Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2004
Minimally invasive great saphenous vein harvest for coronary artery bypass grafting aims to reduce post-operative leg-wound related morbidity. In a meta-analysis of randomised trials we have shown leg wound infection rates to be significantly lower in patients undergoing minimally invasive harvest. This study aims to use meta-analysis to compare the two techniques with regards to non-infective wound healing disturbances (NIWHD) (wound drainage, haematoma, dehiscence, necrosis, need for surgical debridement, and seroma formation). A meta-analysis of all studies published between 1995 and 2002 reporting a comparison between the two techniques was performed. Primary outcomes of interest were the six wound healing disturbances mentioned above and length of hospital stay. Heterogeneity was assessed using graphical exploration and sensitivity analysis with subgroup analysis. Twenty-seven studies published between 1997 and 2002 matched our selection criteria, with a combined total of 4953 subjects, of which 2442(49%) underwent minimally invasive harvest and 2511(51%) underwent conventional surgery. When considering only randomised studies, the total number of non-infective wound disturbances was lower in minimally invasive (4%) as compared to the conventional (13%) group (random effect OR 0.24, CI 0.16-0.38). Similar results were found when only fully matched studies were considered. The absolute risk reduction when comparing the two techniques was calculated to be 0.10, which translates to a number of patients needed to treat of 10. Length of stay was significantly reduced in the minimally invasive group in comparison to the conventional group (random effect weighted mean difference of K1.04, CI K1.92 to K0.16). Our results suggest that NIWHD all reduced with minimally invasive harvest techniques. Despite the limitations of this meta-analysis, we feel we have once again illustrated an important link between minimally invasive great saphenous vein harvest and improved tissue healing when compared to conventional open surgery. This has the potential to reduce wound-related morbidity, infection, post-operative pain, length of hospital stay, and re-admission rate. q
The Annals of Thoracic Surgery, 2010
Background. Endoscopic saphenous vein harvest (EVH) decreases leg wound infections and improves cosmesis after coronary artery bypass grafting (CABG). Recent data, however, suggest that EVH may be associated with reduced graft patency rates. The objective of this study is to assess the effect of EVH on short-term and midterm outcomes after CABG. Methods. Data were prospectively collected on all first-time isolated CABG and combined valve/CABG with saphenous vein graft between 1998 and 2007 at a single center. Patients having traditional "open" vein harvest (OVH) were compared with patients having EVH. Multivariate models were used to examine the risk-adjusted impact of EVH on postoperative leg infection, composite in-hospital adverse events, and individual and composite midterm adverse events. Results. The study included 5,825 patients, of whom 2,004 (34.4%) had EVH. Patients having EVH were more likely to have ejection fraction less than 50% (32.0% versus 29.3%, p ؍ 0.04), recent myocardial infarction (24.2% versus 18.3%, p < 0.0001), and left main disease (26.0% versus 22.1%, p ؍ 0.0009). Median follow-up was 2.6 years. After risk adjustment, EVH was associated with reduced rates of leg infection (odds ratio 0.48, p ؍ 0.003) but had no association with either in-hospital (odds ratio 0.93, p ؍ 0.56) or midterm adverse outcomes (hazard ratio 0.93, p ؍ 0.22). Endoscopic saphenous vein harvest was associated with reduced readmission to hospital for unstable angina (odds ratio 0.74, p ؍ 0.01). Conclusions. Endoscopic saphenous vein harvest is associated with a lower rate of leg infection and is not an independent predictor of in-hospital or midterm adverse outcomes. Endoscopic saphenous vein harvest is a safe alternative to OVH for patients undergoing CABG with saphenous vein.
Interactive cardiovascular and thoracic surgery, 2012
The use of an open vein harvesting (OVH) technique for saphenous vein harvesting (SVH) is associated with wound complications and delayed patient mobilization. This has led to the development of minimally invasive vein harvesting (MIVH) techniques, such as standard bridging and endoscopic SVH (EVH). This randomized trial was established to assess immediate clinical outcome and patient satisfaction in our centre. A total of 150 consecutive patients were prospectively randomized into three groups. Group 1 consisted of 50 patients who underwent OVH, Group 2 consisted of 50 patients who underwent a standard bridging technique (SBT) and Group 3 consisted of 50 patients who underwent EVH. Each group was assessed for the incidence of wound infection, postoperative pain and satisfaction and the number of vein repairs using previously validated scoring systems. The MIVH techniques reduced the pain at hospital (P < 0.001) and at 6 weeks (P < 0.001), and improved cosmesis (P < 0.001),...
4-Year Outcome Analysis of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting
ISRN Vascular Medicine, 2013
Objective. Despite increasing recognition that endoscopic vein harvesting (EVH) is associated with decreased leg wound morbidity, improved cosmetic results, and enhanced patient satisfaction, concerns persist regarding the safety and efficacy of EVH. This study compares in-hospital and midterm outcomes for EVH and open vein harvesting (OVH) at our institution.Methods. 772 patients with EVH were propensity matched to 772 patients who had OVH. Their data were prospectively entered into the cardiac surgery database (PATS; Dendrite Clinical Systems, Ltd., Oxford, UK) and analyzed, retrospectively. The mean duration of followup was 26.4 ± 10.3 months.Results. EVH was associated with a significant reduction in rate of donor site infection compared to OVH (0.39% versus 3.9%, ). Short- and medium-term vein graft patency was similar. After adjusting for clinical covariates, EVH did not emerge as an independent predictor of readmission to hospital for cardiac causes (odds ratio (OR) 1.19, 95%...
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2002
Despite renewed clinical interest in radial artery grafts (RA) for coronary artery bypass grafting, there is a paucity of controlled prospective data on its efficacy. We report on the rate of harvest related complications from a randomized radial artery study. Two hundred eighty nine patients were divided into two groups. Group 1 received RA grafts (n=154 patients) and Group 2 (n=135 patients) received saphenous vein grafts (SVG). Postoperative wound problems were assessed using a questionnaire. Postoperative harvest site infections were also carefully documented. In group 1, 6 of 154 (3.9%) patients had harvest site wound infections. Five of them improved by antibiotic therapy alone. In group 2, 24 of 135 (17.8%) patients had harvest site wound infections (p=0.001 vs. group 1). Fifteen of these patients needed redressing due to discharge from the wound. One hundred forty-nine patients (96.7%) in group 1 answered that their hand function was normal on the questionnaire. Concerns and...
European Journal of Cardio-Thoracic Surgery, 2004
Objective: To evaluate the prevalence of leg complications following leg-vein harvest for coronary artery bypass grafting. Method: A questionnaire was sent to patients who had coronary artery bypass surgery between January 1993 and December 1998. Questions addressed pain, numbness, infection, swelling and general healing. The relationship between the risk factors of diabetes, peripheral vascular disease, previous fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs with post operative symptoms of pain, numbness, swelling and general healing was explored with multivariate analysis. Results: Of 700 questionnaires sent out 497 were returned, of which 422 (60%) were suitable for analysis. Numbness or tingling related to the wound was reported by 256 (61%), of whom 94 (37%) improved within 3 months. However, 105 (41%) had persistent numbness beyond 2 years. Pain in the wound was reported by 193 (46%), of whom 149 (77%) reported that this had improved by 3 months and only 19 (10%) had pain persisting beyond 2 years. A leg wound infection was reported by 126 (32%) patients, with 82 (65%) of these receiving antibiotics. A total of 336 (87% of 387 responses) described their wound as completely healed at 3 months. Unilateral leg swelling was reported by 175 (41%) with 98 of these (56% of those with swelling) improving by 3 months and 41 (23%) with swelling persisting beyond 2 years. There was no relation of wound problems to examined risk factors diabetes (P-values for numbness 0.31, wound healing 0.15, swelling 0.21, pain 0.22) and peripheral vascular disease (P-values for numbness 0.8, wound healing 0.21, swelling 0.18, pain 0.09). There was insufficient data to comment on the influence of fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs. Conclusions: Wound complications are common following leg vein harvest. Prevalence of infection was higher than has previously been reported. Few people suffer long-term pain from saphenous nerve damage although paraesthesia and swelling were common long-term complications. We did not identify either diabetes or peripheral vascular disease as a risk factor for pain, numbness, swelling or problems with general healing. There is a need for a large multicentre prospective study. q
2010
Coronary artery bypass graft (CABG) surgery involves harvesting the great saphenous vein (GSV) using the traditional open technique (TOT). This can be associated with significant leg morbidity and patient dissatisfaction. Alternatively, the standard bridging technique (SBT) is a minimally invasive procedure of vein retrieval that uses smaller frequent incisions along the length of the leg and may reduce postoperative complications. This study was designed to compare the success of SBT in reducing leg morbidity and increasing patient satisfaction. One hundred patients were recruited into the study and computer randomised into two groups of 50 undergoing SBT or TOT. Leg morbidity and patient satisfaction were analysed by assessment of pain scores, wound development and scar formation. Closure and harvesting time were also compared between the two groups. SBT was associated with better wound development (P-0.001) and a significantly higher patient satisfaction (P-0.001). Leg pain was significantly reduced amongst SBT group at rest and with movement (P-0.001). There was also a reduction in saphenous neuropathy with the use of SBT (P-0.001). No difference in closure or harvesting time was demonstrated (Ps0.26 and Ps0.23, respectively). This study demonstrates that harvesting the GSV by the minimally invasive SBT reduces postoperative leg morbidity and increases patient satisfaction without the need of costly equipment. SBT represents a safe, effective and financially viable technique for vein harvesting.
Introduction: Wound infection is one of the major complication post CABG that leads to prolonged length of stay and cost post surgery. Coronary artery bypass grafting is one of the most commonly performed operations in the world. The long saphenous vein harvested by traditional techniques is still widely used and caries a risk of wound infection. Objective: The purpose of this study is to ascertain if a single-layer closure result in better wound healing and functional outcome as compared with the traditional two-layer closure after harvest of saphenous vein. Methods: Sixty-seven consecutive patients undergoing CABG were prospectively randomized to have their leg wound closed by either a single-layer technique with a suction drain or double layers without suction drain. All wounds were assessed for the presence of serous discharge, inflammation, edema, purulent exudates, infection of the deep tissues, and pain postoperatively and two weeks after discharge. Results: There were trends towards increased rates of wound related outcomes in patients in double layer group when compared with single layer group. Out of 77 patients in our study, 52 patients underwent single layer closure (males, n = 37; females, n= 15) and 25 patients underwent double layer closure (males, n = 21; females, n = 04). There was significant statistical difference between the treatment groups with single layer group having lower average scores (4.038) compared to double layer group (9.467), P-value 0.001. Patients whose legs were closed with the single layer technique had less post operative edema (23.07% vs 53.30) and pain (44.2 vs 73.33) compared with the double layer group. Conclusions: Single-layer leg wound closure over a suction drain has shown a better wound outcome compared to traditional double-layer closure. A possible mechanism of better wound healing in the former technique might be through decreased tissue handling and a reduction in leg edema. single layer closure; double layer closure; saphenous vein
Preventing deep wound infection after coronary artery bypass grafting: a review
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2013
The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and...