title: Cost analysis of the use of small stitches when closing midline abdominal incisions.
abstract: OBJECTIVE
  Suturing with small stitches instead of with large reduces the risk for surgical site infection and incisional hernia in continuously closed midline abdominal incisions. The purpose was to analyse if using small stitches generated cost savings.
  
  
  METHODS
  Between 2001 and 2006 closure of midline incisions using small stitches was, in a randomised trial, compared with the use of large stitches. In 2011 all patients included in the randomised trial, who until then, had had an incisional hernia repair, were recorded. The cost for an open incisional hernia repair with mesh reinforcement during 2010 was calculated. The analysis included both direct and indirect costs.
  
  
  RESULTS
  Of 321 patients closed with small stitches incisional hernia occurred in 11 and 3 needed repair. Of 370 patients closed with large stitches herniation occurred in 45 and 14 needed repair. The direct cost per hernia repair was 59,909 Swedish krona (SEK) and the indirect cost was 26,348 SEK. Suturing time with small stitches was 4.6 min longer, increasing the cost for the index operation by 1,076 SEK. From the societal perspective (direct and indirect costs), using small stitches generated a cost reduction of 1,339 SEK for each patient. From the perspective of the public payer (direct costs) the cost reduction was 601 SEK. Using small stitches generated cost savings from a societal perspective if the suturing time was not prolonged over 10.3 min.
  
  
  CONCLUSIONS
  Using small stitches when closing midline abdominal incisions with a continuous single-layer technique generates cost savings.
authors.affiliation: Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden, daniel.millbourn@lvn.se.
authors.forename: D
authors.initials: D
authors.lastname: Millbourn
authors.forename: A
authors.initials: A
authors.lastname: Wimo
authors.forename: L A
authors.initials: LA
authors.lastname: Israelsson
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D000328:Adult; D000368:Aged; D017046:Cost Savings / Q000379:methods*; D005260:Female; D006555:Hernia, Ventral / Q000191:economics / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D013529:Surgical Wound Dehiscence / Q000191:economics / Q000209:etiology; D013530:Surgical Wound Infection / Q000191:economics / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects / Q000191:economics; D014945:Wound Healing