Skip to main content

Advertisement

SpringerLink
Log in

Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pull ter Gunne AF, van Laarhoven CJ, Cohen DB (2010) Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 19:982–988

    Article  PubMed Central  PubMed  Google Scholar 

  2. Calderone RR, Garland DE, Capen DA, Oster H (1996) Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:171–182

    CAS  PubMed  Google Scholar 

  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:99–102

    Google Scholar 

  4. Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128

    CAS  PubMed  Google Scholar 

  5. Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426

    Article  CAS  PubMed  Google Scholar 

  6. Blam OG, Vaccaro AR, Vanichkachorn JS, Albert TJ, Hilibrand AS, Minnich JM, Murphey SA (2003) Risk factors for surgical site infection in the patient with spinal injury. Spine 28:1475–1480

    PubMed  Google Scholar 

  7. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98(2 Suppl):149–155

    PubMed  Google Scholar 

  8. Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465

    Article  PubMed  Google Scholar 

  9. Demura S, Kawahara N, Murakami H, Nambu K, Kato S, Yoshioka K, Okayama T, Tomita K (2009) Surgical site infection in spinal metastasis: risk factors and countermeasures. Spine 34:635–639

    Article  PubMed  Google Scholar 

  10. Tofuku K, Koga H, Yanase M, Komiya S (2012) The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation. Eur Spine J 21:2027–2033

    Article  PubMed Central  PubMed  Google Scholar 

  11. Singh B, Mowbray MAS, Nunn G, Mearns S (2006) Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Orthop Surg Traumatol 16:124–129

    Article  Google Scholar 

  12. Singhal AK, Hussain A (2006) Skin closure with automatic stapling in total hip and knee arthroplasty. JK Practit 13:142–143

    Google Scholar 

  13. Smith TO, Sexton D, Mann C, Donell S (2010) Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ 340:c1199

    Article  PubMed Central  PubMed  Google Scholar 

  14. Quinn JV, Drzewiecki A, Li MM, Stiell IG, Sutcliffe T, Elmslie TJ, Wood WE (1993) A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann Emerg Med 22:1130–1135

    Article  CAS  PubMed  Google 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 317–346

    Google 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:CD003326

    Google Scholar 

  17. Liebelt EL (1997) Current concepts in laceration repair. Curr Opin Pediatr 9:459–464

    Article  CAS  PubMed  Google Scholar 

  18. Collin TW, Blyth K, Hodgkinson PD (2009) Cleft lip repair without suture removal. J Plast Reconstr Aesthet Surg 62:1161–1165

    Article  CAS  PubMed  Google 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 52:832–840

    Article  PubMed  Google Scholar 

  20. Lee KW, Sherwin T, Won DJ (1999) An alternate technique to close neurosurgical incisions using octyl cyanoacrylate tissue adhesive. Pediatr Neurosurg 31:110–114

    Article  CAS  PubMed  Google Scholar 

  21. Wang MY, Levy ML, Mittler MA, Liu CY, Johnston S, McComb JG (1999) A prospective analysis of the use of octyl cyanoacrylate tissue adhesive for wound closure in pediatric neurosurgery. Pediatr Neurosurg 30:186–188

    Article  CAS  PubMed  Google Scholar 

  22. Leung GY, Peponis V, Varnell ED, Lam DS, Kaufman HE (2005) Preliminary in vitro evaluation of 2-octyl cyanoacrylate (Dermabond) to seal corneal incisions. Cornea 24:998–999

    Article  PubMed  Google Scholar 

  23. Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS (2006) Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Jt Surg 88-A:1705–1712

    Article  Google Scholar 

  24. Scott GR, Carson CL, Borah GL (2007) Dermabond skin closures for bilateral reduction mammaplasties: a review of 255 consecutive cases. Plast Reconstr Surg 120:1460–1465

    Article  CAS  PubMed  Google Scholar 

  25. Hall LT, Bailes JE (2005) Using Dermabond for wound closure in lumbar and cervical neurosurgical procedures. Neurosurgery 56(1 Suppl):147–150

    Article  PubMed  Google Scholar 

  26. Wachter D, Brückel A, Stein M, Oertel MF, Christophis P, Böker DK (2010) 2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery. Neurosurg Rev 33:483–489

    Article  PubMed Central  PubMed  Google Scholar 

  27. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Inf Cont Hosp Epidemiol 13:606–608

    Article  CAS  Google Scholar 

  28. Stockley I, Elson RA (1987) Skin closure using staples and nylon sutures: a comparison of results. Ann R Coll Surg Engl 69:76–78

    CAS  PubMed Central  PubMed  Google 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 12:191–193

    CAS  Google 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 16:124–129

    Google Scholar 

  31. Gatt D, Quick CR, Owen-Smith MS (1985) Staples for wound closure: a controlled trial. Ann R Coll Surg Engl 67:318–320

    CAS  PubMed Central  PubMed  Google Scholar 

  32. Murphy M, Prendergast P, Rice J (2004) Comparison of clips versus sutures in orthopedic wound closure. Eur J Ortop Surg Traumatol 14:16–18

    Google Scholar 

  33. Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20:506–515

    Article  PubMed  Google Scholar 

  34. Quinn JV, Osmond MH, Yurack JA, Moir PJ (1995) N-2 butyl cyanoacrylate: risk of bacterial contamination with an appraisal of its antimicrobial effects. J Emerg Med 13:581–585

    Article  CAS  PubMed  Google Scholar 

  35. Bhende S, Rothenburger S, Spangler DJ, Dito M (2002) In vitro assessment of microbial barrier properties of Dermabond topical skin adhesive. Surg Inf (Larchmt) 3:251–257

    Article  Google Scholar 

  36. Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J (2010) Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19:1711–1719

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 23:726–732

    Article  CAS  PubMed  Google Scholar 

  38. Chen S, Anderson MV, Cheng WK, Wongworawat MD (2009) Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467:1670–1673

    Article  PubMed Central  PubMed  Google 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:1627–1633

    Google Scholar 

  40. Schwarzkopf R, Chung C, Park JJ, Walsh M, Spivak JM, Steiger D (2010) Effects of perioperative blood product use on surgical site infection following thoracic and lumbar spinal surgery. Spine 35:340–346

    Article  PubMed  Google Scholar 

  41. Veeravagu A, Patil CG, Lad SP, Boakye M (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine 34:1869–1872

    Article  PubMed  Google 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 37:1340–1345

    Article  PubMed  Google Scholar 

  43. Boston KM, Baraniuk S, O’Heron S, Murray KO (2009) Risk factors for spinal surgical site infection, Houston, Texas. Inf Cont Hosp Epidemiol 30:884–889

    Article  Google Scholar 

  44. Chopra T, Zhao JJ, Alangaden G, Wood MH, Kaye KS (2010) Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens. Exp Rev Pharmacoecon Outcom Res 10:317–328

    Article  Google Scholar 

  45. Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG (2010) Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 13:158–164

    Article  PubMed  Google Scholar 

  46. Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Takemoto S, Ames C, Deviren V, Tay B, Weinstein P, Burch S, Liu C (2013) Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38:E1425–E1431

    Article  PubMed  Google Scholar 

  47. Al-Nammari SS, Lucas JD, Lam KS (2007) Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis. Spine 32:2480–2486

    Article  PubMed  Google Scholar 

  48. Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O (2012) Postoperative infections of the lumbar spine: presentation and management. Int Orthop 36:439–444

    Article  PubMed Central  PubMed  Google Scholar 

  49. Pappou IP, Papadopoulos EC, Sama AA, Girardi FP, Cammisa FP (2006) Postoperative infections in interbody fusion for degenerative spinal disease. Clin Orthop Relat Res 444:120–128

    Article  PubMed  Google 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 12:218–230

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan

    Muneharu Ando, Tetsuya Tamaki, Shunji Sasaki, Yasushi Toge, Takuji Matsumoto, Kazuhiro Maio, Ryosuke Sakata & Daisuke Fukui

  2. Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan

    Munehito Yoshida, Yukihiro Nakagawa & Hiroshi Yamada

  3. Department of Orthopedic Surgery, The Cancer Institute Hospital of JFCR, Tokyo, Japan

    Seiji Kanno

Authors
  1. Muneharu Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuya Tamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Munehito Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shunji Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasushi Toge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuji Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuhiro Maio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ryosuke Sakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daisuke Fukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Seiji Kanno
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yukihiro Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muneharu Ando.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ando, M., Tamaki, T., Yoshida, M. et al. Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure. Eur Spine J 23, 854–862 (2014). https://doi.org/10.1007/s00586-014-3202-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3202-5

Keywords

Search

Navigation