Groin Complications Among Obese Patients Undergoing Vascular Procedures

Abstract

Background: Groin incision wound complications (WC) are common among vascular surgery patients. Obesity is a known risk factor, but there is no consensus on the best way to prevent WC in obese patients after vascular procedures. The objective of this study was to identify risk factors for WC and strategies to prevent these complications specifically in obese patients.

Methods: All patients who had longitudinal groin incisions at a single institution from 2021-2022 were included. The medical records were reviewed and all groin-related WC were identified. WC were stratified into major and minor WC where major WC were those requiring reoperation or hospital readmission. Patients were stratified into obese (body mass index > 30 kg/m²) and nonobese cohorts.

Results: A total of 238 groin incisions were included. There were 46 (19.3%) obese and 192 (80.7%) nonobese patients. One hundred fifty six (65.5%) were closed with nylon, 49 (20.6%) were closed in a subcuticular fashion, and 32 (13.4%) were closed with staples. There were 45 (18.9%) WC: 15 (33.3%) major and 30 (66.7%) minor. Obesity was associated with a higher WC rate (39.1% vs. 14.1%, P < 0.001), which was driven by minor WC (32.6% vs. 7.8%, P < 0.001) rather than major WC (6.5% vs. 5.7%, P = 0.873). On multivariable analysis, obesity remained a predictor for overall (odds ratio [OR] 4.953, P < 0.001) and minor WC (OR 7.389, P < 0.001). Additionally, female sex was associated with a higher rate of WC on unadjusted (27.6% vs. 12.8%, P = 0.016) and adjusted analysis (OR 2.411, P = 0.014). Among obese patients, subcuticular closure was associated with higher rates of minor complications (OR 8.454, P = 0.044). Obese patients with major complications less frequently had close follow-up including rehab disposition, discharge with visiting nurse, or frequent office wound checks than those with minor complications (33.33% vs. 86.67%, P = 0.043).

Conclusions: Groin WC are more common in obese and female patients. Among obese patients, this difference is driven primarily by minor WC. Avoiding a subcuticular skin closure may reduce the risk of minor WC in obese patients. In addition, close postoperative follow-up using rehab, visiting nurse services, and frequent office wound checks may prevent minor complications from escalating to major complications.