Summary:
Knoxville, Tennessee - Investigators from the East Tennessee Cardiovascular Surgery Group have published an article about the impact of endoscopic vein harvesting upon wound infections and outcomes in the Medicare population.
Dr Brandt, the leading author of this article believes that the "current trends [are] that patients referred for coronary artery bypass grafting (CABG) are significantly older, sicker, and at higher risk for complications than ever before."
It has been shown over and over again in the heart surgery literature that eliminating leg wound complications would improve outcomes after heart surgery and "reduce the consumption of health care time and dollars."
Endoscopic vein harvesting decreases the risk of wound infection after coronary artery bypass surgery and has been used recently to improve patient outcomes.
In essence, Dr. Brandt and colleagues performed a retrospective analysis of 1909 Medicare patients and 1485 non-Medicare patients who had undergone open saphenous vein or endoscopic saphenous vein harvesting for coronary artery bypass grafting.
The results of univariate analyses of the Medicare versus non-Medicare populations indicated "significant differences for higher preoperative peripheral vascular disease (25.4% versus 17.2%; P <.0001), renal failure (6.0% versus 2.8%; P <.0001), hypertension (75.4% versus 71.5%; P =.011), female sex (31.1% versus 22.4%; P <.0001), older age (69.8 years versus 57.1 years; P <.0001), and mortality risk (4.6% versus 2.2%; P <.0001)" according to the lead author.
The wound infection rates were higher by a factor of 2.5 in the Medicare group for open vein harvesting versus endoscopic vein harvesting (2.8% v 1.1%).
The investigators concluded that "there appears to be a general trend toward a lower treatment cost per patient and less resource use with endoscopic vein harvesting" despite the use of disposable instruments which are more costly for endoscopic vein harvesting.
Editor's Note:
This is a nice study investigating the incidence of saphenectomy site wound infections and complications in the Medicare population compared to a non-Medicare population. It confirms the often made statement by cardiac surgeons that Medicare patients are "sicker" and have "more comorbidities" than non-Medicare patients presenting for heart surgery. The utility of an endoscopic approach in this seminal study has decreased the incidence of leg wound complications in the Medicare population, reducing overall treatment cost per patient after heart surgery. Given the large number of Medicare patients undergoing heart surgery in the United States, if instituted globally, endoscopic vein harvesting will significantly reduce health care costs after heart surgery in this group of patients.
