Invited commentary

Abstract

Postoperative groin complications continue to be the bane of vascular surgeons, often resulting in patients' increased morbidity (or mortality if associated with prosthetic material) and resource utilization with longer lengths of stay, higher rates of readmissions or returns to the operating room, and increased overall costs. Current literature supports a rate of up to nearly 40% of vascular surgery patients' developing groin wound infections after their procedures, and multiple studies have outlined ways to curb these events ranging from negative pressure dressings to perioperative care paths. Despite an interest in this complication by many members of the vascular surgery community as well as a relatively high occurrence rate, Audu et al point out that there is no standardization in the definition or timing of infections after groin incisions among the various quality measures that most vascular surgeons commonly use (National Surgical Quality Improvement Program, Vascular Quality Initiative, Szilagyi scale, Centers for Disease Control and Prevention). As such, they sought to demonstrate the need for more standardization of reporting of these events by analyzing data from a single center with up to 180 days of postprocedure follow-up and with a broader definition of “groin infection.” There are several important findings from this study. In the authors' experience, nearly half of the identified groin complications occurred beyond 30 days postoperatively. The Vascular Quality Initiative and National Surgical Quality Improvement Program, which capture groin complications only through day 30, may thus be grossly underestimating their occurrence. In addition, the events that occurred between day 30 and day 180 in this series were mostly deemed “major” complications that required readmission and could not be managed on an outpatient basis. We are thus potentially missing a higher number of more severe complications in our current quality improvement data metrics. Second, the authors critique the current definitions of wound infection, which are also not standardized among the various quality improvement programs, and they recommend tracking groin wound “complications” rather than just a nebulous “infection.” After a thorough literature review (outlined in Table IV), they identified all factors other authors have used to define groin infection and captured these events in their series of patients. They recommend using a definition of wound complications that encompasses major events of readmission, reoperation, and the initiation of antibiotics for groin wounds. Using specific definitions from existing quality improvement programs on their own data, Audu et al demonstrate event rates ranging from 3.9% to 16% using the same information but varying the definition, revealing that we have not successfully standardized the definition of this complication. To use these quality improvement programs as they are designed, perhaps standardization of definitions as well as a longer data capture period may be beneficial. Finally, the authors have reinforced the vascular literature by identifying several patient and operative risk factors associated with development of a wound complication, notably the presence of tissue loss, infrainguinal bypass, redo incisions, and longer operations. Whereas the authors admit the limitations of their study, primarily the single-center heterogeneity of the sample, they should be commended for their efforts in creating a standardized way of approaching groin wound complications so that we may ultimately develop strategies to lower the rates of these events in our populations of patients. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular or the Society for Vascular Surgery. Variation in timing and type of groin wound complications highlights the need for uniform reporting standardsJournal of Vascular SurgeryVol. 69Issue 2PreviewGroin wound infections represent a substantial source of patients' morbidity and resource utilization. Definitions and reporting times of groin infections are poorly standardized, which limits our understanding of the true scope of the problem and potentially leads to event under-reporting. Our objective was to investigate the timing and variation of groin wound complications after vascular surgery. Full-Text PDF Open Archive