Impact of barbed suture use in complex back closure on operative time, cost, and safety profile

Complex locoregional closure of back wounds following spine surgery via muscle flap closure, as opposed to traditional layer-by-layer approximation, decreases rates of complications such as seroma, infection, and dehiscence. However, the impact of barbed suture use on operative time, surgical cost, and patient outcomes for these cases remains unknown. In this study, the authors aimed to evaluate the complication profile, time, and cost savings of barbed suture in complex flap closure of back wounds following the placement of spinal instrumentation.

An IRB-approved retrospective analysis was conducted on the medical records of all patients who underwent spine surgery followed by locoregional muscle flap complex closure at the authors' institution between January 2016 and July 2021. Patients were in either the barbed or conventional suture cohort. Odds ratios and 95% confidence intervals were computed using multivariable logistic regression with Firth's correction. Estimated cost savings were calculated using literature-reported figures.

A total of 110 patients with comparable baseline demographics were included. Rates of seroma (p > 0.99), infection (p = 0.21), and dehiscence (p = 0.66) were statistically similar between groups. After adjusting for the length of surgical closure, the mean times were 3.1 mins/cm and 4.6 mins/cm for the barbed and conventional suture cohorts, respectively, resulting in a time savings of 1.5 mins/cm (p < 0.001). The calculated time savings for muscle flap closure of an average incision length was 34.5 minutes (95% CI 18.6-50.4 minutes), and the overall financial savings were calculated to be $1094.10 (95% CI $513.75-$1674.45) per case.

Knotless barbed suture use in complex closure of back wounds results in decreased operative time and hospital cost while conferring similar complication rates to conventional suture.