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The VascGSI Score: Development and Temporal Validation of a Predictive Scoring System for Groin Surgical Site
Dragan Nikolić1, Janko Pasternak1, Vladimir Manojlović1
1Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Clinic for Vascular and Endovascular Surgery, University Clinical Center of Vojvodina, Novi Sad, Serbia.
Background:
To develop and temporally validate a predictive scoring system (VascGSI Score) for groin surgical site infection (SSI) after vascular surgery.
Methods:
Retrospective cohort study reported per the TRIPOD statement (Collins et al., 2015). A tertiary referral vascular center serving a defined geographic region. From 12,180 femoral-access procedures (2010-2024), 2,156 percutaneous excluded. Of 10,024 with groin incision, 1,282 excluded. Final cohort: 8,742 incisions in 7,218 patients. Derivation 2010-2020 (n = 6,394); temporal validation 2021-2024 (n = 2,348). Groin SSI within 90 days per Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. Twenty-eight a priori candidate predictors. Multiple imputation (multivariate imputation by chained equations, m = 20). Logistic regression with generalized estimating equation confirmation.
Performance:
area under the receiver operating characteristic curve (AUC), calibration, decision curve analysis (5-30%), and net reclassification index/integrated discrimination improvement. Bootstrap (n = 1,000) and temporal validation.
Results:
Groin SSI occurred in 846/8,742 incisions (9.7%). Ten predictors were retained: diabetes (4 pts), prior femoral exploration/obesity/chronic kidney disease/operative time >180 min/immunosuppression/smoking (3 each), prosthetic graft/chronic limb-threatening ischemia/female sex (2 each). Generalized estimating equation confirmed all predictors (<5% odds ratio change). Derivation AUC 0.831 (0.812-0.850); bootstrap-corrected 0.819. Temporal validation AUC 0.808 (0.778-0.838). Calibration slopes 0.96/0.91. Risk tiers: low (0-6) 3.2%, moderate (7-13) 11.8%, high (14-20) 24.6%, and very high (>20) 41.1%.
Conclusion:
The VascGSI Score demonstrated good discrimination and calibration in temporal validation. Its incremental value over existing models requires confirmation in multicenter prospective studies before clinical implementation.
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