Panos Kougias1, Neal R. Barshes1, Lorena Gonzalez2, Peter H. Lin2, George Pisimisis1, Carlos F. Bechara1
1Surgery, Michael E. DeBakey VAMC, Houston, TX; 2Baylor College of Medicine, Houston, TX.
OBJECTIVES: To compare the incidence of deep groin wound infections between patients having peripheral arterial disease (PAD)-related operations with standard groin incision (SGI) vs. those having exposure of the femoral vessels via an approach lateral to sartorius muscle (LSM).
METHODS: Consecutive patients (n=604) who underwent PAD-related operations were matched on propensity score (PS) calculated as their probability to have either the SGI or the LSM approach on the basis of operative characteristics, demographics and comorbidities. Primary endpoint was the incidence of deep groin wound infections. Single level random effects logistic and Poisson regressions were performed to analyze outcomes.
RESULTS: After PS matching, the groups were well-balanced on all major covariates except for that of groin reoperation; therefore, the final regression models were all adjusted for this predictor. The incidence of deep groin wound infection was lower in the LSM group (2 vs. 6.3%, OR: 0.1, p=0.016). An interaction term between LSM approach and re-operation approached statistical significance (p=0.07) and individual interaction component analysis indicated that the beneficial effect of the LSM approach was mainly in the patients undergoing groin re-operations. Superficial infections (OR: 0.83, p=0.88), intra-operative blood loss (median 275 vs. 350cc, IRR: 1.04, p=0.75), operative time (median: 4.6 vs. 4.9 hours, IRR: 1.01, p=0.875), and incidence of perioperative death and MI (OR: 1, p=0.99) were similar between the SGI and LSM groups respectively. Postoperative length of stay (median 6 vs. 8 days, IRR: 1.3, p=0.052) was slightly higher in the LSM group.
CONCLUSIONS: Patients having femoral vessel exposure via a lateral to sartorius muscle approach have a substantially lower risk of deep groin infections, particularly if undergoing re-operation.
AUTHOR DISCLOSURES: N. R. Barshes: Nothing to disclose; C. F. Bechara: Nothing to disclose; L. Gonzalez: Nothing to disclose; P. Kougias: Nothing to disclose; P. H. Lin: Nothing to disclose; G. Pisimisis: Nothing to disclose.
Posted April 2013