title: Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures.
abstract: BACKGROUND
  Despite several randomized trials, systematic reviews and meta-analyses that have demonstrated the effectiveness of antimicrobial (triclosan-coated or -impregnated) sutures (TCS), the clinical and economic impact of using these sutures compared with conventional non-antimicrobial-coated absorbable sutures (NCS) remains poorly documented.
  
  
  METHODS
  An independent systematic review and meta-analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical-site infection (SSI) was the primary outcome. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCS versus NCS.
  
  
  RESULTS
  Thirty-four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random-effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 0·61, 95 per cent c.i. 0·52 to 0·73; P < 0·001). There was significant heterogeneity (I2= 49 per cent). Using random-effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: £91·25 (90 per cent c.i. 49·62 to 142·76) (€105·09 (57·15 to 164·41); exchange rate 15 November 2016) across all wound types.
  
  
  CONCLUSIONS
  The reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.
authors.affiliation: Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, and Department of Clinical Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Leaper
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Edmiston
authors.affiliation: Johnson & Johnson Epidemiology and Health Informatics - Medical Devices, New Brunswick, New Jersey, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Holy
mesh_terms: D020341:Absorbable Implants; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D017046:Cost Savings; D017721:Hospital Costs; D006801:Humans; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000191:economics* / Q000517:prevention & control*; D013537:Sutures; D014260:Triclosan / Q000008:administration & dosage*
chemical_list: D000891:Anti-Infective Agents, Local; D014260:Triclosan