How Serious Is Your Institution About Reducing Groin Complications?
Kevin Le'roy Colbert, Jr., BS, MEng, Shreyanth Ravi, Pallavi Gorantla, Dylan Brooks, MD, Maham Rahimi, MD, PhD.
Houston Methodist, Houston, TX, USA.
OBJECTIVE - Vascular procedures involving groin incisions often have complications that delay wound healing. This requires further intervention leading to readmission, increased length of stay and an increased morbidity & mortality, including limb loss. No optimal guideline currently exists to systematically reduce these complications which include infection, seroma, and hematoma. Here, we evaluated the implementation of a perioperative protocol to reduce these complications.
METHODS - A retrospective review was performed of all vascular interventions requiring groin incisions performed at our institution before and after the implementation of a perioperative protocol for reducing complications. Information on patient demographics, comorbidities (HTN, obesity, smoker, COPD, CAD), post-operative complications, and procedure type were obtained via electronic medical records and reviewed. The control cohort spanned data obtained from the years 2016 to 2019 and after implementation of the protocol the data was retrospectively reviewed from the years 2020 to 2021.
RESULTS - 330 patients have undergone groin surgery at our institution over the 5-year period studied. Of 330, 198 patients from 2016-2019 did not receive perioperative care and 86 (43.4%) had complications with 7 (3.5%) seromas, 20 (10.1%) hematomas, 39 (19.7%) infections, and 20 (10.1%) other (such as skin necrosis, dehiscence, etc). Subsequently, 132 patients from 2020-2021 complied with a new perioperative protocol, of which 19 (14.4%) had complications with 10 (7.5%) seromas, 4 (3%) hematomas, 2 (1.5%) infections, and 3 (2.3%) others. Data is graphically represented in Figure 1.
CONCLUSIONS - This study identified a perioperative protocol that effectively reduced complications associated with vascular groin incisions by 30%. Compliance of this perioperative protocol has been excellent and suggests that optimizing perioperative plans can reduce future complications.
Figure 1: Complications from vascular intervention requiring groin access from 2016-2021 before A. and after B. the use of perioperative protocol*. *Protocol: 2 showers with 4% Chlorhexidine before surgery, use of hair clippers, 1 hr preop Vanc(15/mg/kg IV)/Ceftriaxone(2g IV), post-operative doxycycline IV or PO 100 mg BID, loban, oblique skin incision, and NPWT/muscle flap/wound products in high risk patients. 
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