Barbed versus conventional suture for spinal surgery: a systematic review and meta-analysis

Abstract

Background: Barbed sutures eliminate knots and may offer some advantages over conventional sutures. This meta-analysis compares clinical, surgical and economic outcomes of barbed sutures with standard closure techniques in spinal surgery.

Methods: We systematically searched PubMed, Embase and Web of Science for studies comparing barbed and conventional suture for patients undergoing spinal surgery.

Results: We included 6 studies in the analysis, totaling 965 patients. There was no significant difference between the groups in relation to deep infection (RR 0.49; 95% CI: 0.19-1.28; I² = 0%), hospital stay duration (MD -0.55; 95% CI: -1.11 to 0.01; I² = 8%), postoperative hematoma (RR 0.35; 95% CI: 0.04-3.00; I² = 0%), reintervention due to wound healing problems (RR 0.98; 95% CI: 0.49-1.94; I² = 5%), superficial infection (RR 0.49; 95% CI: 0.19-1.28; I² = 0%), total hospitalization cost (MD -440.81; 95% CI: -1118.90 to 237.29; I² = 63%) and wound dehiscence/seroma, (RR 0.81; 95% CI: 0.29-2.27; I² = 0%). There was a significant lower operating room time (MD -15.37; 95% CI: -29.43 to -1.32; I² = 87%) and suturing time (MD -16.17; 95% CI: -20.58 to -11.75; I² = 91%) in the barbed suture group, beyond a significantly lower risk of total infection (RR 0.55; 95% CI: 0.31-0.98; I² = 0%).

Conclusion: Our meta-analysis showed that barbed sutures were associated with reduced operating room time, suturing time, and infection rates. These results highlight the safety and potential efficacy of using barbed sutures.

Keywords: Barbed suture; Knotless suture; Spinal surgery; Wound closure.