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Modifiable and Non-Modifiable Risk Factors Associated with Groin Wound Complications After Vascular Surgery Involving the Femoral Vessels: A Retrospective Study with More than 500 Incisions

2019; Elsevier BV; Volume: 58; Issue: 6 Linguagem: Inglês

10.1016/j.ejvs.2019.09.127

1532-2165

Joana Cruz Silva, Vânia Constâncio, Manuel Fonseca, Óscar F. Gonçalves,

Aortic aneurysm repair treatments

Introduction: Wound complications following vascular surgery procedures are associated with important morbidity and cost and have been reported in 10 to 44% of infrainguinal procedures. Previous studies have mainly compared complication rates in infrainguinal incisions for lower limb revascularization and not individually groin wounds. The aim of this study was to evaluate the incidence and severity of inguinal surgical wound complications, including dehiscence, surgical site infections, seroma and hematoma and also to define correlated modifiable and non-modifiable risk factors. Methods: All patients with inguinal incisions with surgical femoral vessels approach, including inferior limb thrombembolectomy, bypass surgery, endarterectomy, angioplasty/stent, open aneurysm repair and Endovascular Aortic Repair from a 2-year period in our hospital were evaluated. Epidemiologic data, comorbidities, factors related to surgical technique as well as incidence, severity and need for additional treatment associated to these wound complications were determined and evaluated by multiple regression. Results: After exclusion of the patients who died within the first 30 days after surgery, 437 patients with 520 groin incisions were retrospectively identified. Patients with active groin infection were also not included. 23% were female. 24% of the patients were under 65 years old, 48% were 65-80 years old and 28% were over 80 years old. 42% were urgent or emergency surgeries, 15% had prior ipsilateral groin incision and in 37% a prosthetic graft was used in the femoral vessels. 51% of the surgeries were over 120min long. 27% of the incisions were transverse and 7% had more than 10cm long. In total there was a 9% wound complication rate. Patients with transverse incisions had less local surgical complications. 3% of all the patients had longer hospitalization time due to inguinal incision complications. 1.3% were readmitted and 2.7% had additional operative intervention(s) because of severe infection, dehiscence or seroma. Overall, female gender, obesity, urgent or emergency procedure status (OR 2.2, p< 0.05) and prior ipsilateral groin incision (OR 2.2, p< 0.05) were identified as independent risk factors for inguinal wound complications and diabetes was identified as a protective factor. Transverse incisions were associated with less infection/dehiscence/seroma rate (OR 0.18, p < 0.05) but not hematoma. On the other hand, age >80 years old, incisions longer than 10cm (OR 4.7, p < 0.05) and surgeries over 2h long (OR 1.7, p 0.18) were associated with a higher infection/dehiscence/seroma rate but not hematoma. Prosthetic grafts revealed no significant difference in the incidence of complications. Conclusion: In this study patients with severe wound complications, especially surgical site infections, dehiscence and seroma experienced a longer total hospitalization time and additional surgical interventions, therefore accounting for higher hospital charges. Consequently, modifiable risk-factors for inguinal wound complications, including using transverse incisions, making smaller/ separate incisions, avoiding urgent procedures and shorten the surgical duration should be pursued whenever possible to lower morbidity and costs. Disclosure: Nothing to disclose