title: Surgical wound complications after groin dissection in melanoma patients - a historical cohort study and risk factor analysis.
abstract: OBJECTIVE
  Wound complications occur frequently after inguinal lymph node dissection (ILND) in melanoma patients. Evidence on risk factors for complications is scarce and inconsistent. This study assessed wound complication rates after ILND and investigated associated risk factors, in the melanoma unit of a specialised cancer hospital.
  
  
  METHODS
  A chart review was conducted of all patients on whom inguinal lymph node dissection had been performed between 2003 and 2013. Wound infections, seroma formation and skin flap problems were assessed according to explicit definitions and graded through the modified Clavien system. Univariable and multivariable penalized logistic regression was used to identify risk factors. The primary factors of interest were body mass index, age, smoking, diabetes, cardiovascular and/or pulmonal comorbidity, palpable disease and postoperative bedrest. Additionally, the influence of incision-type, sartorius transposition, saphenous vein sparing and skin removal was examined.
  
  
  RESULTS
  A total of 145 procedures was examined. One or more complications occurred in 104 (72%) of the procedures; wound infection in 45%, seroma formation in 37% and skin flap problems in 26%. The only statistically significant risk factor was age (odds ratio for one standard deviation increase: 1.46, 95%CI 1.01-2.14, p = 0.05).
  
  
  CONCLUSIONS
  Wound complication rates after ILND in melanoma patients are high. Age was the only predictor of complications in this cohort, other previously identified risk factors could not be confirmed.
authors.affiliation: The Netherlands Cancer Institute, Department of Physiotherapy, The Netherlands; Academic Medical Centre, University of Amsterdam, Department of Clinical Epidemiology Biostatistics and Bioinformatics, The Netherlands. Electronic address: m.stuiver@nki.nl.
authors.forename: M M
authors.initials: MM
authors.lastname: Stuiver
authors.affiliation: The Netherlands Cancer Institute, Skin and Melanoma Center and Department of Surgical Oncology, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Westerduin
authors.affiliation: The Netherlands Cancer Institute, Skin and Melanoma Center and Department of Surgical Oncology, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: ter Meulen
authors.affiliation: The Netherlands Cancer Institute, Department of Biostatistics, The Netherlands.
authors.forename: A D
authors.initials: AD
authors.lastname: Vincent
authors.affiliation: The Netherlands Cancer Institute, Skin and Melanoma Center and Department of Surgical Oncology, The Netherlands.
authors.forename: O E
authors.initials: OE
authors.lastname: Nieweg
authors.affiliation: The Netherlands Cancer Institute, Skin and Melanoma Center and Department of Surgical Oncology, The Netherlands.
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery*; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D049291:Seroma / Q000453:epidemiology*; D012878:Skin Neoplasms / Q000601:surgery*; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
keywords: Inguinal lymph node dissection; Melanoma; Neoplasms; Risk factors; Wound complications