Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures

Abstract

Healthcare systems are receiving increasing pressures from payers, such as the Centers for Medicare and Medicaid (CMS), to reduce the costs associated with procedures, and with the implementation of the Affordable Care Act, high costs are addressed through pay-for-performance programs. Thus, multiple areas of total knee arthroplasty (TKA) surgery are under scrutiny, including surgical times, material costs, and the costs of associated complications and readmissions. Suture type has been determined to be a factor that may influence closure times, as well as direct material costs. Therefore, the purpose of this review was to compare: (I) the cost of using barbed conventional interrupted sutures; (II) the additional cost of differences in complications, if any; (III) to extrapolate cost savings on a hospital and national level; and (IV) to discuss the role of these findings on hospital savings and the effect on bundled payments. It was found that the main factors affecting differences in overall costs between barbed and standard interrupted suture were material cost and closure time. Many studies have demonstrated greater cost savings with the barbed suture due to shorter operative times, despite the higher material costs. The majority of studies also demonstrated similar complication rates between the suture types, and thus these are unlikely to affect the cost difference. However, to the best of our knowledge, there are no TKA studies in the literature evaluating the effect of suture type and associated complications on lengths of stay and readmission rates. Thus, it is unclear how these cost savings will translate to reimbursements rates and the role that they might play in bundled payments. Several studies in other specialties demonstrate decreased infection rates with the use of barbed sutures, which, if found to be true for TKA can be extrapolated to 3 million dollars of savings in revision TKA costs. Further studies on this topic are needed to define these relationships.

Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis

“…Within the setting of orthopaedic surgery it has been demonstrated that usage of barbed suture materials for wound closure lead to an overall cost saving, largely as a result of reduced operative times compared with interrupted sutures. 29 Two of the studies included within the current analysis were able to demonstrate reduced material costs when using a barbed suture material in a continuous method compared with interrupted stitches using standard suture materials. 15,17 One study also hypothesised that the potential reduction in operating theatre time would reduce the overall costs of each procedure by approximately US $200, 22 which would easily offset the additional costs of the barbed suture material.…”

Barbed sutures reduce arthrotomy closure duration and suture utilisation compared to interrupted conventional sutures for primary total hip arthroplasty: a randomised controlled trial

“…12,13 As the United States healthcare system shifts towards a bundled-payment based reimbursement model, increasing attention and scrutiny have been direct towards potential methods to improve quality of care and reduce costs. 14 Barbed sutures may reduce operative time, costs, and complications associated with THA 1,3,15 Prior studies have evaluated the use of barbed sutures for superficial closure after THA. 7,8 These studies generally support the use of barbed sutures in superficial closure, but they have been limited by non-random design and their applicability to closure of the arthrotomy is uncertain.…”

“…1,2 Closure with barbed sutures theoretically produces water-tight wounds and also provides other benefits such as reduced closure time, lower rates of infection, and lower total hospital costs. 3 A recent systematic review of closure modalities concluded that barbed sutures may in fact significantly reduce closure time; however, this report noted that the inconsistent designs and methodological features of prior studies limited the strength of conclusions regarding these sutures. 1…”

Barbed vs conventional suture at cesarean delivery: A systematic review and meta‐analysis

“…In terms of costs, based on head‐to‐head comparison from one trial included in our systematic review, barbed sutures were found to be costlier than the conventional sutures. In terms of the cost of the suture itself, it was found that the cost per stitch for monofilament absorbable sutures ranged between US$ 1.75 and US$ 1.83, and the cost per stitch for barbed sutures was US$ 19.96 30 . However, when determining cost‐effectiveness of interventions in obstetrics, consideration should be given to long‐ and short‐term consequences to mother and baby, in addition to the implications for healthcare systems 31,32 .…”

“…In terms of the cost of the suture itself, it was found that the cost per stitch for monofilament absorbable sutures ranged between US$ 1.75 and US$ 1.83, and the cost per stitch for barbed sutures was US$ 19.96. 30 However, when determining cost-effectiveness of interventions in obstetrics, consideration should be given to long-and short-term consequences to mother and baby, in addition to the implications for healthcare systems. 31,32 Currently, the small reduction in the operative time and estimated blood loss in cesarean deliveries may not justify the use of barbed sutures routinely.…”