title: The use of barbed sutures during scoliosis fusion wound closure: a quality improvement analysis.
abstract: BACKGROUND
  Growing evidence in the orthopaedic arthroplasty literature supports the use of running bidirectional barbed suture (barbed suture) for closure of knee arthrotomies. More rapid wound closure and suture line integrity are described as its major advantages. No studies of barbed suture for the closure of posterior spinal wounds exist. The purpose of this project is to compare wound closure times and hospital charges using traditional closure versus barbed suture closure of posterior spine wounds created during scoliosis surgery.
  
  
  METHODS
  A quality improvement project was initiated at a single tertiary-referral children's hospital spine program evaluating traditional layered interrupted suture closure (group 1) and running bidirectional barbed suture closure (Quill SRS) (group 2). Data regarding wound closure time, length of incision, fusion levels, suture cost, and hospital charges were prospectively collected over a 1-month period.
  
  
  RESULTS
  Ten incisions comprised group 1 and 15 comprised group 2. The average wound closure times were 29.5 and 17 minutes, respectively, P=0.006. The wound lengths between the groups were statistically comparable (P=0.15). Taking into account the wound length, the average closure time in group 1 was 1.29 cm/min compared with 1.97 cm/min in group 2 (P<0.01). When accounting for the extra cost associated with the use of barbed sutures ($62.54; P<0.0001), the impact of a more rapid closure resulted in a difference in hospital charges of $884.60 per case (P=0.0013).
  
  
  CONCLUSIONS
  Barbed suture closure of spinal fusion incisions results in a 40% reduction in closure time, resulting in an $884.60 decrease in hospital charges related to operating room time. This may represent significant yearly cost savings in a high-volume spine fusion center and warrants further investigation comparing patient-related outcomes.
  
  
  CONCLUSIONS
  This quality improvement analysis provides preliminary economic justification for using barbed suture for scoliosis fusion wound closure resulting in decreased operating room times and subsequent hospital charges.
  
  
  METHODS
  Level II-therapeutic study, prospective nonrandomized cohort.
authors.affiliation: *Department of Orthopaedic Surgery, UTHealth, Houston, TX †Department of Orthopaedic Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mansour
authors.forename: Ryan
authors.initials: R
authors.lastname: Ballard
authors.forename: Sumeet
authors.initials: S
authors.lastname: Garg
authors.forename: David
authors.initials: D
authors.lastname: Baulesh
authors.forename: Mark
authors.initials: M
authors.lastname: Erickson
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D013536:Suture Techniques / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome