J Thorac Cardiovasc Surg 2004;127:1535
© 2004 The American Association for Thoracic Surgery
Saphenectomy wound complications: The real story
Keith B. Allen, MD
10590 N Meridian St, Suite 105, Indianapolis, IN 46290 USA
To the Editor:
Olsen and colleagues,1 in a recent retrospective analysis, have suggested that the Society of Thoracic Surgeons database is a useful tool for tracking saphenous vein harvest site infections and determining predictors for this complication. They report a 4.5% wound complication rate after traditional open saphenectomy in 1980 patients undergoing coronary artery bypass grafting from 1996 through 1999. Although their article may accurately report wound complications identified while the patient is in the hospital, it is unlikely they capture the vast majority of leg wound complications, because most occur after discharge. They cite poor outpatient follow-up as a potential limitation of their study; however, their article fails to site published, prospectively collected data on this topic. Two prospective studies, by Allen and coworkers2 and Utley and associates,3 have evaluated longitudinal saphenectomy wound complications after coronary artery bypass grafting with the same wound complication definition and independent assessment, including outpatient follow-up. They reported complication rates of 19% and 24%, respectively, which are much higher then observed in this retrospective series.
Contrary to the discussion by Olsen and colleagues,1 endoscopic vein harvest as a means of reducing leg wound complications has been validated by more than one prospective, randomized trial, and it has consistently been shown to be superior regarding wound complications relative to an open harvest technique. In the first prospective, randomized comparison of endoscopic versus longitudinal saphenectomy, endoscopic vein harvest was associated with a significant reduction in leg wound complications (4% vs 19%, respectively).2 Unfortunately, that 1998 article was missed during the literature search for the article of Olsen and colleagues.1 Furthermore, traditional saphenectomy has been identified as an independent predictor for leg wound complications, and the use of endoscopic vein harvest modifies the impacts of diabetes, peripheral vascular disease, female gender, and obesity as risk factors for development of leg wound complications.4 Olsen and colleagues are to be applauded for continuing to bring the problem of saphenectomy wound complications to the attention of cardiac surgeons. They do a disservice, however, by publishing a 4.5% complication rate that underestimates the true scope of this problem. Databases such as that of the Society of Thoracic Surgeons do an excellent job of tracking events while patients are hospitalized; however, their ability to track events that occur and are managed on an outpatient basis is less reliable.
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References
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- Olsen MA, Sundt TM, Lawton JS, Damiano RJ, Hopkins-Broyles D, Lock-Buckley P, et al. Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2003;126:992–999[Abstract/Free Full Text]
- Allen KB, Griffith GL, Heimansohn DA, Robison RJ, Matheny RG, Schier JJ, et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg. 1998;66:26–32[Abstract/Free Full Text]
- Utley JR, Thomason ME, Wallace DJ, Mutch DW, Staton L, Brown V, et al. Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg. 1989;98:147–149[Abstract]
- Allen KB, Heimansohn DA, Robison RJ, Schier JJ, Griffith GL, Fitzgerald EB, et al. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surg Forum. 2000;3:325–330[Medline]
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