Postoperative groin wound complications after common femoral artery exposure are associated with increased long-term systemic and limb adverse outcomes in a national propensity-matched analysis

OBJECTIVES: Common femoral artery (CFA) exposure is a critical step in many vascular procedures. Although local postoperative complications are well described, their association with long-term high-acuity sequelae remains incompletely characterized. This study aimed to evaluate the relationship between hematoma, seroma, surgical site infection, and wound necrosis/dehiscence, and the subsequent development of acute respiratory failure, acute kidney injury (AKI), stroke (cerebrovascular accident), ST-elevation myocardial infarction, limb loss, and mortality.

METHODS: A retrospective cohort study was conducted using the TriNetX database, identifying patients who underwent CFA exposure. Patients were stratified based on occurrence of hematoma, seroma, surgical site infection, or necrosis/dehiscence within 6 months, and whether they underwent surgical correction of the complication within 3 months. The 1- and 5-year incidences of high-acuity sequelae were analyzed. Propensity score matching controlled for demographics and comorbidities, including hypertension, diabetes, ischemic heart disease, end-stage renal disease, and tobacco use. Relative risk ratios (RRs) with 95% confidence intervals were calculated.

RESULTS: Among 129,774 patients, wound necrosis/dehiscence was the most prevalent complication and strongest predictor of long-term adverse outcomes. Complication rates generally peaked within the first postoperative month. Any postoperative complication significantly increased the 1-year incidence of limb loss (RR, 4.43; P < .0001) and AKI (RR, 1.42; P < .0001), as well as the 5-year incidence of limb loss (RR, 3.61; P < .0001), acute respiratory failure (RR, 1.28; P < .0001), AKI (RR, 1.28; P < .0001), cerebrovascular accident (RR, 1.09; P = .027), and mortality (RR, 1.03; P = .044). Patients requiring corrective procedures experienced additional risk, including higher 1-year and 5-year rates of limb loss and AKI.

CONCLUSIONS: Postoperative groin wound complications after CFA exposure are independently associated with increased long-term systemic and limb adverse outcomes, particularly limb loss and AKI. Wound necrosis/dehiscence demonstrated the strongest association across outcomes. These findings suggest that groin complications represent clinically meaningful markers of downstream risk and identify a critical early postoperative window for intensified surveillance and preventive intervention.