Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison

Abstract

Objective: To compare economic and clinical outcomes of barbed sutures versus conventional sutures alone in wound closure for patients undergoing spinal surgery. Method: A retrospective study using the Premier Healthcare Database. The database was searched for patients who underwent elective inpatient spinal surgery (fusion or laminectomy) for a spinal disorder between 1 January 2014 and 30 June 2018 (first=index admission). Using billing records for medical supplies used during the index admission, patients were classified into mutually-exclusive groups: patients with any use of STRATAFIX (Ethicon, US) knotless tissue control devices (barbed sutures group); or patients with use of conventional sutures alone (conventional sutures group). Outcomes included the index admission's length of stay, total and subcategories of hospital costs, non-home discharge, operating room time (ORT, minutes), wound complications and readmissions within ≤90 days. Propensity score matching and generalised estimating equations were used to compare outcomes between the study groups. Results: After matching, 3705 patients were allocated to each group (mean age=61.5 years [standard deviation, SD±12.9]; 54% were females). Compared with the conventional suture group, the barbed suture group had significantly lower mean ORT (239±117 minutes, versus 263±79 minutes conventional sutures, p=0.015). Operating room costs were also siginificantly lower in the barbed suture group ($6673±$3976 versus $7100±$2700 conventional sutures, p=0.020). Differences were statistically insignificant for other outcomes (all p>0.05). Subanalysis of patients undergoing fusions of ≥2 vertebral joints yielded consistent results. Conclusion: In this study, wound closure incorporating barbed sutures was associated with lower ORT and operating room costs, with no significant difference in wound complications or readmissions, when compared with conventional sutures alone.

The use of novel knotless barbed sutures in posterior long-segment lumbar surgery: a randomized controlled trial

“…Our results indicated significant lower ORT when incorporating barbed sutures, suggesting clinical efficiency of using barbed sutures in posterior long-segment lumbar surgery as overall ORT was measured as an efficiency outcome, consistent with previous findings [ 9 , 12 ]. Additionally, our findings revealed that applying barded sutures cost significantly shorter time than the traditional sutures both in the entire wound closure procedure (17.24 min difference, P < 0.001) and wound closure for per centimeter of incision (1.04 min difference, P < .…”

“…Therefore, it has been a critical wound complication that deserves special attention in spinal surgeries. In earlier studies, no statistical differences in wound infection rates were reported between the barbed sutures and conventional sutures groups [ 9 , 15 ]. However, our results yielded disparate outcomes.…”

“…In the surgical area of orthopedics, while previous attempts of comparing the clinical outcomes between barbed sutures and conventional sutures were made in total knee arthroplasty and hip arthroplasty [ 16 , 17 ], to the best of our knowledge, only three prior studies have investigated the employment of barbed sutures in spinal surgery [ 8 , 9 , 15 ]. They all found barbed sutures associated with shorter wound closure time or suture time but varied in the findings of hospital costs.…”

Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy

“…Despite barbed sutures being more expensive than its conventional counterparts 10 , three studies have shown that the use of barbed sutures reduced the time in the operating room in patients who have undergone spinal surgery 20 and total knee arthroplasty 21,22 . The same studies reported that the reduction in the time spent in the operating room was associated with a decrease in the final cost of the procedures.…”

The efficacy of bidirectional barbed sutures for incision closure in total knee replacement

“…[ 11 ] Previous studies have reported that using the barbed sutures to close incision in a variety of surgeries was related to a reduction of wound complications and operation time in various surgeries. [ 12 , 13 ] Despite all potential advantages, barbed suture is not commonly used in TKR. This might be due to its higher cost and uncertain clinical benefits.…”