Burden Of Groin Wound Complications After Vascular Surgery Involving The Femoral Vessels.

Introduction Wound complications following vascular surgery procedures are associated with important morbidity and cost. Economic burden and risk factors associated with inguinal wounds have not been previously described. Objectives We aimed to evaluate the incidence, severity and healthcare costs of inguinal surgical wound complications, including surgical site infections, dehiscence, lymphorrhagia/ seroma and haematoma. Materials and Methods We retrospectively identified all patients with inguinal incisions for surgical femoral vessels approach in our institution from 2017 and 2018. Surgical reinterventions in patients with active wound infection were excluded. All additional costs related to surgical groin wound complications were calculated. Risk factors associated with groin wound complications were also identified. Multiple regression and T-tests were used for statistical analysis. Results 524 incisions were identified in 415 patients, 77,3% were male and median age was 81.5 years-old (range 15-102). 15,5% had prior ipsilateral groin incision. There was a 12,8% wound complication rate (n=67): 40,3% (n=27) had wound infection (63% superficial and 37% deep incisional infections), 17,9% had dehiscence without infection, 26,9% had lymphorrhagia/seroma without infection and 25,4% haematoma without infection. 3,4% of all patients (n=18) were readmitted due to wound complications and 3,8% (n=20) had longer hospitalization time (median 8,4±13,0), with a total 563 extra hospitalization days and cost 126.283,92€. Median extension of hospitalization time was 11,6 days (range 2-40). 2,8% (n=15) had additional operative interventions (range 1-4 surgeries), total cost 13.474€. 22 patients went to emergency department due to wound complication (estimated cost 3.822€) and 26 patients had additional consultations (total cost 855,36€). An additional 35.040€ were estimated for dressing care in primary health system and 9.306,6€ for ambulance transport. Only 4 patients had vacuum therapy (cost 4.623,13€). Overall, extra 193.402€ were spent in groin wound complications in patients with vascular surgery involving the femoral vessels in 2017 and 2018 (2.886,6€/patient±3.828,9€). 64,3% of total cost was spent in additional hospitalization days. Patients with infection had higher readmission and reoperation rates (51,9% versus 6,3-11,8% and 40,7% versus 0-17,6% in dehiscence/seroma/haematoma, respectively). On the other hand, patients with seroma had longer hospitalization time (50,0% versus 17,6-33,3%). Diabetes (OR1.7, p=.04), >10cm incision (OR2.79, p=.01), urgent surgery (OR1.9, p=.016) and reoperation (OR1.89, p=.042) were associated with higher surgical wound complications and transverse incision (OR0.43, p=.015) was a protective factor. Conclusions Groin wound complications have high additional charges. Good glycemic control, smaller and transversal incisions and non-urgent surgeries should be pursued in order to decrease wound complications and economic burden.