Variation in Timing and Type of Groin Wound Complications Highlights the Need for Uniform Reporting Standards

Abstract

Groin wound infections represent a substantial source of patient 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. We reviewed all patients who underwent vascular surgery with a groin incision at our institution during 2013 (N = 256; 32% female; mean age, 68.8 years). We analyzed patient- and procedure-level variables. Our primary outcome was any groin infection within 180 days. We classified groin infections as major (hospital readmission or reoperation for groin wound) or minor (wound opened in clinic, initiation of antibiotics specifically for a groin wound, or new groin hematoma or wound drainage). Overall, 21% (n = 53/256) of patients sustained a groin infection, of which 29 (54%) were major and 24 (46%) minor (Fig). The Kaplan-Meier 30-day infection rate was 13% for any infection and only 3% for major infection, indicating that most infections within the first 30 days did not require readmission or reoperation (Fig). By 6 months, the overall infection rate rose to 23% and the major infection rate to 14%, indicating that nearly all infections occurring after 30 days required readmission or reoperation. Those with a groin infection more commonly had tissue loss (23% vs 12%; P = .05), underwent infrainguinal bypass (42% vs 22%; P = .004), had a redo incision (32% vs 18%; P = .03), and had a longer operation (surgery >200 minutes, 77% vs 65%; P = .07). There were no significant differences in patient comorbidities, skin closure, dressing type, prosthetic implants, hemostatic agents, or discharge status. Whereas >20% of patients suffered a groin infection, nearly half of these events occurred after 30 days. Reporting measures limited to 30-day events or infection definitions limited to antibiotic use may misrepresent the true infection rate and highlight the need for uniform reporting standards.