Occurrence, Definition and Risk Factors Related to Groin Wound Complications Following Open Vascular Surgeries

TL;DR

This study finds that 21% of patients undergoing open vascular surgeries experience significant groin wound complications, with lymphatic leakage being a major cause.

Contribution

The study introduces a standardized definition and grading system for groin wound complications and identifies drainage volume as a predictive risk factor.

Findings

Groin wound complications occurred in 21% of cases, with lymphatic leakage being a significant contributor.

Drainage volume exceeding 70 mL/24 hours on postoperative day 4 predicted complications with high sensitivity.

A standardized grading system can improve the evaluation of preventive interventions.

Abstract

Open femoral vessel access is commonly performed in vascular surgery, but surgical site complications (SSCs) occur frequently. The aim of this study is to evaluate the incidence and identify potential risk factors by applying a new standardised definition and grading of various types of groin wound complications. This retrospective analysis includes 201 consecutive patients with 219 vertical groin incisions to expose the femoral vessels for different vascular interventions. A prophylactic drain was placed intraoperatively in almost all incisions (91%). Groin SSCs were defined and graded into four categories according to a modified Clavien‐Dindo classification. Potential risk factors were evaluated using univariable analysis. For multivariable analysis, a multiple logistic regression was performed. Cutoff values were determined through ROC analysis. According to the proposed definition, regular postoperative course grade 0 (no SSC) occurred in 163 patients (74.4%), grade 1 (minor SSC) in 10 (4.6%), grade 2 (moderate SSC) in 14 (6.4%), and grade 3/4 (major or life‐threatening SSC) in 32 (14.6%) incisions. The incidence of clinically relevant SSCs (grade 2–4) was 21%. Drainage volume was an independent parameter that predicted relevant SSCs with a threshold value of 70 mL/24 h on postoperative day 4 (sensitivity 100%; specificity 67%; AUC = 0.835; p = 0.0004). Groin wound complications following vascular procedures are common. Lymphatic leakage appears to be the most significant, potentially preventable condition associated with relevant SSCs. Prophylactic or early therapeutic interventions should focus on reducing lymphatic morbidity.

This single‐center retrospective cohort study analyzed 219 vertical groin incisions for vascular access regarding the occurrence of wound complications. These are the key findings:
Relevant groin wound complications after vascular procedures occurred in 21% of cases.Lymphatic leakage was associated significantly to high incidence rates.Drainage volume on postoperative day 4 predicted complicated wound scenarios.The management of wounds and drainage should be optimized.A standardized definition facilitates the evaluation of prophylactic interventions.

Relevant groin wound complications after vascular procedures occurred in 21% of cases.

Lymphatic leakage was associated significantly to high incidence rates.

Drainage volume on postoperative day 4 predicted complicated wound scenarios.

The management of wounds and drainage should be optimized.

A standardized definition facilitates the evaluation of prophylactic interventions.

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