Subcutaneous barbed suture, as an adjunct to staples, reduces post-operative wound drainage in total knee arthroplasty

Background

Prolonged wound drainage (>72 h), has been associated with increased risk of surgical site infection and prolonged hospital admission. This study reviews the outcome in three different wound closure methods, following total knee arthroplasty. We also analysed the cost effectiveness of these methods.

Methods

A total of 69 patients undergoing total knee arthroplasty: 22 with stapled skin closure; 21 with tissue adhesive and stapled skin closure and 26 with subcutaneous barbed suture instead of a non barbed suture with stapled skin closure, were studied to review the number of dressing changes, prolonged wound drainage (>72 h), length of hospital stay and delayed discharge (>5 days). Statistical analysis was conducted using Minitab Statistical Software® and statistical significance was set at p < 0.05.

Results

The median hospital stay for the staples only group was 4 days (inter-quartile range [IQR] 3–5), for the adhesive group was 4 days ([IQR] 3–6) and for the barbed suture group was 3 days ([IQR] 3–4) (p = 0.009). The rates of prolonged wound drainage for the staples only group was 8 (36.4%), for the adhesive group was 4 (19.0%) and for barbed suture group was 0 (0%) (p = 0.004).

Conclusion

The use of subcutaneous barbed sutures was associated with reduced number of wound dressing changes, reduced risk of prolonged wound drainage and shorter hospital stay, as well as conferring a saving of at least £236.60 per patient, compared to the other two skin closure methods.