Risk Factors for Leg Wound Infection After Conventional and No-Touch Vein Harvesting: Insights From a Multicentre Randomised Trial

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OBJECTIVES: To identify patient- and procedure-related risk factors for surgical site infection following open saphenous vein graft harvesting for coronary artery bypass grafting, using either conventional or no-touch techniques. DESIGN: We conducted a sub-study of the SWEDEGRAFT multicentre randomised trial (ClinicalTrials.gov: ID NCT03501303) comparing conventional and no-touch saphenous vein harvesting for coronary artery bypass grafting. The outcome was leg wound infection, defined as a wound healing disturbance requiring antibiotic treatment. Univariable and multivariable logistic regression assessed associations between prespecified covariates and infection. RESULTS: Of 900 patients, 860 were followed up at 3 months. The proportion of patients with leg wound infections was 12.0%. In the adjusted analysis, covariates independently associated with leg wound infection were the use of the no-touch harvesting technique (adjusted OR 2.78; 95% CI 1.75-4.44) and left ventricular ejection fraction <30% (adjusted OR 3.66; 95% CI 1.29-10.38). Female sex showed a numerically higher risk that did not reach statistical significance (adjusted OR 1.76; 95% CI 0.98-3.16). No significant statistical interaction was found between sex or diabetes mellitus and vein harvest technique regarding the risk of infection. There were significant differences in leg wound infections among the participating centres. CONCLUSIONS: The no-touch vein harvesting technique and poor left ventricular systolic function were independently associated with infectious complications at the vein harvest site after coronary artery bypass grafting. The findings also suggest that female patients may be at higher risk, although the estimate was imprecise. These results could be helpful, should a selective use of the no-touch technique be desired.

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