Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure
- 1.1k Downloads
Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.
This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.
Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.
This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.
KeywordsSurgical site infection Spinal surgery Wound closure 2-Octyl-cyanoacrylate Staples
Conflict of interest
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
- 3.Rubinstein E, Findler G, Amit P, Shaked I (1994) Perioperative prophylactic cefazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Jt Surg 76-B:99–102Google Scholar
- 12.Singhal AK, Hussain A (2006) Skin closure with automatic stapling in total hip and knee arthroplasty. JK Practit 13:142–143Google Scholar
- 15.Ikada Y (1997) Tissue adhesives. In: Chu CC, Greisler HP, Von Fraunhofer JA (eds) Wound closure biomaterials and devices. CRC Press, Boca Raton, pp 317–346Google Scholar
- 16.Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N (2002) Tissue adhesives for traumatic lacerations in children and adults. Cochr Datab Sys Rev 3:CD003326Google Scholar
- 19.Cho J, Harrop J, Veznadaroglu E, Andrews DW (2003) Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution. Neurosurgery 52:832–840PubMedCrossRefGoogle Scholar
- 29.Shetty AA, Kumar VS, Morgan-Hough C, Georgeu GA, James KD, Nicholl JE (2004) Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial. J Orthop Surg 12:191–193Google Scholar
- 30.Singh B, Mowbray MAS, Nunn G, Mearns S (2006) Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Ortop Surg Traumatol 16:124–129Google Scholar
- 32.Murphy M, Prendergast P, Rice J (2004) Comparison of clips versus sutures in orthopedic wound closure. Eur J Ortop Surg Traumatol 14:16–18Google Scholar
- 39.Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Jt Surg 93-A:1627–1633Google Scholar
- 42.Abdul-Jabbar A, Takemoto S, Weber MH, Hu SS, Mummaneni PV, Deviren V, Ames CP, Chou D, Weinstein PR, Burch S, Berven SH (2012) Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine 37:1340–1345PubMedCrossRefGoogle Scholar
- 50.Dipaola CP, Saravanja DD, Boriani L, Zhang H, Boyd MC, Kwon BK, Paquette SJ, Dvorak MF, Fisher CG, Street JT (2012) Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J 12:218–230PubMedCrossRefGoogle Scholar