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Clips versus suture technique: is there a difference?
T Chughtai1, L Q Chen, G Salasidis
1Department of Cardiothoracic Surgery, Montreal General Hospital, McGillUniversity Health Centre, Montreal, Quebec, Canada.
Insights
Subcuticular suture closure for coronary artery bypass grafting (CABG) incisions resulted in fewer infections and lower costs compared to skin clips. This technique offers better wound outcomes for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Wound Healing
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) is a common procedure with significant wound complication rates.
- Wound complications increase patient morbidity and healthcare costs.
Purpose of the Study:
- To compare wound outcomes and costs of subcuticular suture versus skin stapling for sternal and leg incisions in CABG patients.
- To evaluate the economic impact in a Canadian healthcare setting.
Main Methods:
- Prospective randomized trial of 162 CABG patients.
- Incisions closed with either subcuticular sutures or skin clips.
- Wound assessments included leakage, inflammation, infection, necrosis, swelling, dehiscence, and cosmesis (graded 1-4).
- Cost analysis in Canadian dollars.
Main Results:
- Trends toward increased inflammation with skin clips for sternal (P=0.09) and leg (P=0.17) incisions.
- Significantly higher sternal wound infection rate with skin clips (P=0.05).
- Tendency for increased mediastinitis with clips (P=0.15).
- Similar cosmetic outcomes for both techniques.
- Significantly greater cost with skin clips, exceeding $10,000 annually.
Conclusions:
- Subcuticular suture closure demonstrates superior wound outcomes compared to skin clips in CABG patients.
- Subcuticular closure is more cost-effective, considering direct costs and intangible factors.
- Subcuticular suture technique is a favorable method for CABG wound closure.
Introduction:
Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost.
Objective:
To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients.
Patients And Methods:
One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars.
Results:
There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year.
Conclusions:
Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.