Editorial on the article entitled "Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study"

Effectiveness of a Rotating-Leg Prepper for Reducing Pressure Injury and Preventing Surgical Site Infection in Patients Undergoing Heart Surgery: Paired Matching Randomised Controlled Trial

This study aims to evaluate the effectiveness of a rotating-leg prepper (intervention) compared with a rolled gauze bandage (control) in reducing pressure injury and preventing surgical site infection in the legs of patients undergoing heart surgery. The paired-matched, open, randomised controlled trial was conducted from September 2022 to July 2024. The participants were composed of the patient and the staff groups. Sixty patients were paired-matched to the intervention and control groups. Before painting the resting area with an antiseptic, the ankle presented non-blanchable erythema, which was recorded as a pressure injury. The intervention group showed significantly lower pressure injury (0% vs. 76.6%, p = 0.001) than the control group, with a relative risk of 5.29 (95% CI: 2.71-10.30). Both groups exhibited no significant difference in surgical site infection. However, the relative risk of surgical site infection in the control group was 2.03 (95% CI: 1.57-2.64). Thirty staff participants were purposively sampled to evaluate the effects of both leg lifting methods and assess their satisfaction with the leg prepper. The overall satisfaction with the rotating-leg prepper was 4.87 ± 0.22. Rotating-leg preppers can reduce pressure injury and prevent surgical site infections in patients' legs during heart surgery.

1-Year Patency of Biorestorative Polymeric Coronary Artery Bypass Grafts in an Ovine Model

Many attempts have been made to inhibit or counteract saphenous vein graft (SVG) failure modes; however, only external support for SVGs has gained momentum in clinical utility. This study revealed the feasibility of implantation, and showed good patency out to 12 months of the novel biorestorative graft, in a challenging ovine coronary artery bypass graft model. This finding could trigger the first-in-man trial of using the novel material instead of SVG. We believe that, eventually, this novel biorestorative bypass graft can be one of the options for coronary artery bypass graft patients who have difficulty harvesting SVG.

Sternal-Wound Infections following Coronary Artery Bypass Graft: Could Implementing Value-Based Purchasing be Beneficial?

BACKGROUND/OBJECTIVES

Sternal-wound infections (SWIs) are rare but consequential healthcare-healthcare-associated infections following coronary artery bypass graft surgery (CABG). The impact of SWIs associated on the cost of health care provision is unknown. The aim of this study was to quantify the burden of CABG-related SWIs across countries with mature health care systems and estimate value-based purchasing (VBP) levels based on the local burden.

METHODS

A structured literature review identified relevant data for 14 countries (the Netherlands, France, Germany, Austria, the United Kingdom, Canada, Italy, Japan, Spain, the United States, Brazil, Israel, Taiwan, and Thailand). Data, including SWI rates, CABG volume, and length of stay, were used to populate a previously published Markov model that simulates the patient's CABG-care pathway and estimates the economic (US$) and care burden of SWIs for each country. Based on this burden, scenarios for VBP were explored for each country. A feasible cost of intervention per patient for an intervention providing a 20% reduction in the SWI rate was calculated.

RESULTS

The SWI burden varied considerably between settings, with SWIs occurring in 2.8% (the United Kingdom) to 10.4% (the Netherlands) of CABG procedures, while the costs per SWI varied between US$8172 (Brazil) to US$54 180 (Japan). Additional length of stay after SWI was the largest cost driver. The overall highest annual burden was identified in the United States (US$336 million) at a mean cost of US$36 769 per SWI. Given the SWI burden, the median cost of intervention per patient that a hospital could afford ranged from US$20 (US$13 to US$42) in France to US$111 (US$65 to US$183) in Japan.

CONCLUSIONS

SWIs represent a large burden with a median cost of US$13 995 per case and US$900 per CABG procedure. By tackling SWIs, there is potential to simultaneously reduce the burden on health care systems and improve outcomes for patients. Mutually beneficial VBP agreements might be one method to promote uptake of novel methods of SWI prevention.