Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting

Objective: The influence of endoscopic harvesting techniques on the prevale nce of leg-wound complications after coronary artery bypass grafting remain s to be defined for patients at high risk for the development of wound infe ctions. Methods: Among 1473 patients undergoing coronary artery bypass graf ting who had the saphenous vein harvested by either a continuous incision o r skip incisions leaving intact skin bridges, we determined the prevalence of wound infections to be 9.6%. The following variables were entered into l ogistic regression analysis to identify significant risk factors that might be predictive of wound infection: diabetes, peripheral vascular disease, o besity, renal failure, steroid use, age, sex, and type of closure. We then prospectively randomized 132 patients found to be at high risk of wound inf ection to either endoscopic vein harvesting or a continuous open incision. Results: Univariate analysis showed female sex (P =.04), diabetes (P <.001) , and obesity (P <.001) to be predictors of wound infection. In a multivari ate model diabetes (P =.02) and obesity (P =.001) were independent predicto rs. In patients at high risk, the prevalence of wound infection was 4.5 % f or the endoscopic group versus 20% for the open group (P =.01). Vein procur ement time was greater in the endoscopic group (65 minutes vs 32 minutes, P <.001), as was the number of vein repairs required (2.5 vs 0.6, P <.001). Conclusion: The use of endoscopic vein harvesting decreases the prevalence of postoperative leg-wound infections in high-risk patients with diabetes a nd obesity. Whether this translates into an economic benefit that justifies the additional cost of that technology requires further analysis.