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Higher Surgical Site Infection Rate after Endoscopic Vein Harvest at the Lower Leg than at the Thigh - A Prospective Analysis Including 1251 Patients undergoing CABG
Devdas T. Inderbitzin1, Oliver Reuthebuch1, Bernhard Winkler1, Ludovic Melly1, Peter Matt1, Florian Rueter1, Martin Grapow1, Brigitta Gahl2, Friedrich Eckstein1, Andreas Widmer3.
1Clinic for Cardiac Surgery Basel-Bern, University Hospital Basel, Basel, Switzerland, 2Clinic for Cardiac Surgery Bern-Basel, University Hospital Bern, Basel, Switzerland, 3Clinic for Epidemiology and Infectious Disease, University Hospital Basel, Basel, Switzerland.
Background: Surgical site infection (SSI) after vein harvesting in CABG is a rare, but devastating complication. We prospectively analyzed the incidence of and potential risk factors for SSI in a 2 years follow-up. Methods: From 1.8.2008-31.8.2011, data from all patients consecutively undergoing venous coronary arterial bypass grafting (CABG) were prospectively collected in a standardized case report form, including age, gender, underlying diseases, location of venous harvest (thigh and lower leg, incision approx. 5 cm), endoscopic vs. open harvest. SSI was defined as surgical site irritation with classic infectious cardinal symptoms (dolor, rubor, calor). SSI-follow-up was accomplished by phone call 1 and 6 months after surgery. Data were statistically analyzed for potential risk factors for SSI in a multivariate analysis. Results: Totally 1251 patients (80.8% male, mean age 67 ± 9.9 years, bodymass index (BMI) 27.4 ± 4.5 kg/m2; no significant differences between open vs. endoscopic vein harvesting by Mann-Whitney Test p>0.05) were included and 100% were analyzed. Endoscopic vein harvest was performed in 77.8% (n=973), open in 22.2% (n=278). The overall incidence of SSI at the harvest site was 1.8% (n=23); 1.4% (n=14) after endoscopic and 3.2% (n=9) after open harvest. Endoscopic harvest (vs. open) showed no clear tendency for less SSI (p 0.542 by Fishers Exact Test). Initially, endoscopic harvesting above the knee was significantly protective for SSI (p 0.001*). This effect was not anymore statistically significant in the multivariate analysis. In addition, BMI, peripheral arterial vascular disease (PAVD), diabetes, age, gender, and duration of surgery were also not significantly associated with SSI. Conclusions: Endoscopic vein harvesting was associated with a low incidence of local SSI (1.4%). The absence of evident common risk factors for SSI in endoscopic vein harvesting suggests this technique to be safe even in obese, PAVD- and diabetic patients and long lasting cardiac surgery.
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