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

Abstract

Objective: Abdominal aortic aneurysm (AAA)-related mortality is decreasing since the introduction of endovascular aneurysm repair, but mortality from AAAs by age, sex, and race has not been recently reported.Methods: We abstracted crude mortality rates by International Classification of Diseases, Tenth Revision code from the Centers for Disease Control and Prevention Wonder database from 1999 to 2015 and stratified these by year, diagnosis, age, sex, race, and state.Results: We found that overall AAA-related mortality decreased steadily from a maximum 2.83 annual deaths per 100,000 patients in 1999 to 1.2 deaths per 100,000 patients in 2015. This decrease occurred among intact and ruptured AAAs (Fig 1) and among white men, black men, white women, and black women. AAA-related mortality reached a nadir in 2015, with rates by age, sex, and race summarized in Table . Notably, crude AAA-related mortality was higher in males than in females and higher in white compared with black compared with Asian Americans. Mortality similarly increased with age. Finally, mortality from intact and ruptured (Fig 2) aneurysms varied dramatically across the United States during the study period.Conclusions: AAA-related mortality continues to decline dramatically, from both intact and ruptured AAA, which is likely secondary to the increased use of endovascular aneurysm repair. This decrease occurs across all gender and racial groups, but there remains a geographic disparity in AAA-related mortality that should be addressed in future studies.

The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin

“…4 Audu et al (2019) reported groin complications after vascular surgery in 20.7% of patients during a 6 month follow-up period, ranging from minor infection treated with antibiotics as an outpatient, to major complications requiring re-admission and often surgery. 1 Wound dehiscence may be caused by a post-operative haematoma and dermal or fat necrosis. 5 Another problem is that of lymphatic leak (LL) following uncomplicated arterial revascularisation, which reportedly occurs in as many as 5% to 8% of all cases.…”

“…Complications include surgical site infection, wound breakdown, and poor healing with risk to the integrity of any underlying graft. Management of such problems may require prolonged hospital stay, re‐admission, and surgical re‐intervention 1‐4 . Rates of groin wound complications vary in the literature depending on definitions and reporting standards.…”

“…Nguyen et al (2007) reported wound complications in 39% of patients within 30‐days of infra‐inguinal bypass surgery, the most common being infection and haematoma or haemorrhage 4 . Audu et al (2019) reported groin complications after vascular surgery in 20.7% of patients during a 6 month follow‐up period, ranging from minor infection treated with antibiotics as an outpatient, to major complications requiring re‐admission and often surgery 1 …”

“…Management of such problems may require prolonged hospital stay, re-admission, and surgical re-intervention. [1][2][3][4] Rates of groin wound complications vary in the literature depending on definitions and reporting standards. Nguyen et al (2007) reported wound complications in 39% of patients within 30-days of infra-inguinal bypass surgery, the most common being infection and haematoma or haemorrhage.…”

Groin wound infection after vascular exposure (GIVE) multicentre cohort study

“…The majority of published literature regarding groin SSIs have been small, 28 from single centres, 10,11 historical, reliant on national registry data, 7,28 use varying definitions of SSI 29 and are retrospective. 28 This has made it difficult to benchmark practice and provide estimates to inform the design of future randomised trials.…”