title: Wound complications after inguinal lymph node dissection for melanoma: is ACS NSQIP adequate?
abstract: BACKGROUND
  In the treatment of melanoma, inguinal lymph node dissection (ILND) is the standard of care for palpable or biopsy-proven lymph node metastases. Wound complications occur frequently after ILND. In the current study, the multicenter American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was utilized to examine the frequency and predictors of wound complications after ILND.
  
  
  METHODS
  Patients with cutaneous melanoma who underwent superficial and superficial with deep ILND from 2005-2010 were selected from the ACS NSQIP database. Standard ACS NSQIP 30-day outcome variables for wound occurrences-superficial surgical site infection (SSI), deep SSI, organ space SSI, and disruption-were defined as wound complications.
  
  
  RESULTS
  Of 281 total patients, only 14 % of patients had wound complications, a rate much lower than those reported in previous single institution studies. In a multivariable model, superficial with deep ILND, obesity, and diabetes were significantly associated with wound complications. There was no difference in the rate of reoperation in patients with and without wound complications.
  
  
  CONCLUSIONS
  ACS NSQIP appears to markedly underreport the actual incidence of wound complications after ILND. This may reflect the program's narrow definition of wound occurrences, which does not include seroma, hematoma, lymph leak, and skin necrosis. Future iterations of the ACS NSQIP for Oncology and procedure-specific modules should expand the definition of wound occurrences to incorporate these clinically relevant complications.
authors: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors: Carly E
authors: CE
authors: Glarner
authors: David Y
authors: DY
authors: Greenblatt
authors: Robert J
authors: RJ
authors: Rettammel
authors: Heather B
authors: HB
authors: Neuman
authors: Sharon M
authors: SM
authors: Weber
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000592:standards; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D016015:Logistic Models; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*