Abstract
Purpose
Barbed sutures are tissue control devices that can reduce operating room time and costs. We analyzed the utility of barbed sutures in posterior spinal surgery in order to prove non-inferiority to conventional methods for wound closure.
Methods
A cohort of patients undergoing elective posterior spinal surgery in which barbed (prospective) versus conventional sutures (retrospective) were used was analyzed. The primary endpoint was the occurrence of wound healing complications or the need for surgical revision. Secondary endpoints included postoperative stay, readmission rate, and duration and cost of wound closure.
Result
A total of 483 patients participated in the study, 183 in the Barbed group and 300 in the Conventional group. Wound dehiscence or seroma occurred in 3.8% and 2.7% of the Barbed and Conventional groups, respectively (p = 0.6588). Both superficial (1.6% versus 4.0%, P = 0.2378) and deep infections (2.7% versus 4.7%, p = 0.4124) occurred similarly in both groups. Overall, the rate of re-intervention due to wound healing problems was also similar (4.9% versus 5.3%, p = 0.9906), as well as, total median hospital stay, postoperative stay and 30-day re-admission rates. The average duration of wound closure (1.66 versus 4.16 min per level operated, p < 0.0001) strongly favored the Barbed group. The mean cost of wound closure per patient was higher in the Barbed group (43.23 € versus 22.67 €, p < 0.0001).
Conclusions
In elective posterior spinal procedures, the use of barbed sutures significantly reduced the duration of wound closure. The wound healing process was not hindered and the added cost related to the suture material was small.
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Availability of data and material
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
Abbreviations
- ASA:
-
American Society of Anesthesiologists
References
Piper KF, Tomlinson SB, Santangelo G, Van Galen J, DeAndrea-Lazarus I, Towner J, Kimmell KT, Silberstein H, Vates GE (2017) Risk factors for wound complications following spine surgery. Surg Neurol Int 8:269. https://doi.org/10.4103/sni.sni_306_17
Anderson PA, Savage JW, Vaccaro AR, Radcliff K, Arnold PM, Lawrence BD, Shamji MF (2017) Prevention of Surgical Site Infection in Spine Surgery. Neurosurgery 80(3S):S114–S123. https://doi.org/10.1093/neuros/nyw066
Kumar S, van Popta D, Rodrigues-Pinto R, Stephenson J, Mohammad S, Siddique I, Verma RR (2015) Risk factors for wound infection in surgery for spinal metastasis. Eur Spine J 24(3):528–532. https://doi.org/10.1007/s00586-013-3127-4
Yilmaz E, Blecher R, Moisi M, Ankush C, O’Lynnger TM, Abdul-Jabbar A, Dettori JR, Oskouian RJ (2018) Is There an Optimal Wound Closure Technique for Major Posterior Spine Surgery? A Systematic Review, Global Spine J 8(5):535–544. https://doi.org/10.1177/2192568218774323
Elmallah RK, Khlopas A, Faour M, Chughtai M, Malkani AL, Bonutti PM, Roche M, Harwin SF, Mont MA (2017) Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures. Ann Transl Med 5(Suppl 3):S26. https://doi.org/10.21037/atm.2017.08.21
Borzio RW, Pivec R, Kapadia BH, Jauregui JJ, Maheshwari AV (2016) Barbed sutures in total hip and knee arthroplasty: what is the evidence? A meta-analysis. Int Orthop 40(2):225–231. https://doi.org/10.1007/s00264-015-3049-3
Sun C, Chen L, Du R, Wu S, Ma Q, Cai X (2021) Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials. J Knee Surg 34(14):1516–1526. https://doi.org/10.1055/s-0040-1710373
Chan VWK, Chan PK, Chiu KY, Yan CH, Ng FY (2017) Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial. J Arthroplasty 32(5):1474–1477. https://doi.org/10.1016/j.arth.2016.12.015
Peleg D, Ahmad RS, Warsof SL, Marcus-Braun N, Sciaky-Tamir Y, Ben Shachar I (2018) A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. Am J Obstet Gynecol 218(3):343.e1-343.e7. https://doi.org/10.1016/j.ajog.2018.01.043
Pennestrì F, Gallucci P, Prioli F, Giustacchini P, Ciccoritti L, Sessa L, Bellantone R, Raffaelli M (2019) Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center. Updates Surg 71(1):113–120. https://doi.org/10.1007/s13304-018-0589-2
Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A, Milone F, Musella M, De Palma GD, Milone M (2022) Barbed suture in gastro-intestinal surgery: A review with a meta-analysis. Surgeon 20(2):115–122. https://doi.org/10.1016/j.surge.2021.02.011
Moya AP (2013) Barbed sutures in body surgery. Aesthet Surg J 33(3 Suppl):57S-71S. https://doi.org/10.1177/1090820x13499577
Paul MD (2013) Barbed sutures in aesthetic plastic surgery: evolution of thought and process. Aesthet Surg J 33(3 Suppl):17S-31S. https://doi.org/10.1177/1090820x13499343
Mansour A, Ballard R, Garg S, Baulesh D, Erickson M (2013) The use of barbed sutures during scoliosis fusion wound closure: a quality improvement analysis. J Pediatr Orthop 33(8):786–790. https://doi.org/10.1097/bpo.0b013e3182a11eee
Chen J, Xie CL, Xuan J, Yan YZ, Dou HC, Zheng ZM, Chen Y, Chen XB, Wang XY, Wu AM (2018) A Novel Knotless Barbed Suture Technique for Traumatic Thoracolumbar Fracture in Posterior Surgery. World Neurosurg 114:e1031–e1037. https://doi.org/10.1016/j.wneu.2018.03.138
Johnston SS, Chen BP, Tommaselli GA, Jain S, Pracyk JB (2020) Barbed and conventional sutures in spinal surgery patients an economic and clinical outcomes comparison. J Wound Care 29:9–20. https://doi.org/10.12968/jowc.2020.29.sup5a.s9
Luther E, Berry K, McCarthy D, Sandhu J, Mayrand R, Guerrero C, Eichberg DG, Buttrick S, Shah A, Richardson AM, Komotar R, Ivan M (2020) Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor. Acta Neurochir (Wien) 162(4):719–727. https://doi.org/10.1007/s00701-020-04239-3
Buttrick SS, Eichberg D, Ali SC, Komotar RJ (2018) Intradermal Scalp Closure Using Barbed Suture in Cranial Tumor Surgeries: A Technical Note. Oper Neurosurg (Hagerstown) 15(1):E5–E8. https://doi.org/10.1093/ons/opx195
Cong Z, Wang H, Ma C (2019) Simple dural closure using a knotless barbed suture in endoscopic transsphenoidal surgery: preliminary experience. Acta Otolaryngol 139(12):1140–1144. https://doi.org/10.1080/00016489.2019.1668570
Vakil JJ, O’Reilly MP, Sutter EG, Mears SC, Belkoff SM, Khanuja HS (2011) Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty 26(5):710–713. https://doi.org/10.1016/j.arth.2010.07.003
Templeton MM, Krebs AI, Kraus KH, Hedlund CS (2015) Ex vivo biomechanical comparison of V-LOC 180® absorbable wound closure device and standard polyglyconate suture for diaphragmatic herniorrhaphy in a canine model. Vet Surg 44(1):65–69. https://doi.org/10.1111/j.1532-950X.2014.12201.x
Zaruby J, Gingras K, Taylor J, Maul D (2011) An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. Aesthet Surg J 31(2):232–240. https://doi.org/10.1177/1090820x10395010
Acknowledgements
To the Neurosurgery Nurse section for their implication and daily work.
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No funding, either public or private, was received for the preparation of this manuscript. The manufacturer of barbed sutures did not fund or supported in any way the conduction of this study.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Pedro Delgado-López, Javier Martín-Alonso and Ana Isabel Herrero-Gutiérrez. The first draft was written by Pedro Delgado-López and all authors revised and commented on previous versions of the manuscript. All authors read, reviewed and approved the final version of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received local institutional ethics board committee approval (Ethics Committee approval number, CEIC ref #: 2251).
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Delgado-López, P.D., Martín-Alonso, J., Herrero-Gutiérrez, A.I. et al. Barbed versus conventional suture in elective posterior spine surgery. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08224-7
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DOI: https://doi.org/10.1007/s00586-024-08224-7