Johnson Barbara H, T Sinchana, Johnston Stephen S, Gunja Najmuddin
MedTech Epidemiology & Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ 08901, USA.
Data Sciences, Mu Sigma, Bengaluru, Karnataka, India.
J Comp Eff Res. 2025 Apr;14(4):e240229. doi: 10.57264/cer-2024-0229. Epub 2025 Mar 17.
Trends in the use and comparative outcomes for barbed and conventional sutures have not been well-reported for robotic surgery. This retrospective study used hospital discharge data in the US to assess suture use during robotic colorectal surgery (CR), total hysterectomy (TH) and ventral hernia repair (VHR) performed between 1 October 2015 and 30 June 2022. We first examined quarterly trends in use of barbed sutures, (specifically STRATAFIX™ knotless tissue control devices [KTCD]) and then compared clinical and economic outcomes between KTCD and conventional sutures. Outcomes included wound-related complications (infection/wound dehiscence) through 90 days post discharge, operating room (OR) time, hospital costs and 30/60/90 days readmissions. Propensity score weighting was used to address potential confounding in the comparisons of outcomes, performed separately for each procedure. Generalized linear models, accounting for hospital-level clustering, with link functions and error distributions tailored to the empirical distribution of outcomes were used to test for statistically significant differences in outcomes between the KTCD and conventional suture cohorts. We identified 15,875 patients with CR (668 KTCD), 175,963 patients with TH (15,075 KTCD) and 32,469 patients with VHR (6776 KTCD). Over the study period, the proportion of robotic surgeries using KTCD tripled for CR (2.0-6.4%) and TH (2.9-10.4%) and more than doubled for VHR (12.2-25.3%). Compared with conventional sutures, KTCD was associated with significantly shorter OR time for TH (-19.1 min, 95% CI: [-30.2, -8.0]) and VHR (-17.3 min, 95% CI: [-31.4, -3.2]), and was numerically shorter, but did not reach statistical significance for CR (-23.2 min 95% CI: [-48.1 to 1.7]). All other outcomes were similar between the two suture cohorts for all procedures, apart from CR 90-day readmissions, which were lower for the KTCD cohort (-2.8%, 95% CI: [-5.2 to -0.4%]). Adoption of KTCD has grown substantially over the past 6 years. While most clinical and economic outcomes were similar between the two groups, KTCD was associated with lower OR time versus conventional sutures for TH and VHR and lower 90-day readmissions for CR.
关于倒刺缝线和传统缝线在机器人手术中的使用趋势及比较结果，此前尚未有充分报道。这项回顾性研究利用美国医院出院数据，评估了2015年10月1日至2022年6月30日期间进行的机器人结直肠手术（CR）、全子宫切除术（TH）和腹疝修补术（VHR）中缝线的使用情况。我们首先研究了倒刺缝线（特别是STRATAFIX™免打结组织控制装置[KTCD]）的季度使用趋势，然后比较了KTCD和传统缝线的临床及经济结果。结果包括出院后90天内与伤口相关的并发症（感染/伤口裂开）、手术室（OR）时间、医院费用以及30/60/90天再入院情况。倾向得分加权用于解决结果比较中的潜在混杂因素，针对每个手术分别进行。使用广义线性模型，考虑医院层面的聚类情况，根据结果的经验分布调整链接函数和误差分布，以检验KTCD和传统缝线队列在结果上的统计学显著差异。我们确定了15875例CR患者（668例使用KTCD）、175963例TH患者（15075例使用KTCD）和32469例VHR患者（6776例使用KTCD）。在研究期间，使用KTCD的机器人手术比例在CR中增加了两倍（从2.0%增至6.4%），在TH中增加了两倍（从2.9%增至10.4%），在VHR中增加了一倍多（从12.2%增至25.3%）。与传统缝线相比，KTCD与TH（-19.1分钟，95%CI：[-30.2，-8.0]）和VHR（-17.3分钟，95%CI：[-31.4，-3.2]）的OR时间显著缩短相关，在CR中数值上较短，但未达到统计学显著差异（-23.2分钟，95%CI：[-48.1至1.7]）。除CR的90天再入院情况外，两个缝线队列在所有手术的所有其他结果上相似，KTCD队列的CR 90天再入院率较低（-2.8%，95%CI：[-5.2至-0.4%]）。在过去6年中，KTCD的采用率大幅增长。虽然两组的大多数临床和经济结果相似，但与传统缝线相比，KTCD与TH和VHR的OR时间较短以及CR的90天再入院率较低相关。
