Groin wound infection after vascular exposure (GIVE) multicentre cohort study

Groin wound Infection after Vascular Exposure (GIVE) Study Group, Brenig L Gwilym, Athanasios Saratzis, Ruth A Benson, Rachael Forsythe, George Dovell, Nikesh Dattani, Tristan Lane, Joseph Shalhoub, David Bosanquet, Brenig L Gwilym, Louise Hitchman, Nikesh Dattani, Sarah Onida, George Dovell, Rachael Forsythe, David Bosanquet, Brenig L Gwilym, Athanasios Saratzis, Graeme K Ambler, David Bosanquet, Ruth A Benson, Sandip Nandhra, Joseph Shalhoub, Athanasios Saratzis, Sarah Onida, Rachael Forsythe, Nikesh Dattani, Graeme K Ambler, David Bosanquet, Philip Stather, Aminder Singh, Enrico Mancuso, Mohedin Arifi, Mohamed Altabal, Ahmed Elhadi, Abdulmunem Althini, Hazem Ahmed, Huw Davies, Madhu Rangaraju, Maciej Juszczak, Jonathan Nicholls, Nicholas Platt, James Olivier, Emily Kirkham, David Cooper, Iain Roy, Gareth Harrison, James Ackah, Devender Mittapalli, Ian Barry, Toby Richards, Ahmed Elbasty, Hayley Moore, Adnan Bajwa, Andrew Duncan, Andrew Batchelder, Tryfon Vanias, Matthew Brown, Athanasios Saratzis, Trixie Yap, Lucy Green, George Smith, Katherine Hurst, Daniel U Rodriguez, Ella Schofield, Hannah Danbury, Tom Wallace, James Forsyth, Amy Stimpson, Luke Hopkins, Kamran Mohiuddin, Sandip Nandhra, Ghazaleh Mohammadi-Zaniani, Konstantinos Tigkiropoulos, Ahmed Shalan, Khalid Bashar, Rachel Sam, Craig Forrest, Samuel Debono, Keith Hussey, Rachel Falconer, Salil Korambayil, Ciaran Brennan, Thomas Wilson, Aled Jones, Tom Hardy, Hannah Burton, Andrew Cowan, Ummul Contractor, Elaine Townsend, Olivia Grant, Michelle Cronin, Michael Rocker, Danielle Lowry, Annie Clothier, Dafydd Locker, Rachael Forsythe, Olivia McBride, Calvin Eng, Russell Jamieson, Nishath Altaf, Fernando Picazo, Kishore Sieunarine, Ruth A Benson, Alexander Crichton, Nikesh Dattani, Tasleem Akhtar, Helen Suttenwood, Francesca Guest, Bethany Wardle, George Dovell, Natasha Chinai, Graeme K Ambler, David Bosanquet, Robert Hinchliffe, Timothy Beckitt, Arsalan Wafi, Ankur Thapar, Paul Moxey, Tristan Lane, Ryan Preece, Kamil Naidoo, Benjamin Patterson, Claire Perrott, Joseph Shalhoub, Thomas Aherne, Ahmed Hassanin, Emily Boyle, Bridget Egan, Sean Tierney, Shaneel Patel, Panagiota Birmpili, Sandhir Kandola, Simon Neequaye, Muhammed Elhadi, Ahmed Msherghi, Ala Khaled, Lewis Meecham, Owain Fisher, Asif Mahmood, David Milgrom, Kerry Burke, Faris Saleh, Tariq Al-Samarneh, Groin wound Infection after Vascular Exposure (GIVE) Study Group, Brenig L Gwilym, Athanasios Saratzis, Ruth A Benson, Rachael Forsythe, George Dovell, Nikesh Dattani, Tristan Lane, Joseph Shalhoub, David Bosanquet, Brenig L Gwilym, Louise Hitchman, Nikesh Dattani, Sarah Onida, George Dovell, Rachael Forsythe, David Bosanquet, Brenig L Gwilym, Athanasios Saratzis, Graeme K Ambler, David Bosanquet, Ruth A Benson, Sandip Nandhra, Joseph Shalhoub, Athanasios Saratzis, Sarah Onida, Rachael Forsythe, Nikesh Dattani, Graeme K Ambler, David Bosanquet, Philip Stather, Aminder Singh, Enrico Mancuso, Mohedin Arifi, Mohamed Altabal, Ahmed Elhadi, Abdulmunem Althini, Hazem Ahmed, Huw Davies, Madhu Rangaraju, Maciej Juszczak, Jonathan Nicholls, Nicholas Platt, James Olivier, Emily Kirkham, David Cooper, Iain Roy, Gareth Harrison, James Ackah, Devender Mittapalli, Ian Barry, Toby Richards, Ahmed Elbasty, Hayley Moore, Adnan Bajwa, Andrew Duncan, Andrew Batchelder, Tryfon Vanias, Matthew Brown, Athanasios Saratzis, Trixie Yap, Lucy Green, George Smith, Katherine Hurst, Daniel U Rodriguez, Ella Schofield, Hannah Danbury, Tom Wallace, James Forsyth, Amy Stimpson, Luke Hopkins, Kamran Mohiuddin, Sandip Nandhra, Ghazaleh Mohammadi-Zaniani, Konstantinos Tigkiropoulos, Ahmed Shalan, Khalid Bashar, Rachel Sam, Craig Forrest, Samuel Debono, Keith Hussey, Rachel Falconer, Salil Korambayil, Ciaran Brennan, Thomas Wilson, Aled Jones, Tom Hardy, Hannah Burton, Andrew Cowan, Ummul Contractor, Elaine Townsend, Olivia Grant, Michelle Cronin, Michael Rocker, Danielle Lowry, Annie Clothier, Dafydd Locker, Rachael Forsythe, Olivia McBride, Calvin Eng, Russell Jamieson, Nishath Altaf, Fernando Picazo, Kishore Sieunarine, Ruth A Benson, Alexander Crichton, Nikesh Dattani, Tasleem Akhtar, Helen Suttenwood, Francesca Guest, Bethany Wardle, George Dovell, Natasha Chinai, Graeme K Ambler, David Bosanquet, Robert Hinchliffe, Timothy Beckitt, Arsalan Wafi, Ankur Thapar, Paul Moxey, Tristan Lane, Ryan Preece, Kamil Naidoo, Benjamin Patterson, Claire Perrott, Joseph Shalhoub, Thomas Aherne, Ahmed Hassanin, Emily Boyle, Bridget Egan, Sean Tierney, Shaneel Patel, Panagiota Birmpili, Sandhir Kandola, Simon Neequaye, Muhammed Elhadi, Ahmed Msherghi, Ala Khaled, Lewis Meecham, Owain Fisher, Asif Mahmood, David Milgrom, Kerry Burke, Faris Saleh, Tariq Al-Samarneh

Abstract

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow-up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post-operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90-day mortality. Female sex, Body mass index≥30 kg/m2 , ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.

Keywords: vascular.

Conflict of interest statement

The authors declare no potential conflict of interest.

© 2020 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patient recruitment and outcomes
FIGURE 2
FIGURE 2
Funnel plot of SSI rates of each centre, with +/−2 and +/−3 SD lines
FIGURE 3
FIGURE 3
Funnel plot of deep and organ/space SSI rates of each centre, with +/−2 and +/− 3 SD lines

References

    1. WHO . Global Guidelines for the Prevention of Surgical Site Infection [accessed on November 1, 2019]. .
    1. Public Health England . Surveillance of surgical site infections in NHS hospitals in England: 2016 to 2017 [accessed on November 1, 2019]. .
    1. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical‐site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725‐730.
    1. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003;9(2):196‐203.
    1. Chakfé N, Diener H, Lejay A, et al. European Society for Vascular Surgery (ESVS) 2020 clinical practice Guidelines on the Management of Vascular Graft and Stent Graft Infections with the endorsement of the European Association of Nuclear Medicine (EANM). Eur J Vasc Endovasc Surg. 2020;59(3):339‐384.
    1. Inui T, Bandyk DF. Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg. 2015;28(3–4):201‐207.
    1. Trinidad B, Rybin D, Doros G, Eslami M, Tan TW. Factors associated with wound complications after open femoral artery exposure for elective endovascular abdominal aortic aneurysm repair. Int J Angiol. 2019;28(2):124‐129.
    1. Wiseman JT, Fernandes‐Taylor S, Barnes ML, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery presented at the 2015 vascular annual meeting of the Society for Vascular Surgery, Chicago, ill, June 17–20, 2015. J Vasc Surg. 2015;62(4):1023‐1031.e5.
    1. Newington DP, Houghton PWJ, Baird RN, Horrocks M. Groin wound infection after arterial surgery. Br J Surg. 1991;78(5):617‐619.
    1. Derksen WJM, Verhoeven BAN, van de Mortel RHW, Moll FL, de Vries J‐PPM. Risk factors for surgical‐site infection following common femoral artery Endarterectomy. Vasc Endovascular Surg. 2009;43(1):69‐75.
    1. Kuy S, Dua A, Desai S, et al. Surgical site infections after lower extremity revascularization procedures involving groin incisions. Ann Vasc Surg. 2014;28(1):53‐58.
    1. Van Der Slegt J, Kluytmans JAJW, Mulder PGH, Veen EJ, Ho GH, Van Der Laan L. Surgical site infection after multiple groin incisions in peripheral vascular surgery. Surg Infect (Larchmt). 2014;15(6):752‐756.
    1. NICE . Surgical site infections: prevention and treatment, 2019. Clinical Guideline. [accessed on November 1, 2019]. .
    1. McGuinness B, Ali KP, Phillips S, Stacey M. A scoping review on the use of antibiotic‐impregnated beads and applications to vascular surgery. Vasc Endovascular Surg. 2019;54(2):147‐161.
    1. Totty JP, Bua N, Smith GE, et al. Dialkylcarbamoyl chloride (DACC)‐coated dressings in the management and prevention of wound infection: a systematic review. J Wound Care. 2017;26(3):107‐114.
    1. Wee IJY, Syn N, Choong AMTL. Closed incision negative pressure wound therapy in vascular surgery: a systematic review and meta‐analysis. Eur J Vasc Endovasc Surg. 2019;58(3):446‐454.
    1. Antoniou GA, Onwuka CC, Antoniou SA, Russell D. Meta‐analysis and trial sequential analysis of prophylactic negative pressure therapy for groin wounds in vascular surgery. J Vasc Surg. 2019;70(5):1700‐1710.e6.
    1. Gwilym BL, Saratzis A, Benson R, et al. Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study. Int J Surg Protoc. 2019;16:9‐13.
    1. Bosanquet DC, Stather P, Sidloff DA, et al. How to engage in trainee‐led multicentre collaborative vascular research: the vascular and endovascular research network (VERN). Eur J Vasc Endovasc Surg. 2016;52(3):392.
    1. Saratzis A, Dattani N, Brown A, et al. Multi‐Centre study on cardiovascular risk management on patients undergoing AAA surveillance. Eur J Vasc Endovasc Surg. 2017;54(1):116‐122.
    1. Stather P, Muscara F. Cardiovascular risk reduction in referrals to outpatient vascular clinics. Ann R Coll Surg Engl. 2018;100:194‐198.
    1. Saratzis A, Jaspers NEM, Gwilym B, et al. Observational study of the medical management of patients with peripheral artery disease. Br J Surg. 2019;106:1168‐1177.
    1. Wong KHF, Bosanquet DC, Ambler GK, Qureshi MI, Hinchliffe RJ, Twine CP. The CLEAR (considering leading Experts' antithrombotic regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention. CVIR Endovasc. 2019;2(1):37.
    1. Saratzis A, Joshi S, Benson RA, et al. Acute kidney injury (AKI) in aortic intervention: findings from the midlands aortic renal injury (MARI) cohort study. Eur J Vasc Endovasc Surg. 2020;59(6):899‐909.
    1. Centres for Disease Control and prevention . National Healthcare Safety Network (NHSN) Patient Safety Component Manual; 03/05/2019. [accessed on November 1, 2019]. .
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344‐349.
    1. England PH . Fingertips technical guidance. [accessed on November 1, 2019] .
    1. Melvin JC, Smith JB, Kruse RL, Vogel TR. Risk factors for 30‐day hospital re‐admission with an infectious complication after lower‐extremity vascular procedures. Surg Infect (Larchmt). 2017;18(3):319‐326.
    1. Audu CO, Columbo JA, Sun SJ, et al. Variation in timing and type of groin wound complications highlights the need for uniform reporting standards. J Vasc Surg. 2019;69(2):532‐543.
    1. Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect. 2015;21(11):1008.e1‐1008.e8.
    1. Drake TM, Nepogodiev D, Chapman SJ, et al. Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery. Br J Surg. 2016;103(9):1157‐1172.
    1. Texakalidis P, Giannopoulos S, Charisis N, et al. A meta‐analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy. J Vasc Surg. 2018;68(4):1241‐1256.e1.
    1. Wiseman JT, Fernandes‐Taylor S, Barnes ML, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg. 2015;62:1023‐1031.e5.
    1. Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2011;54(2):433‐439.
    1. Smith GE, Long J, Wallace T, Carradice D, Chetter IC. Identifying the research priorities of health care professionals in UK vacular surgery‐a modified Delphi approach. Br J Surg Open. In press.
    1. Ott E, Bange FC, Sohr D, Teebken O, Mattner F. Risk factors associated with surgical site infections following vascular surgery at a German university hospital. Epidemiol Infect. 2013;141(6):1207‐1213.

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