title: Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis.
abstract: Minimally invasive great saphenous vein harvest for coronary artery bypass grafting aims to reduce post-operative leg-wound related morbidity. In a meta-analysis of randomised trials we have shown leg wound infection rates to be significantly lower in patients undergoing minimally invasive harvest. This study aims to use meta-analysis to compare the two techniques with regards to non-infective wound healing disturbances (NIWHD) (wound drainage, haematoma, dehiscence, necrosis, need for surgical debridement, and seroma formation). A meta-analysis of all studies published between 1995 and 2002 reporting a comparison between the two techniques was performed. Primary outcomes of interest were the six wound healing disturbances mentioned above and length of hospital stay. Heterogeneity was assessed using graphical exploration and sensitivity analysis with subgroup analysis. Twenty-seven studies published between 1997 and 2002 matched our selection criteria, with a combined total of 4953 subjects, of which 2442(49%) underwent minimally invasive harvest and 2511(51%) underwent conventional surgery. When considering only randomised studies, the total number of non-infective wound disturbances was lower in minimally invasive (4%) as compared to the conventional (13%) group (random effect OR 0.24, CI 0.16-0.38). Similar results were found when only fully matched studies were considered. The absolute risk reduction when comparing the two techniques was calculated to be 0.10, which translates to a number of patients needed to treat of 10. Length of stay was significantly reduced in the minimally invasive group in comparison to the conventional group (random effect weighted mean difference of -1.04, CI -1.92 to -0.16). Our results suggest that NIWHD all reduced with minimally invasive harvest techniques. Despite the limitations of this meta-analysis, we feel we have once again illustrated an important link between minimally invasive great saphenous vein harvest and improved tissue healing when compared to conventional open surgery. This has the potential to reduce wound-related morbidity, infection, post-operative pain, length of hospital stay, and re-admission rate.
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College of Science, Technology and Medicine, The National Heart and Lung Institute, St Mary's Hospital London, 70 St Olaf's Road, Fulham, London SW6 7DN, UK. tathan5253@aol.com
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Omer
authors.initials: O
authors.lastname: Aziz
authors.forename: Sharif
authors.initials: S
authors.lastname: Al-Ruzzeh
authors.forename: Pandelis
authors.initials: P
authors.lastname: Philippidis
authors.forename: Catherine
authors.initials: C
authors.lastname: Jones
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Roberto
authors.initials: R
authors.lastname: Casula
authors.forename: Brian
authors.initials: B
authors.lastname: Glenville
mesh_terms: D001026:Coronary Artery Bypass; D006801:Humans; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014945:Wound Healing