Mohammed Hamouda, Umu-Hawa Rogers, Alik Farber, Vincent L Rowe, Michael S Conte, Mahmoud B Malas
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Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS), and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modeling analyzed primary and secondary outcomes.</p><p><strong>Results: </strong>A total of 18,268 LEB procedures were included (staples, n = 5676; 31.07%); sutures (n = 12,592; 68.93%). Compared with suture closure, staples utilization was associated with 57% higher odds of SSI (196 [3.46%] vs 259 [2.06%]; odds ratio [OR], 1.57; 95% confidence interval [CI], 1.21-2.04; P = .001) and 30% higher odds of RTOR (860 [15.17%] vs 1449 [11.53%]; OR, 1.30; 95% CI, 1.12-1.50; P = .001) and PLOS (1630 [28.72%] vs 2835 [22.51%]; OR, 1.30; 95% CI, 1.16-1.45; P < .001). However, there was no significant difference in 30-day mortality among both closure methods (P > .05).</p><p><strong>Conclusions: </strong>In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared with sutures in patients who underwent LEB. Although staple closure might be easier and more time efficient, meticulous wound closure with sutures should be the preferred closure method for LEB.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery.\",\"authors\":\"Mohammed Hamouda, Umu-Hawa Rogers, Alik Farber, Vincent L Rowe, Michael S Conte, Mahmoud B Malas\",\"doi\":\"10.1016/j.jvs.2024.11.023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.</p><p><strong>Methods: </strong>The Vascular Quality Initiative database was queried for patients who underwent LEB from August 2014 to March 2024. Patients were stratified according to skin closure method: staples vs sutures (which included either absorbable subcuticular or nonabsorbable interrupted sutures). The primary outcome was surgical site infection (SSI). Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS), and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modeling analyzed primary and secondary outcomes.</p><p><strong>Results: </strong>A total of 18,268 LEB procedures were included (staples, n = 5676; 31.07%); sutures (n = 12,592; 68.93%). Compared with suture closure, staples utilization was associated with 57% higher odds of SSI (196 [3.46%] vs 259 [2.06%]; odds ratio [OR], 1.57; 95% confidence interval [CI], 1.21-2.04; P = .001) and 30% higher odds of RTOR (860 [15.17%] vs 1449 [11.53%]; OR, 1.30; 95% CI, 1.12-1.50; P = .001) and PLOS (1630 [28.72%] vs 2835 [22.51%]; OR, 1.30; 95% CI, 1.16-1.45; P < .001). However, there was no significant difference in 30-day mortality among both closure methods (P > .05).</p><p><strong>Conclusions: </strong>In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared with sutures in patients who underwent LEB. 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引用次数: 0
摘要
目的：伤口并发症是开放血管手术尤其是下肢旁路手术（LEB）后发病率的主要来源之一。首选的皮肤闭合方法是基于外科医生的偏好。由于没有数据清楚地表明一种方法优于另一种方法，我们的目的是比较LEB术后皮肤闭合的钉书钉和缝线的结果。方法：查询2014年8月至2024年3月期间接受LEB手术的患者的血管质量倡议数据库。根据皮肤闭合方法对患者进行分层：钉与缝合线（包括可吸收的皮下缝合线或不可吸收的中断缝合线）。主要结局为手术部位感染（SSI）。次要终点为返回手术室（RTOR）、延长住院时间（PLOS）和30天死亡率。在调整基线和临床相关变量后，多变量logistic回归模型分析了主要和次要结果。结果：共纳入LEB手术18268例[订书钉5676例（31.07%）]；缝合[12,592例（68.93%）]。与缝合闭合相比，使用订书钉发生SSI的几率高出57%[196（3.46%）比259 (2.06%)；OR 1.57, 95% CI 1.21 ~ 2.04, p=0.001]， RTOR的几率增加30% [860 (15.17%)vs 1449 (11.53%)；OR 1.30, 95% CI 1.12 - 1.50, p=0.001]和PLOS[1,630（28.72%）对2,835 (22.51%)]；OR 1.30, CI 1.16 - 1.45, p0.05)。结论：在这项大型多机构研究中，我们的分析表明，与LEB患者缝合伤口相比，用钉书钉缝合伤口后SSI、RTOR和PLOS的风险增加。虽然订书钉缝合可能更容易和更省时，但用缝合线细致地缝合伤口应是下肢旁路手术的首选缝合方法。
Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery.
Objective: Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.
Methods: The Vascular Quality Initiative database was queried for patients who underwent LEB from August 2014 to March 2024. Patients were stratified according to skin closure method: staples vs sutures (which included either absorbable subcuticular or nonabsorbable interrupted sutures). The primary outcome was surgical site infection (SSI). Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS), and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modeling analyzed primary and secondary outcomes.
Results: A total of 18,268 LEB procedures were included (staples, n = 5676; 31.07%); sutures (n = 12,592; 68.93%). Compared with suture closure, staples utilization was associated with 57% higher odds of SSI (196 [3.46%] vs 259 [2.06%]; odds ratio [OR], 1.57; 95% confidence interval [CI], 1.21-2.04; P = .001) and 30% higher odds of RTOR (860 [15.17%] vs 1449 [11.53%]; OR, 1.30; 95% CI, 1.12-1.50; P = .001) and PLOS (1630 [28.72%] vs 2835 [22.51%]; OR, 1.30; 95% CI, 1.16-1.45; P < .001). However, there was no significant difference in 30-day mortality among both closure methods (P > .05).
Conclusions: In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared with sutures in patients who underwent LEB. Although staple closure might be easier and more time efficient, meticulous wound closure with sutures should be the preferred closure method for LEB.
期刊介绍：
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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