NEW YORK (Reuters Health) – In orthopedic surgery, closing incisions with staples rather than sutures nearly quadruples the risk of wound infection, according to a meta-analysis in the March 17th issue of BMJ Online First.
But while the authors advise against staple closure, they caution that “substantial methodological limitations” in the studies they analyzed prevent any definitive recommendations.
The best method of skin closure has been unclear, said lead author Dr. Toby O. Smith and colleagues, from Norfolk and Norwich University Hospital, U.K. Advocates of staples claim they are quicker and easier to use, while proponents of sutures believe they carry a lower risk of wound infection and may produce better cosmetic outcomes.
In searching MEDLINE, Embase, and other sources from 1950 to 2009, the researchers identified 6 trials that compared staples and sutures for skin closure of 683 orthopedic surgery wounds.
Infection developed in 17 of 350 wounds closed with staples and 3 of 333 wounds closed with sutures (p = 0.01). This translates into a 3.83-fold increased risk of infection when staples rather than sutures are used. In patients who underwent hip surgery, the relative risk with staple closure was even higher, 4.79 (p = 0.02).
By contrast, the method of skin closure did not influence risks of wound discharge, inflammation, wound necrosis, dehiscence, or allergic reactions.
Only two trials used intent-to-treat analyses. Although all were controlled, only three used random allocation. Other limitations included small sample sizes, unblinded assessors, and inadequate follow-up. Just one study met more than half of the quality criteria set by the authors.
“Well designed randomized controlled trials are needed to examine further the increased risk of infection found by Smith and colleagues,” Dr. B. I. Singh and Dr. C. Mcgarvey, from Medway Foundation NHS Trust, Gillingham, UK, comment in an editorial. “They are also needed to discern whether the risks are exclusive to hip surgery, and to compare the risk of infection with staples in elective hip arthroplasty as opposed to hip fracture.”
Reference:
BMJ 2010.
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