Mansour Alfred, Ballard Ryan, Garg Sumeet, Baulesh David, Erickson Mark
*Department of Orthopaedic Surgery, UTHealth, Houston, TX †Department of Orthopaedic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
J Pediatr Orthop. 2013 Dec;33(8):786-90. doi: 10.1097/BPO.0b013e3182a11eee.
Growing evidence in the orthopaedic arthroplasty literature supports the use of running bidirectional barbed suture (barbed suture) for closure of knee arthrotomies. More rapid wound closure and suture line integrity are described as its major advantages. No studies of barbed suture for the closure of posterior spinal wounds exist. The purpose of this project is to compare wound closure times and hospital charges using traditional closure versus barbed suture closure of posterior spine wounds created during scoliosis surgery.
A quality improvement project was initiated at a single tertiary-referral children's hospital spine program evaluating traditional layered interrupted suture closure (group 1) and running bidirectional barbed suture closure (Quill SRS) (group 2). Data regarding wound closure time, length of incision, fusion levels, suture cost, and hospital charges were prospectively collected over a 1-month period.
Ten incisions comprised group 1 and 15 comprised group 2. The average wound closure times were 29.5 and 17 minutes, respectively, P=0.006. The wound lengths between the groups were statistically comparable (P=0.15). Taking into account the wound length, the average closure time in group 1 was 1.29 cm/min compared with 1.97 cm/min in group 2 (P<0.01). When accounting for the extra cost associated with the use of barbed sutures ($62.54; P<0.0001), the impact of a more rapid closure resulted in a difference in hospital charges of $884.60 per case (P=0.0013).
Barbed suture closure of spinal fusion incisions results in a 40% reduction in closure time, resulting in an $884.60 decrease in hospital charges related to operating room time. This may represent significant yearly cost savings in a high-volume spine fusion center and warrants further investigation comparing patient-related outcomes.
This quality improvement analysis provides preliminary economic justification for using barbed suture for scoliosis fusion wound closure resulting in decreased operating room times and subsequent hospital charges.
Level II-therapeutic study, prospective nonrandomized cohort.
骨科关节置换文献中越来越多的证据支持使用连续双向倒刺缝线（倒刺缝线）来闭合膝关节切开术。更快的伤口闭合速度和缝线处的完整性被描述为其主要优点。目前尚无关于倒刺缝线用于闭合脊柱后路伤口的研究。本项目的目的是比较在脊柱侧弯手术中使用传统缝合与倒刺缝线缝合脊柱后路伤口的伤口闭合时间和住院费用。
在一家单一的三级转诊儿童医院脊柱项目中启动了一项质量改进项目，评估传统分层间断缝合（第1组）和连续双向倒刺缝线缝合（Quill SRS）（第2组）。在1个月的时间内前瞻性收集有关伤口闭合时间、切口长度、融合节段、缝线成本和住院费用的数据。
第1组有10个切口，第2组有15个切口。平均伤口闭合时间分别为29.5分钟和17分钟，P = 0.006。两组之间的伤口长度在统计学上具有可比性（P = 0.15）。考虑到伤口长度，第1组的平均闭合时间为1.29厘米/分钟，而第2组为1.97厘米/分钟（P < 0.01）。当考虑到使用倒刺缝线的额外成本（62.54美元；P < 0.0001）时，更快闭合的影响导致每例病例的住院费用差异为884.60美元（P = 0.0013）。
脊柱融合切口的倒刺缝线缝合使闭合时间减少40%，导致与手术室时间相关的住院费用减少884.60美元。在高容量脊柱融合中心，这可能意味着每年可节省大量成本，并且有必要进一步研究比较与患者相关的结果。
这项质量改进分析为使用倒刺缝线进行脊柱侧弯融合伤口闭合提供了初步的经济依据，从而减少了手术室时间和随后的住院费用。
二级治疗性研究，前瞻性非随机队列研究。
