Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery

Judson B. Williams, Eric D. Peterson, J. Matthew Brennan, Art Sedrakyan, Dale Tavris, John H. Alexander, Renato D. Lopes, Rachel S. Dokholyan, Yue Zhao, Sean M. O'Brien, Robert E. Michler, Vinod H. Thourani, Fred H. Edwards, Hesha Duggirala, Thomas Gross, Danica Marinac-Dabic, Peter K. Smith

Research output: Contribution to journalArticle

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Abstract

Context: The safety and durability of endoscopic vein graft harvest in coronary artery bypass graft (CABG) surgery has recently been called into question. Objective: To compare the long-term outcomes of endoscopic vs open vein-graft harvesting for Medicare patients undergoing CABG surgery in the United States. Design, Setting, and Patients: An observational study of 235 394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008 at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. The STS records were linked to Medicare files to allow longitudinal assessment (median 3-year follow-up) through December 31, 2008. Main Outcome Measures: All-cause mortality. Secondary outcome measures included wound complications and the composite of death, myocardial infarction, and revascularization. Results: Based on Medicare Part B coding, 52% of patients received endoscopic veingraft harvesting during CABG surgery. After propensity score adjustment for clinical characteristics, there were no significant differences between long-term mortality rates (13.2% [12 429 events] vs 13.4% [13 096 events]) and the composite of death, myocardial infarction, and revascularization (19.5% [18 419 events] vs 19.7% [19 232 events]). Time-to-event analysis for those patients receiving endoscopic vs open veingraft harvesting revealed adjusted hazard ratios [HRs] of 1.00 (95% CI, 0.97-1.04) for mortality and 1.00 (95% CI, 0.98-1.05) for the composite outcome. Endoscopic vein-graft harvesting was associated with lower harvest site wound complications relative to open vein-graft harvesting (3.0% [3654/122 899 events] vs 3.6% [4047/112 495 events]; adjusted HR, 0.83; 95% CI, 0.77-0.89; P<.001). Conclusion: Among patients undergoing CABG surgery, the use of endoscopic vein-graft harvesting compared with open vein-graft harvesting was not associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)475-484
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume308
Issue number5
DOIs
StatePublished - Aug 1 2012

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Coronary Artery Bypass
Veins
Transplants
Mortality
Wounds and Injuries
Medicare
Myocardial Revascularization
Medicare Part B
Myocardial Infarction
Outcome Assessment (Health Care)
Propensity Score
Observational Studies
Thorax
Databases
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. / Williams, Judson B.; Peterson, Eric D.; Brennan, J. Matthew; Sedrakyan, Art; Tavris, Dale; Alexander, John H.; Lopes, Renato D.; Dokholyan, Rachel S.; Zhao, Yue; O'Brien, Sean M.; Michler, Robert E.; Thourani, Vinod H.; Edwards, Fred H.; Duggirala, Hesha; Gross, Thomas; Marinac-Dabic, Danica; Smith, Peter K.

In: JAMA - Journal of the American Medical Association, Vol. 308, No. 5, 01.08.2012, p. 475-484.

Research output: Contribution to journalArticle

Williams, JB, Peterson, ED, Brennan, JM, Sedrakyan, A, Tavris, D, Alexander, JH, Lopes, RD, Dokholyan, RS, Zhao, Y, O'Brien, SM, Michler, RE, Thourani, VH, Edwards, FH, Duggirala, H, Gross, T, Marinac-Dabic, D & Smith, PK 2012, 'Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery', JAMA - Journal of the American Medical Association, vol. 308, no. 5, pp. 475-484. https://doi.org/10.1001/jama.2012.8363
Williams, Judson B. ; Peterson, Eric D. ; Brennan, J. Matthew ; Sedrakyan, Art ; Tavris, Dale ; Alexander, John H. ; Lopes, Renato D. ; Dokholyan, Rachel S. ; Zhao, Yue ; O'Brien, Sean M. ; Michler, Robert E. ; Thourani, Vinod H. ; Edwards, Fred H. ; Duggirala, Hesha ; Gross, Thomas ; Marinac-Dabic, Danica ; Smith, Peter K. / Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 308, No. 5. pp. 475-484.
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AU - Peterson, Eric D.

AU - Brennan, J. Matthew

AU - Sedrakyan, Art

AU - Tavris, Dale

AU - Alexander, John H.

AU - Lopes, Renato D.

AU - Dokholyan, Rachel S.

AU - Zhao, Yue

AU - O'Brien, Sean M.

AU - Michler, Robert E.

AU - Thourani, Vinod H.

AU - Edwards, Fred H.

AU - Duggirala, Hesha

AU - Gross, Thomas

AU - Marinac-Dabic, Danica

AU - Smith, Peter K.

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N2 - Context: The safety and durability of endoscopic vein graft harvest in coronary artery bypass graft (CABG) surgery has recently been called into question. Objective: To compare the long-term outcomes of endoscopic vs open vein-graft harvesting for Medicare patients undergoing CABG surgery in the United States. Design, Setting, and Patients: An observational study of 235 394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008 at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. The STS records were linked to Medicare files to allow longitudinal assessment (median 3-year follow-up) through December 31, 2008. Main Outcome Measures: All-cause mortality. Secondary outcome measures included wound complications and the composite of death, myocardial infarction, and revascularization. Results: Based on Medicare Part B coding, 52% of patients received endoscopic veingraft harvesting during CABG surgery. After propensity score adjustment for clinical characteristics, there were no significant differences between long-term mortality rates (13.2% [12 429 events] vs 13.4% [13 096 events]) and the composite of death, myocardial infarction, and revascularization (19.5% [18 419 events] vs 19.7% [19 232 events]). Time-to-event analysis for those patients receiving endoscopic vs open veingraft harvesting revealed adjusted hazard ratios [HRs] of 1.00 (95% CI, 0.97-1.04) for mortality and 1.00 (95% CI, 0.98-1.05) for the composite outcome. Endoscopic vein-graft harvesting was associated with lower harvest site wound complications relative to open vein-graft harvesting (3.0% [3654/122 899 events] vs 3.6% [4047/112 495 events]; adjusted HR, 0.83; 95% CI, 0.77-0.89; P<.001). Conclusion: Among patients undergoing CABG surgery, the use of endoscopic vein-graft harvesting compared with open vein-graft harvesting was not associated with increased mortality.

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