Endoscopic vein harvest in patients at high risk for leg wound complications: A cost-benefit analysis of an initial experience.

BACKGROUND: A cost-benefit analysis of endoscopic vein harvesting (EVH) versus open vein harvest (OVH) was performed in patients at high risk for wound complications.

METHODS: Risk factors for leg wound infection were identified as age older than 75 years, being a woman, body mass index > 28, having diabetes, being a smoker, and diagnosis of peripheral vascular disease. Patients who had at least 2 of these risk factors were selected for a pilot use of EVH and were matched to patients undergoing OVH (n = 50 patients/group). Costs incurred included costs of dressings, additional hospital stay, and costs for attending our outpatient wound clinic (OWC), amongst others. For the EVH group, there was the additional cost of the kit (£650 per patient). Data were prospectively collected.

RESULTS: There were no significant differences in the preoperative characteristics between the 2 groups. During in-hospital stay, 18% (9 out of 50) versus 32% (16 out of 50) (P = .08) of patients (EVH vs OVH, respectively) had minor leg-wound suppurations. Patients in the OVH group had longer hospital stay (P = .01). Attendance at the OWC for leg-wound issues was 4% (2 out of 50) versus 48% (24 out of 50), respectively (P < .01), costing a total of £2,758 for the EVH group compared with £78,036 for the OVH group (P < .01). This amounted to cost savings of £42,778 (including EVH kit costs) favoring EVH.

CONCLUSIONS: In patients at high-risk of leg wound complications, EVH was associated with significant cost-savings and less leg wound complications.