To conduct a systematic literature review of studies assessing clinical outcomes associated with minimally invasive hysterectomies performed with barbed sutures versus those performed with conventional sutures. A systematic search of PubMed and Scopus was conducted for literature published between January 2011 and June 2020. The Boolean query (barb* OR knotless AND sutur* AND minimally AND invasive OR robot* OR laparoscopic AND hysterectomy) was employed. Additional articles were identified through manual reviews of references. Pre-clinical studies, case reports and conference abstracts were excluded from review. Of the 105 studies identified, five met the predefined inclusion criteria. The risk for major vaginal bleeding for the barbed suture group was up to 50% lower than that for the conventional suture group (14% vs. 27%). There was no significant difference in minor vaginal bleeding incidence in the two studies that examined this outcome. Vaginal cuff dehiscence incidence was up to 7% lower in the barbed suture group compared to the conventional group (0% vs. 7%). The difference in median operative time ranged from 1 minute (extracorporeal suturing) to 19 minutes, with time saved for the barbed suture group in all studies. Median vaginal cuff suture time was also shorter for the barbed suture group by 2-6 minutes, according to three out of four studies. The literature suggests that barbed sutures are a useful tool for vaginal cuff suturing in minimally invasive hysterectomies. While there was variation in statistical significance of the differences in the outcomes of interest, all studies demonstrated similar or moderately better outcomes and shorter operation time for the barbed suture group. More research is needed to generate a more conclusive evidence.

Surgical site infection following cesarean section (CS) can result in significant morbidity and cost. New mothers are particularly vulnerable as they face infant-care responsibilities leading to sleep deprivation, risk of depression and stress. This study was thus designed to understand risk of infection types (deep vs superficial vs organ/space) and associated costs for these patients. A retrospective study of patients undergoing CS between 2014 and 2017 was conducted using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. All patients continuous enrollment for ≥12 months before and 6 months after CS. Patients were categorized by demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index. The outcome were new diagnoses of infection, categorized as organ/space, deep, or superficial within 6 months of CS. Logistic regression models were evaluated to determine variables associated with each infection category. Generalized linear regression models were built and adjusted total payments due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index. A total of 362,132 patients were included in the analysis, with mean age 30 years (SD:5.9), 36.2% Medicaid (all others commercially insured), 94.8% with no post-CS infection. Of the 4.8 % patients with infection, > 84% were identified within 60 days of CS. Post-surgical infection included 0.9% organ/space, 0.3% deep, 0.04% both organ/space and deep and 3.5% superficial cases (remainder unspecified). Adjusted total payments in patients with commercial insurance ranged from $42,829 (95% CI: $41,900-$43,780) for superficial to $53,684 (95% CI: $48,936-$58,894) for deep infection in two years following CS. Key risk factors for infection included payer type (Medicaid vs Commercial) and obesity. Nearly 5% of patients suffer from surgical site infection following cesarean section. Ongoing research include understanding patient risk profiles and developing risk mitigation strategies.

Primary total hip replacement (P_THR) is a common procedure with low complication rates. However, revision THR (R_THR) is associated with significantly greater risks. This study was thus designed to understand risk of infection types (deep vs superficial) and associated costs for patients presenting with either P_THR or R_THR. A retrospective study of patients undergoing P_THR or R_THR between 2014 and 2017 was conducted using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. Patients were categorized by demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index. The outcome were new diagnoses of infection, categorized as deep and superficial within 6 months of surgery. Logistic regression models were evaluated to examine variables associated with infection. Generalized linear regression models were built and adjusted total payments due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index. A total of 92,029 P_THR and 6,298 R_THR patients were included in the analysis. Mean age and percentage female was 62 years (SD: 12.2), 63 years (SD: 12.7) and 54.4%, 56.3% in the P_THR and R_THR cohorts, respectively. Overall 6.1% P_THR and 14.9% R_THR patients presented with any infection (deep infection: 2.7% in P_THR and 11.0% in R_THR). Adjusted total payments in patients with commercial insurance ranged from $100,262 (95% CI: $94,986-$105,831) for superficial to $136,753 (95% CI: $128,486-$145,571) for deep infection in P_THR. For R_THR, payments ranged from $122,373 (95%CI: $97,037-$154,321) to $153,417 (95%CI: 134,586-174,882). Key variables associated with infection included obesity and liver disease for P_THR and; obesity and fluid/electrolyte disorders for R_THR. Revision THR patients experience greater risk of infection post-surgery, including risks of deep infections. Ongoing research include understanding patient risk profiles and developing risk mitigation strategies.

Colorectal surgery (CS) is known for its inherent high risk of surgical site infection, estimated between 20%-30%. This study was thus designed to understand risk of infection types (deep vs superficial vs organ/space) and associated costs for these patients. A retrospective study of patients undergoing CS between 2014 and 2017 was conducted using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. All patients had continuous enrollment for ≥12 months before and 6 months after CS. Patients were categorized by demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index. The outcome were new diagnoses of infection, categorized as organ/space, deep, or superficial within 6 months of CS. Logistic regression models were evaluated to determine variables associated with infection. Generalized linear regression models were built and adjusted total payments due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index. A total of 83,691 patients were included in the analysis, with mean age 56 years (SD:17.38), 53.6% female, 27.4% cancer patients of which 5.3% with metastatic neoplasms, 21.5% Medicare and 21.60% Medicaid (all others commercially insured), 78.8% with no post-CS infection. Of the 21.1% patients with infection, > 84% were identified within 60 days of CS. Post-surgical infection included 9.0% organ/space, 1.0% deep, 0.8% for both organ/space and deep and 10.4% superficial cases. Adjusted total payments in patients with commercial insurance ranged from $154,332 (95% CI: $149,353-$159,478) for superficial to $185,435 (95% CI: $163,586-$210,202) for deep infection between CS and two-years post. Key risk factors for infection included weight loss and fluid and electrolyte disorder. More than 21% patients suffer from post-CS infection, nearly 51% of which affected by deep or organ/space infection. Ongoing research include understanding patient risk profiles and developing risk mitigation strategies.

While the implant represents a substantial proportion of surgery costs and remains a focus in total knee arthroplasty (TKA), soft tissue management has a key role to play in achieving optimal surgical outcomes. A modified Delphi panel with two parts, each comprising two rounds, was used to establish consensus on the key goals and challenges in wound closure and bleeding management in TKA (‘Challenges Delphi’), and the associated solutions (‘Solutions Delphi’). Ten orthopaedic surgeons from six Asia-Pacific countries were invited to participate. Questionnaires were conducted through an online platform via email (‘Challenges’ Round 1) or at a face-to-face meeting (subsequent rounds). Statements for Round 1 of both parts were generated from a literature review. Experts ranked their agreement with each goal, the importance of each challenge, or their agreement with each solution on a five-point scale. Consensus was achieved if ≥70% of experts either selected 4 or 5, or selected 1 or 2. A Steering Committee comprising two independent orthopaedic surgeons reviewed questions, consensus definitions, feedback from the panel, and facilitated discussions. Consensus was reached on 13 goals of wound management, including: minimising dead space formation, achieving good soft tissue tension and watertight closure, preventing infection or scarring, reducing blood loss, maximising functional recovery. Experts agreed on 38 challenges and 71 solutions primarily addressing surgical techniques or wound closure materials for each tissue layer (capsular, subcutaneous, skin), and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. Experts agreed that appropriate soft tissue management plays an important role in achieving optimal TKA outcomes. The consensus framework may be a useful guide for future surgical education to reduce variability in patient outcomes.

Surgical site infections (SSIs) are a common and costly complication, increasing readmission rates, length of hospitalization, mortality, and resulting in overall costs of $3.3 billion to the US healthcare system. Triclosan-coated sutures (TCS) have been demonstrated to reduce the risk of SSI, and large global health authorities recommend their use. The objective of this study was to conduct a budget impact analysis comparing TCS to traditional non-coated sutures (NCS) using the US hospital perspective. An economic model was developed to evaluate the impact of TCS use in the US. Current treatment practices assumed use of NCS, while future practice assumed 50% NCS and 50% TCS use. Each procedure was assumed to require 3 suture units. Surgery types were broken down into clean, clean-contaminated, and contaminated-dirty wounds per CDC definition. NCS and TCS SSI rates by wound type were calculated using data from a systematic review and meta-analysis by Leaper and colleagues. The average of cost per NCS strand and SSI episode were taken from the literature and inflated to 2018 USD. were calculated as costs per patient and population, assuming a hypothetical cohort of 2,000. Sensitivity analyses using conservative estimates for the reductions in the risk of SSIs with TCS were also conducted. The analysis predicted introduction of TCS in the future practice could result in savings of $554.25 per patient due to avoided SSIs. This translated into a potential savings of $1,108,490 when considering a population of 2,000 procedures. of the sensitivity analyses estimated savings for all scenarios tested. Based on the results of this analysis, the increased upfront additional costs of TCS is minimal in comparison to the estimated cost savings from reduced risk of infections versus NCS. TCS should be considered as part of the comprehensive approach for hospitals to address the risk of SSI.

Surgical site infection after spinal surgery is the most common complication resulting in increased rates of morbidity and mortality. The aim of this study was to evaluate the rates of deep and superficial surgical site infections and associated costs for patients undergoing spinal surgery. This was a retrospective cohort study of patients undergoing spinal surgery between 2014 and 2017 using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. Patients demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index were reported. The rates for new diagnoses of infection, categorized as deep or superficial within 6 months of spinal surgery were calculated. Generalized linear regression models were built and adjusted total payments over two-year period due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index. A total of 31,416 patients with spinal surgery were included in the analysis. Most of the patients were between 45-64 years of age (54.9%), female (58.8%) and commercially insured (60.9%). Diabetes without complications (17.9), chronic pulmonary disease (13.6%) and peripheral vascular disease (5.2%) were the three most common comorbidities among patients undergoing spinal surgery. The overall rate of surgical site infections was 8.5% with 3.9% patients with deep infection and 4.6% patients with superficial infection. The mean adjusted total payments for commercially insured patients with deep and superficial infections were statistically significantly higher than those without infections, respectively ($303,835 and $227,115 vs $177,035, p<0.05) over the two-year period post-spinal surgery. Similar trend was observed among patients with Medicare and Medicaid insurances. More than 8% of patients suffer from surgical site infection, of which 46% have deep infection following spinal surgery. Commercially insured patients with deep infection had nearly 72% increased costs as compared to those without infection.

Hysterectomy is a highly prevalent procedure, with more than 30% American women expected to have had the procedure by age 60. Surgical site infection following hysterectomy can result in significant morbidity and cost. This study was thus designed to understand risk of infection types (deep vs superficial vs organ/space) and associated costs for these patients. A retrospective study of patients undergoing hysterectomy between 2014 and 2017 was conducted using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. Patients were categorized by demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index. The outcomes were new diagnoses of infection, categorized as organ/space, deep or superficial within 6 months of hysterectomy. Logistic regression models were developed to evaluate variables associated with infection. Generalized linear regression models were built and adjusted total payments due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index. A total of 150,000 patients were included in the analysis, with mean age 46 years (SD:9.9), 3.4% Medicare and 15.6 % Medicaid (all others commercially insured), 93.0% with no post-hysterectomy infection. Of the 6.99% patients with infection, > 78% were identified within 60 days of hysterectomy. Post-surgical infection included 1.7% organ/space, 0.5% deep, 0.1% organ/space and deep and 4.7% superficial cases. Adjusted total payments in patients with commercial insurance ranged from $61,586 (95% CI: $59,741-$63,488) for superficial to $75,586 (95% CI: $67,892-$84,151) for deep infection in two years following hysterectomy. Key risk factors for infection included cancer with and without metastasis and renal failure. Nearly 7% patients suffer from post-hysterectomy infection, of which nearly 33% are affected by deep or organ/space infection. Ongoing research include understanding patient risk profiles and developing risk mitigation strategies.

Wound closure is a key component of knee arthroplasty. Innovative technologies, such as the DERMABOND® PRINEO® Skin Closure System (skin closure system) and STRATAFIX™ Knotless Tissue Control Devices (barbed suture) provide improved wound closure strength, antimicrobial benefits, and improved patient outcomes (i.e. ability to shower and no dressings required). The objective of this study is to estimate the hospitals's economic impact using a skin closure system and barbed sutures compared to conventional wound closure methods during knee arthroplasty; in France, Germany, Italy, and the Netherlands. An economic model was developed in which a current treatment pathway (using traditional absorbable sutures for deeper tissue closure and staples/sutures for the final skin layer) was compared to a future practice (introducing the use of barbed sutures and the skin closure system). Healthcare resources associated with knee arthroplasty included final skin layer materials, deeper tissue layer sutures, dressings (standard or premium), operating room time, length of hospital stay, surgical site infections, outpatient visits, and hospital readmissions up to 90 days. Resource use for each parameter was based on country specific literature, expert clinical opinion and database findings. Costs were based on appropriate country sources for each of the four countries analysed. Compared to a current practice using traditional absorbable sutures and staples/sutures, use of the skin closure system and barbed suture in the future practice was predicted to result in cost savings to hospitals. By country, cost savings per patient ranged from €326 to €335 (France), €357 to €366 (Germany), €419 to €428 (Italy), and €590 to €599 (the Netherlands), depending on the dressing type used. Results of the economic analysis suggest that the introduction of the skin closure system and barbed suture for wound closure in knee arthroplasty can save costs to European hospitals due to reduced intra- and post-operative resource use.