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OBJECTIVES: Groin wound complications following vascular surgery procedures are associated with significant morbidity and cost. A consecutive series of open groin procedures was analyzed to derive a risk assessment tool to identify patients at high risk for requiring salvage muscle flap coverage of dehisced, compromised, or infected groin incisions.
METHODS: A retrospective review of patients at a single university hospital undergoing groin cutdowns for femoral access between 2005 and 2011 was performed. Patient characteristics and clinical course were recorded; the primary outcome variable was the need for groin salvage using local muscle flap coverage for wound complications. A predictive model was developed using stepwise logistic regression and validated using a bootstrap technique. A simplified risk score with greater clinical accessibility was subsequently constructed using weighted logistic regression coefficients.
RESULTS: A total of 925 patients (64.6% male, average age 67.1±14.5 years) undergoing groin cutdowns were examined. 104 patients who required groin salvage surgery were compared to 821 patients who did not. A majority of patients (n=638, 69.0%) underwent groin cutdowns to establish vascular access for endovascular procedures (EVAR and TEVAR), but a significant portion (n=235, 25.4%) underwent cutdowns for lower extremity revascularization procedures. Predictors determined by logistic regression included prior groin surgery, use of prosthetic material, coronary artery disease, peripheral arterial disease, and obesity. The logistic regression demonstrated excellent discrimination with a c-statistic of 0.89 in the derivation dataset, 0.87 by internal validation (optimism corrected), and good calibration (goodness of fit χ²=8.65, P=0.373). A simplified salvage risk score (SRS, see Table), was subsequently derived and validated with good discrimination (c=0.84). Patients with relatively low risk (SRS 0-2, n=387), intermediate (SRS 3-6, n= 407) and high risk (SRS 7-10, n= 131) had groin salvage rates of 0.5%, 14.3%, and 41.0%, respectively.
CONCLUSIONS: A simple, accurate risk assessment score that predicts major wound morbidity requiring operative salvage in vascular surgery patients undergoing open groin procedures was derived. This risk assessment tool provides a basis from which prospective trials studying preemptive interventions, such as prophylactic muscle flaps, can be undertaken.

Results of logistic regression analysis and simplified salvage risk score (SRS) coefficients

	Logistic Coefficient	Standard Error	Adjusted OR	95% Wald Confidence Interval	Salvage Risk Score
Prior Ipsilateral Groin Surgery	1.385	0.229	4.00	2.50-6.38	3
Use of Prosthetic Graft Material	0.995	0.253	2.70	1.65-4.44	2
Coronary Artery Disease	0.561	0.240	1.75	1.10-2.81	1
Peripheral Arterial Disease	1.638	0.280	5.02	2.87-8.90	3
Obesity	0.527	0.256	1.70	1.03-2.80	1