Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure.
BACKGROUND
Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.


METHODS
This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.


RESULTS
Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.


CONCLUSIONS
This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.
Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan, mando@gaia.eonet.ne.jp.
Muneharu
M
Ando
Tetsuya
T
Tamaki
Munehito
M
Yoshida
Shunji
S
Sasaki
Yasushi
Y
Toge
Takuji
T
Matsumoto
Kazuhiro
K
Maio
Ryosuke
R
Sakata
Daisuke
D
Fukui
Seiji
S
Kanno
Yukihiro
Y
Nakagawa
Hiroshi
H
Yamada
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003487:Cyanoacrylates / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019637:Orthopedic Procedures; D011446:Prospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013537:Sutures / Q000191:economics; D014014:Tissue Adhesives / Q000191:economics; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000191:economics / Q000295:instrumentation*; D055815:Young Adult
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate