title: A systematic review of systematic reviews and panoramic meta-analysis: staples versus sutures for surgical procedures.
abstract: OBJECTIVE
  To systematically evaluate the evidence across surgical specialties as to whether staples or sutures better improve patient and provider level outcomes.
  
  
  METHODS
  A systematic review of systematic reviews and panoramic meta-analysis of pooled estimates.
  
  
  RESULTS
  Eleven systematic reviews, including 13,661 observations, met the inclusion criteria. In orthopaedic surgery sutures were found to be preferable, and for appendicial stump sutures were protective against both surgical site infection and post surgical complications. However, staples were protective against leak in ilecolic anastomosis. For all other surgery types the evidence was inconclusive with wider confidence intervals including the possibly of preferential outcomes for surgical site infection or post surgical complication for either staples or sutures. Whilst reviews showed substantial variation in mean differences in operating time (I(2) 94%) there was clear evidence of a reduction in average operating time across all surgery types. Few reviews reported on length of stay, but the three reviews that did (I(2) 0%, including 950 observations) showed a non significant reduction in length of stay, but showed evidence of publication bias (P-value for Egger test 0.05).
  
  
  CONCLUSIONS
  Evidence across surgical specialties indicates that wound closure with staples reduces the mean operating time. Despite including several thousand observations, no clear evidence of superiority emerged for either staples or sutures with respect to surgical site infection, post surgical complications, or length of stay.
authors.affiliation: Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Karla
authors.initials: K
authors.lastname: Hemming
authors.forename: Thomas
authors.initials: T
authors.lastname: Pinkney
authors.forename: Kay
authors.initials: K
authors.lastname: Futaba
authors.forename: Mary
authors.initials: M
authors.lastname: Pennant
authors.forename: Dion G
authors.initials: DG
authors.lastname: Morton
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lilford
mesh_terms: D006801:Humans; D015201:Meta-Analysis as Topic; D019637:Orthopedic Procedures / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing