Incidence and Risk Factors of Surgical Site Infections in Vascular Surgical Procedures of the Groin

Abstract Background The reported incidence of surgical site infections (SSI) in vascular surgery procedures in the groin varies from 8% to a staggering 30%. SSI represent a major burden in postoperative care, cause hospital readmissions and reoperations and generate costs. In the presence of prosthetic grafts, SSI are even more problematic. Aims To investigate the incidence of SSI following unselected open vascular surgery procedures in the groin in a real-world setting and to explore potential factors associated with SSI. Methods Retrospective analysis of consecutive patients undergoing any arterial surgery in the groin in two teaching hospitals between 2011 and 2022. Primary endpoint is SSI at 30 days for all patients and occurrence of SSI at 90 days for those patients with implants. To identify factors associated with SSI within 30 days, univariable and multivariable logistic regression analyses were performed using prespecified variables. Results Mean age was 70.7 (11.5) years and 1993 patients (67.1%) were male. While 1094 patients (36.9%) received a patch and 1195 (40.3%) underwent endarterectomy, 1514 (51%) had concomitant bypass surgery. Out of 2967 patients, 180 (6.1%) experienced SSI at 30 days and 27 (0.9%) had SSI at 90 days. On univariable logistic regression, diabetes (OR 1.923, 95%CI 1.411-2.611, p=0.001), patch reconstruction (OR 1.848, 95%CI 1.329-2.56 for bovine pericardial patch and OR 1.915, 95%CI 1.095-3.18 for autologous vein patch p=0.004), endarterectomy (p=0.005) lymphatic complications (OR 3.515, 95%CI 2.385-5.094, p<0.001) were associated with significantly increased odds of experiencing SSI. Duration of surgery (p=0.631) and concomitant bypass surgery (p=0.325) were not associated with the odds of having SSI. On multivariable analysis, only diabetes (OR 1.67, 95%CI 1.18-2.33, p=0.004) and lymphatic complications (OR 3.03, 95%CI 1.98-4.53, p<0.001) remained significantly associated with the odds of having SSI. Conclusion In this series, the SSI rate was lower than expected and some otherwise accepted risk factors could not be confirmed.