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Skin Closure Using Surgical Skin Staples May Have Increased Risk for Deep Surgical Site Infection Compared to Running
Saechin Kim1, John G Massoud1, Philip Hanna1
1Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
Surgical Infections
|September 2, 2025
Summary
Surgical skin staples (SS) may increase the risk of deep surgical site infections (SSI) after open posterior lumbar spine surgery compared to running subcuticular absorbable sutures (RSAS). RSAS demonstrated a significantly lower deep SSI rate in this study.
Area of Science:
- Spine Surgery
- Wound Closure Techniques
- Infection Control
Background:
- Systemic analyses often show no significant difference in surgical site infection (SSI) rates between wound closure methods.
- Spine surgeons commonly use continuous sutures, interrupted sutures, and surgical skin staples (SS).
- Surgical skin staples (SS) and running subcuticular stitch using absorbable suture (RSAS) are prevalent in spine surgery for skin closure.
Purpose of the Study:
- To compare the incidence of surgical site infections (SSI) between surgical skin staples (SS) and running subcuticular stitch using absorbable suture (RSAS) for skin closure in open posterior lumbar spine surgeries (OPLS).
- To test the hypothesis that infection rates do not differ between SS and RSAS closure methods.
Main Methods:
- Retrospective review of billing and hospital records for open posterior lumbar spine surgeries (OPLS) performed by a single surgeon between 2018-2022.
- Inclusion criteria: OPLS closed with RSAS or SS. Exclusion criteria: oncologic conditions, prior surgical site infection.
- Analysis of patient demographics, clinical history, surgical characteristics, and deep SSI rates for both closure groups.
Main Results:
- No significant differences in patient risk factors (age, BMI, diabetes, smoking) or surgical characteristics (levels decompressed/fused, operative time) between RSAS and SS groups.
- The RSAS group had a higher incidence of prior surgery at the site and instrumented fusion, factors typically associated with increased SSI risk.
- Deep SSI rate was significantly lower in the RSAS group (1.4%) compared to the SS group (5.9%) (p = 0.02).
Conclusions:
- Running subcuticular stitch using absorbable suture (RSAS) may be associated with a lower risk of deep surgical site infection (SSI) compared to surgical skin staples (SS) in open posterior lumbar spine surgery.
- The findings challenge the assumption of equivalent infection rates between common skin closure techniques in spine surgery.
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