Cary, NC.)
Results: The cohort included 115 patients (49 CEA, 44 LER, 22 AMP). Median follow-up was 14 months (SD 9.97 months) and 30-day follow-up was 94.8%. At 30 days, 22 (19.1%) patients had wound complications—namely, superficial surgical site infections (14/22), hematoma (4/22), dehiscence (4/22), seroma or lymph leak (3/22), and deep surgical site infection (1/22). There were several statistically significant, plasma/perivascular/subcutaneous compartment-specific relationships between logarithmically transformed mediator levels and wound complications. Most notably, mean plasma TNF levels were higher in patients with superficial surgical site infections (figure, panel A), whereas plasma (figure, panel A), and perivascular (figure, panel B) TNF levels were lower in patients with wound dehiscence. There was also a trend relating elevated subcutaneous TNF levels and any wound complication (p=0.05.)
Conclusions: Adipose-associated mediator levels at the time of operation demonstrate a compartment-specific relationship to wound outcomes in patients undergoing vascular surgical procedures. These associations likely have implications for mechanisms underlying the pathogenesis of wound complications, and suggest novel interventional strategies to reduce wound complications based on the plasticity of the adipose organ’s phenotype.
