Predicting Patient Risk Of Seroma Complications From Vascular Groin Incision
Kevin Le'roy Colbert, BS, MEng, Dylan Brooks, MD, Shreyanth Ravi, Pallavi Gorantla, Edward Graviss, PhD, MPH, Duc Nguyen, MD, PhD, Maham Rahimi, MD, PhD.
Houston Methodist, Houston, TX, USA.
OBJECTIVE - Postoperative complications, such as seroma, from vascular groin incisions remain challenging to manage and necessitate additional hospital visits, operations, and medical expenses. Identifying patient subpopulations who are at higher risk of seroma formation can enable vascular surgeons to take steps towards prevention. Currently, no predictive measure is known to identify those who are more at risk for this complication.
METHODS - A retrospective review was performed of all vascular interventions requiring groin incisions performed at our institution from 2016-2019 to identify causative factors of seroma formation. Factors such as age, sex, comorbidities (smoking, diabetes, renal disease, COPD, coronary artery disease, and HTN), redo operations, emergent status, graft type, preoperative status, and surgery duration were obtained via electronic medical records and reviewed. The differences across these 14 patient characteristics were determined by Chi-square or Fisher's exact tests for categorical variables and Kruskal Wallis test for continuous variables.
RESULTS - Of the 198 patients reviewed in this study, 7 (3.5%) developed postoperative incision site seromas. Contributing patient characteristics that were initially considered as potentially relevant prognostic markers were sex (43% female, p=0.68), age (median 77, p=0.10), smoking status (71% smoker, p = 0.62), diabetes (43% diabetics, p=1.00), end stage renal disease (29%, p=1.00), redo procedure (29%, p=0.24), emergency procedure (14%, p=1.00), prosthetic graft (14%, p = 0.20), and preoperative albumin level (3.7±0.9, p = 0.74). None of these markers resulted in a statistically significant difference between subgroups, as well as the 5 other characteristics listed in Table 1.
CONCLUSION - It is known that lifestyle factors play a role in disease progression, yet this study found that no clear comorbidity or perioperative factor could statistically predict patients that would develop surgical site seroma. Without a higher volume of patients, and with what is currently available in the vascular surgery literature, seroma prediction is not possible. It is our conclusion that surgical dissection techniques, site closure techniques or instruments used during dissection may be the underlying cause.
Table 1. Patient characteristics, comorbidities, and perioperative factors reviewed for incisional seroma formation with statistical significance. 
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