Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery

Mohammed Hamouda; Umu-Hawa Rogers; Alik Farber; Vincent L Rowe; Michael S Conte; Mahmoud B Malas

doi:10.1016/j.jvs.2024.11.023

Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery

J Vasc Surg. 2024 Nov 27:S0741-5214(24)02108-6. doi: 10.1016/j.jvs.2024.11.023. Online ahead of print.

Authors

Mohammed Hamouda¹, Umu-Hawa Rogers¹, Alik Farber², Vincent L Rowe³, Michael S Conte⁴, Mahmoud B Malas⁵

Affiliations

¹ Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), UC San Diego (UCSD), San Diego, CA.
² Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
³ Division of Vascular Surgery and Endovascular Therapy, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁴ Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA.
⁵ Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), UC San Diego (UCSD), San Diego, CA. Electronic address: [email protected].

PMID: 39608414
DOI: 10.1016/j.jvs.2024.11.023

Abstract

Objective: Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.

Methods: The Vascular Quality Initiative database was queried for patients who underwent LEB from August 2014 to March 2024. Patients were stratified according to skin closure method: staples vs sutures (which included either absorbable subcuticular or nonabsorbable interrupted sutures). The primary outcome was surgical site infection (SSI). Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS), and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modeling analyzed primary and secondary outcomes.

Results: A total of 18,268 LEB procedures were included (staples, n = 5676; 31.07%); sutures (n = 12,592; 68.93%). Compared with suture closure, staples utilization was associated with 57% higher odds of SSI (196 [3.46%] vs 259 [2.06%]; odds ratio [OR], 1.57; 95% confidence interval [CI], 1.21-2.04; P = .001) and 30% higher odds of RTOR (860 [15.17%] vs 1449 [11.53%]; OR, 1.30; 95% CI, 1.12-1.50; P = .001) and PLOS (1630 [28.72%] vs 2835 [22.51%]; OR, 1.30; 95% CI, 1.16-1.45; P < .001). However, there was no significant difference in 30-day mortality among both closure methods (P > .05).

Conclusions: In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared with sutures in patients who underwent LEB. Although staple closure might be easier and more time efficient, meticulous wound closure with sutures should be the preferred closure method for LEB.

Keywords: Lower extremity bypass; Nonabsorbable interrupted sutures; Skin closure; Skin staples; Subcuticular sutures; Surgical site infection; Wound complications.