215 * COST-BENEFIT OF ENDOSCOPIC VEIN HARVESTING IN HIGH-RISK PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Abstract

Objectives: Our aim was to assess the cost-benefit of endoscopic vein harvesting (EVH) in high-risk patients undergoing CABG. Methods: Patients at high risk of leg wound complication (female, age >75 years), diabetic, peripheral vascular disease (PVD), BMI >28 kg/m2, smoker) were selected for pilot use of EVH and were propensity-matched to patients undergoing open vein harvest (OVH). Patients had at least two of these risk factors (n = 50 patients/group). Data was prospectively collected. All wounds were assessed during in-hospital stay, regularly in the wound clinic and up until wounds had healed. Costs of treating wounds included additional in-hospital stay, costs of the various dressings, costs of attending wound clinic and any additional treatment (e.g. wound debridement, vacuum-assisted closure therapy etc.). For the EVH group, there was the additional cost for the kit (£650/patient). Results: There were no significant differences between the two groups in preoperative characteristics (age, gender, diabetes, PVD, smokers, procedure, logistic EuroSCORE, etc.). Prior to hospital discharge, 9% vs 16% (P = 0.08) of patients (EVH vs OVH) had minor leg-wound suppurations. Leg-wound pain score was lower for the EVH group (P < 0.01). There was an additional 1-day ward postoperative stay for the OVH group (P = 0.02). At follow-up, 2% vs 48% patients had leg-wound issues requiring attendance to the wound clinic, respectively (P < 0.01) costing a total of £2,758 (EVH) as compared to £78,036 (OVH) (P < 0.01). This amounted to a cost saving of £42,778 (including EVH kit costs) favouring EVH. Conclusion: EVH provided better patient outcomes (less leg-wound problems, reduced leg-wound pain and shorter ward-stay postoperatively). This was associated with significant cost savings for treating leg wound complications in high-risk patients undergoing EVH.