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Hassoun-Kheir N, Hasid I, Bozhko M, Shaban Z, Glam R, Hussein K, Paul M. Risk factors for limb surgical site infection following coronary artery bypass graft using open great saphenous vein harvesting: a retrospective cohort study. Interact Cardiovasc Thorac Surg 2019; 27:530-535. [PMID: 29688524 DOI: 10.1093/icvts/ivy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to define risk factors for limb (leg) surgical site infections (SSIs) following coronary artery bypass grafting (CABG) with open saphenous vein grafting and to estimate their consequences for patients. METHODS We performed a retrospective cohort study in a primary and tertiary hospital in Israel that included all adult patients undergoing CABG with open saphenous vein harvesting (November 2014-August 2016). Patients were followed perioperatively from admission until 90 days postoperatively, including post-discharge follow-up. Operative data were collected prospectively. We analysed risk factors for leg SSIs using univariate and multivariate methods. RESULTS Thirty-six of 351 (10.3%) patients developed leg SSI. Median time to detection was 14 days (interquartile range 11-24) and 25/36 (69.4%) patients were diagnosed after discharge. Independent risk factors for SSI included female sex [odds ratio (OR) 4.08, 95% confidence interval (CI) 1.79-9.28], body mass index >30 (OR 2.12, 95% CI 1.01-4.48), peripheral vascular disease (OR 3.33, 95% CI 1.48-7.49) and use of more than 1 saphenous vein graft (OR 2.08, 95% CI 0.88-4.96). Infected patients had longer hospitalizations after surgery [7 days (5-12) vs 6 days (5-7), P = 0.002], higher antibiotic consumption (P = 0.002) and higher readmission rates of 24/36 (66.7%) vs 59/262 (22.5%) (P < 0.001) than non-infected controls. CONCLUSIONS Leg SSIs following coronary artery bypass surgery are common and associated with morbidity. We suggest reconsidering open saphenous vein harvesting in obese female patients with peripheral vascular disease.
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Affiliation(s)
- Nasreen Hassoun-Kheir
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Inon Hasid
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Masha Bozhko
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Ziyad Shaban
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Roi Glam
- Department of Cardiovascular Surgery, Rambam Heath Care Campus, Haifa, Israel
| | - Khetam Hussein
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Heath Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Voellinger DC, Jordan WD. Video-Assisted Vein Harvest: A Single Institution's Experience of 103 Peripheral Bypass Cases. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449803200605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditional harvesting of the greater saphenous vein (GSV) has meant a long, continuous incision with the potential for increased morbidity, pain, and hospital stay. The authors have used a minimally invasive video-assisted technique in an attempt to reduce these complications. In this report, they retrospectively analyze a series of 103 cases of videoassisted saphenous vein harvests for vascular bypass procedures. All patients from September 1994 to May 1997 who underwent video-assisted saphenous vein harvest were reviewed for vein harvest time, hospital length of stay, surgical complications, graft patency, and clinical outcome. Operative technique used limited incisions, video-assisted dissection, and two different subcutaneous retractors-endoplastic (Type I) (Snowden Pencer, Tucker, GA) and endosaphenous (Type II) (Ethicon Endosurgery, Cincinnati, OH). Ninety-six patients underwent 103 operations for lower and upper extremity vascular disease. For all patients, the average time of vein removal was 0.74 cm vein/minute operative time, for procedures with the Type I retractor 0.63 cm vein/minute, for procedures with the Type II retractor 1.07 cm vein/minute (p≤0.0001). Postoperative length of stay (LOS) averaged 7.7 days (median 5 days) for all patients and was longer between patients with rest pain (6.4 days) and tissue loss (10.1 days) vs claudicants (4.4 days) (p<0.05), between patients with tibioperoneal anastomoses (10.0 days) vs patients with popliteal anastomoses (6.0 days) (p<0.05), and between Type I patients (8.3 days) and Type II patients (6.9 days) (p=0.03). Nine wound complications occurred (8.7%), two of which (1.9%) were directly related to the video-assisted technique. Cumulative graft patency was 84% ±9% after 18 months. According to the International Society for Cardiovascular Surgery reporting standards for lower extremity occlusive disease, patient outcome averaged +2.03 for all patients, and was improved between patients with claudication (+2.82) vs patients with rest pain (+1.50) (p<0.05) and between Type II patients (+2.36) vs Type I patients (+1.64) (p=0.01). Video-assisted saphenous vein harvest can be accomplished with low morbidity and provides a satisfactory conduit. The patients had a short postoperative LOS, a satisfactory wound complication rate, and a good operative outcome. The Type II saphenous vein retractor decreased operative time, shortened hospital LOS, and improved outcome.
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Affiliation(s)
| | - William D. Jordan
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Sharma M, Fakih MG, Berriel-Cass D, Meisner S, Saravolatz L, Khatib R. Harvest surgical site infection following coronary artery bypass grafting: risk factors, microbiology, and outcomes. Am J Infect Control 2009; 37:653-7. [PMID: 19375819 DOI: 10.1016/j.ajic.2008.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 12/25/2008] [Accepted: 12/30/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our goals were to evaluate the risk factors predisposing to saphenous vein harvest surgical site infection (HSSI), the microbiology implicated, associated outcomes including 30-day mortality, and identify opportunities for prevention of infection. METHODS All patients undergoing coronary artery bypass grafting (CABG) procedures from January 2000 through September 2004 were included. Data were collected on preoperative, intraoperative, and postoperative factors, in addition to microbiology and outcomes. RESULTS Eighty-six of 3578 (2.4%) patients developed HSSI; 28 (32.6%) of them were classified as deep. The median time to detection was 17 (range, 4-51) days. An organism was identified in 64 (74.4%) cases; of them, a single pathogen was implicated in 50 (78%) cases. Staphylococcus aureus was the most frequently isolated pathogen: 19 (38% [methicillin-susceptible S aureus (MSSA) = 12, methicillin-resistant S aureus (MRSA) = 7]). Gram-negative organisms were recovered in 50% of cases, with Pseudomonas aeruginosa predominating in 11 (22%) because of a single pathogen. Multiple pathogens were identified in 14 (22%) cases. The 30-day mortality was not significantly different in patients with or without HSSI. Multivariate analysis showed age, diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery to be associated with increased risk. CONCLUSION Diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery were associated with increased risk for HSSI. S aureus was the most frequently isolated pathogen.
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Affiliation(s)
- Mamta Sharma
- Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI, USA.
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Ho CKL, Sun MP, Au TWK, Chiu CSW. Pneumatic pump reduces leg wound complications in cardiac patients. Asian Cardiovasc Thorac Ann 2008; 14:452-7. [PMID: 17130317 DOI: 10.1177/021849230601400602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Leg wound complications at the site of vein harvest for coronary artery bypass graft, although infrequent, cause significant morbidity. Pneumatic pressure therapy is valuable in venous and lymphatic diseases, but its usefulness after leg vein harvest has not been determined. A prospective randomized controlled trial was conducted on 200 patients, half of whom had sequential pneumatic leg pump therapy postoperatively. Wound healing, extent of lower limb edema, patient satisfaction, and the financial implications of pneumatic pressure therapy were assessed. In the study group, 71 patients had satisfactory wound healing vs. 23 in the control group. The leg wound infection rate in the study group was 3% vs. 15% in the control group ( p = 0.003). Lower limb edema was significantly reduced in the study group in the early postoperative period ( p < 0.05), and the mean postoperative length of hospital stay was reduced by 2.6 days in patients given pneumatic pressure therapy ( p = 0.003). The sequential pneumatic leg pump is an effective, inexpensive, and convenient device that reduces leg wound complications after coronary artery bypass grafting.
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Affiliation(s)
- Cally K L Ho
- Division of Cardiothoracic Surgery, Department of Surgery, Grantham Hospital, The University of Hong Kong, Hong Kong, China.
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Shah SA, Chark D, Williams J, Hessheimer A, Huh J, Wu YC, Chang PA, Scholl FG, Drinkwater DC. Retrospective analysis of local sensorimotor deficits after radial artery harvesting for coronary artery bypass grafting. J Surg Res 2007; 139:203-8. [PMID: 17292405 DOI: 10.1016/j.jss.2006.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 09/19/2006] [Accepted: 10/03/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The radial artery (RA) has gained widespread acceptance as a conduit for coronary artery bypass. We analyze patient-based data to determine risk factors for long-term upper limb morbidities associated with RA harvest for coronary artery bypass grafting. STUDY DESIGN/METHODS Between April 1997 and March 2004, a total of 1030 patients underwent RA harvesting for coronary artery bypass grafting for a total of 1704 harvest sites. Patients were contacted by telephone and asked to report any ongoing severe sensory and functional motor deficits for each harvest site since surgery. Retrospective chart review was performed and preoperative risk factors were evaluated. Patient-based risk factors were evaluated for development of significant long-term local sensorimotor deficits including gender, elderly age (>70 y), diabetes, smoking, and whether the RA was harvested from the dominant hand. RESULTS Successful evaluation of 629 patients for a total of 1048 RA harvest sites was completed. The mean follow-up time was 48.3 mo (range, 2 to 86 mo). The mean age of the patients analyzed was 62.2 y. On statistical analysis, diabetics and elderly did not report significantly greater functional or sensory deficits than nondiabetics and nonelderly, respectively. There was a significantly higher incidence of sensory deficits in smokers compared with nonsmoker patients (4.2% versus 1.4%; P = 0.005) but no difference in their functional impairment was noted. Harvesting from the dominant hand did not influence the occurrence of sensory or motor functional deficits. CONCLUSIONS RA harvesting for coronary artery bypass grafting can be done with minimal serious long-term upper limb morbidity in higher risk patients. Based on our findings, harvesting of the RA from the dominant hand is not contraindicated in these patients.
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Affiliation(s)
- Salman A Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-9292, USA.
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Hata M, Shiono M, Sezai A, Iida M, Saitoh A, Hattori T, Wakui S, Soeda M, Negishi N, Sezai Y. Comparative Study of Harvest-Site Complications Following Coronary Artery Bypass Grafting Between the Radial Artery and the Saphenous Vein in Identical Patients. Surg Today 2005; 35:711-3. [PMID: 16133663 DOI: 10.1007/s00595-005-3033-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 01/18/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to assess the early outcome for complications associated with the radial artery harvest site, in comparison to using the saphenous vein, in patients harvested for both vessels. METHODS During the last 2 years, 134 radial arteries were used in 133 patients, and the saphenous vein was also concomitantly used in 94 patients. We assessed the post-harvest forearm perception using a questionnaire that contained two statements regarding pain and numbness in those 94 patients. The incidences of the harvest-site hematoma and infection were also compared between both the arms and legs where the grafts were harvested. RESULTS Numbness of the harvest site was indicated in 26.6% (radial artery) and 33.0% (saphenous vein), respectively (P = 0.4252). Hematoma was found in 6.4% and 12.8%, respectively (P = 0.2152). On the other hand, the incidences of pain and wound infection were significantly lower in the radial artery sites (pain: 1.1% vs 23.4%, P = 0.0002; infection: 2.1% vs 11.7%, P = 0.0182). CONCLUSIONS Our early experience suggests that the use of the radial artery is safe and also demonstrates a lower incidence of harvest-site complications than saphenous vein harvesting in patients where both vessels are used as harvest sites.
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Affiliation(s)
- Mitsumasa Hata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi, Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Olsen MA, Sundt TM, Lawton JS, Damiano RJ, Hopkins-Broyles D, Lock-Buckley P, Fraser VJ. Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2003; 126:992-9. [PMID: 14566237 DOI: 10.1016/s0022-5223(03)00200-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Harvest site infections are more common than chest surgical infections after coronary artery bypass surgery, yet few studies detail risk factors for these infections. We sought to determine independent risk factors for leg surgical site infections using our institutional Society of Thoracic Surgeons database. METHODS We retrospectively analyzed data collected from 1980 coronary artery bypass patients undergoing surgery at our institution from January 1, 1996, through June 30, 1999, using The Society of Thoracic Surgeons database. Independent risk factors for leg harvest site infection were identified by multivariate logistic regression. RESULTS Seventy-six patients (4.5%) were coded as having had a leg harvest site infection, of which 67 were confirmed by infection control. The length of hospital stay after surgery was significantly longer in patients with leg harvest site infection (mean 10.1 days) compared with that of patients without infection (mean 7.1 days, P <.001), and infected patients were more likely to be readmitted to the hospital within 30 days of surgery. Independent risk factors for leg harvest site infection included previous cerebrovascular accident (odds ratio, 2.9), postoperative transfusion of 5 units or more of red blood cells (odds ratio, 2.8), obesity (odds ratio, 2.5), age 75 years or older (odds ratio, 1.9), and female gender (odds ratio, 1.8). CONCLUSIONS Consistent with previous studies, female gender and obesity were identified as independent risk factors for leg harvest site infection, while previous cerebrovascular accident, postoperative transfusion, and older age are newly described risk factors. The Society of Thoracic Surgeons database is a useful tool for identification of predictors of leg harvest site infections.
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Affiliation(s)
- Margaret A Olsen
- Washington University School of Medicine, Division of Infectious Diseases, 660 South Euclid Ave, Campus Box 8051, St Louis, MO 63110-1093, USA.
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Rosenfeldt FL, Negri J, Holdaway D, Davis BB, Mack J, Grigg MJ, Miles C, Esmore DS. Occlusive wrap dressing reduces infection rate in saphenous vein harvest site. Ann Thorac Surg 2003; 75:101-5; discussion 105. [PMID: 12537200 DOI: 10.1016/s0003-4975(02)04121-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infection in the saphenous vein harvest site is a common problem. We developed an occlusive circumferential wrap dressing technique that reduces skin edge tension, eliminates dead space, and prevents external contamination. We compared the surgical site infection rate using the wrap dressing technique with that of standard longitudinal dressings. METHODS. One hundred fifty-two consecutive patients were randomly assigned to receive either standard dressings or the wrap dressing. Data were collected in the hospital and then 4 to 6 weeks postoperatively. Superficial and deep wound infections were defined by the standard criteria from the Centers for Disease Control and Prevention. RESULTS The infection rate in the wrap group was 14% compared with 35%, for the standard group (p = 0.006). Multivariate analysis showed that wrap technique was the only significant predictor (negative) of infection (odds ratio, 0.19; p = 0.001). CONCLUSIONS In saphenous vein harvest wounds, the occlusive wrap dressing technique has the potential to reduce the rate of infection by 50%. This simple and inexpensive technique is also readily applicable to the radial artery harvest site in the arm and may provide similar benefit.
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Affiliation(s)
- Franklin L Rosenfeldt
- Cardiac Surgical Research Unit, Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
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Hata M, Raman J, Seevanayagam S, Hare D, Buxton BF. Post radial artery harvest hand perception: postoperative 12-month follow-up results. Circ J 2002; 66:816-8. [PMID: 12224818 DOI: 10.1253/circj.66.816] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 12-months' follow-up results for radial artery harvest in relation to complications are reported and compared with the postoperative 3-months' results. The postoperative wound problems of 155 patients who underwent coronary artery bypass grafting with radial artery harvesting were assessed using a questionnaire at 3 and 12 months after surgery. The questionnaire contained 9 statements concerning hand and forearm problems in daily life. The answers were graded in 7 levels. An answer of higher than grade 3 (mild symptoms) was regarded as a significant symptom. No hand ischemic complications was observed. In the 12 month-study, 152 patients (98.1%) were normal. Hand pain and numbness occurred in 25 patients (16.1 %) and 33 patients (21.3%), respectively, at 3 months and were markedly improved at 12 months (pain: 13 (8.4%), p = 0.045, numbness: 20 (12.9%), p = 0.069). Total scores for all questions also significantly decreased at 12 months (10.2 +/- 3.5) compared with 3 months (11.1 +/- 3.9) postoperatively (mean +/- SD, p = 0.0003). Radial artery harvest was quite acceptable from the patient's perception, although a few patients had numbness and pain in the 3 months after surgery. Those complications significantly improve in the later postoperative phase.
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Affiliation(s)
- Mitsumasa Hata
- Department of Cardiac Surgery, Austin & Repatriation Medical Centre, University of Melbourne, Victoria, Australia.
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Reddy VS, Parikh SM, Drinkwater DC, Lo A, Rauth TP, Moleski RM, Chang PA. Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization. Ann Thorac Surg 2002; 73:803-7; discussion 807-8. [PMID: 11899184 DOI: 10.1016/s0003-4975(01)03576-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of radial arteries for coronary revascularization is increasing. There remain concerns regarding alteration of upper extremity function after radial artery procurement. This study evaluates the functional morbidity in higher risk patients. METHODS Between April 1997 and September 1999, 374 patients underwent unilateral or bilateral radial artery procurement. A questionnaire was used to evaluate symptoms related to motor and sensory function and changes in appearance after radial artery harvest. RESULTS Two hundred eighty-nine patients were successfully interviewed. The average age was 63 years. Median follow-up was 9.5 months (range, 2 to 23 months). No patient suffered limb loss. Altered gross and fine motor function, residual pain, paresthesias, numbness, pallor, swelling, and altered temperature sensation were compared among diabetic patients, patients older than 70 years, and patients without these characteristics. CONCLUSIONS Radial artery procurement for elective coronary revascularization can be done with minimal serious morbidity in higher risk patients. The most common symptoms were numbness and paresthesia. Despite the finding of greater residual pain in diabetic patients, we do not believe the use of radial artery conduits is contraindicated in these patients.
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Affiliation(s)
- V Seenu Reddy
- Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5734, USA
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Trick WE, Scheckler WE, Tokars JI, Jones KC, Smith EM, Reppen ML, Jarvis WR. Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery. Clin Infect Dis 2000; 30:270-5. [PMID: 10671327 DOI: 10.1086/313657] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Radial arteries increasingly are used during coronary artery bypass graft (CABG) surgery. Although risk factors for saphenous vein harvest site infection (HSI) have been reported, rates of and risk factors for radial artery HSI are not well established. We compared rates of radial artery HSI that were detected by 2 surveillance methods, regular and heightened. Risk factors were determined by a case-control study. We identified 35 radial artery HSIs ("case sites") in 26 case patients. The radial artery HSI rate was significantly higher during heightened surveillance than during routine surveillance (12.3% vs. 3.1%, respectively; P=.002). Multivariate analysis showed that diabetes mellitus with a preoperative glucose level >/=200 mg/dL (odds ratio [OR], 4.4; P=. 01) and duration of surgery >/=5 h (OR, 3.1; P=.02) were independent risk factors for radial artery HSI. Infection is a common complication of radial artery harvesting for CABG surgery, and infection rates are dependent on the intensity of surveillance. We identified preoperative hyperglycemia and surgery duration as independent risk factors for radial artery HSI.
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Affiliation(s)
- W E Trick
- Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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