Surgical Site Complications After Complex Iliofemoral Reconstruction and the Role of Negative Pressure Wound Therapy: A Retrospective, Single-center Study

Abstract

Introduction. Surgical site infection (SSI) of groin incisions after vascular surgery is a significant source of morbidity and is associated with high rates of readmission and reoperation, as well as longer hospital length of stay. The patient-reported health care experiences are diminished for those in whom SSI complications occur. Previous studies have analyzed patients undergoing all types of surgery requiring groin incision. The role of closed incision negative pressure therapy (CiNPT) as an adjunct to the primarily closed femoral incision after vascular surgery is unclear. Materials and Methods. This retrospective single-center study focuses on complex iliofemoral reconstruction with extensive dissection, including profundoplasty. The role of CiNPT and short-term outcomes are analyzed. Multivariable logistic regression was used to identify factors that place patients at high risk for SSI. A prediction model was performed to predict high-risk patients. Results. A total of 337 patients who underwent 422 femoral endarterectomies (85 bilateral) were included. The overall SSI rate was 16.1% (9.3% Szilagyi grade II and III), and SSI was associated with a 44% readmission rate, 38% reoperation rate, and longer mean length of stay (8.5 days vs 5.1 days; P =.02). No differences in SSI were evident between the CiNPT (n = 47) and standard dressing cohorts. The final prediction model used 5 variables: obesity (body mass index > 30), insulin use, chronic obstructive pulmonary disease (COPD), immunosuppression, and surgical duration. Conclusions. Patients with obesity, COPD, and insulin-dependent diabetes mellitus are at increased risk for SSI after femoral incisions for peripheral revascularization. A prediction model may assist in identifying patients at high risk for SSI so that targeted risk reduction strategies can be implemented to decrease morbidity and economic costs. Targeted use of CiNPT may help reduce the severity of SSI in these at-risk patients.