Sutures Versus Staples for Wound Closure in Orthopaedic Surgery
Recruitment status was: Recruiting
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Sutures vs Staples for Wound Closure in Orthopaedic Surgery: A Randomized Controlled Trial|
- Surgical site infection [ Time Frame: 6 months ] [ Designated as safety issue: No ]Suspected cases will be identified by one or all of the following: use of intravenous antibiotics, use of oral antibiotics (patient self-reported), re-operation at same site. A blinded committee will adjudicate each suspected case and determine true infections using available clinical information. Agreement will be determined by vote.
- Additional healthcare contact related to their surgery [ Time Frame: 6 months ] [ Designated as safety issue: No ]As defined by self-reported visits to other healthcare professionals.
- Dressing changes by homecare/patient at home [ Time Frame: 6 months ] [ Designated as safety issue: No ]Defined by homecare consult records and patient self-report
- Length of stay [ Time Frame: 6 months ] [ Designated as safety issue: No ]Based on admission and discharge dates
- Wound drainage [ Time Frame: 6 months ] [ Designated as safety issue: No ]As defined by necessity for dressing changes after 72 hours for fluid leakage
- Wound necrosis [ Time Frame: 6 months ] [ Designated as safety issue: No ]Evidence of marginal skin death at the surgical site as evidenced by skin slough, blackening or liquefaction
- Patient satisfaction with wound appearance [ Time Frame: 6 months ] [ Designated as safety issue: No ]Using visual analogue scale
- Visual analogue pain score for suture/staple removal [ Time Frame: 2 weeks post-operative ] [ Designated as safety issue: Yes ]Patients will rate the pain experienced in removing the wound closure materials in clinic prior to unblinding.
|Study Start Date:||July 2010|
|Estimated Study Completion Date:||December 2013|
|Estimated Primary Completion Date:||September 2013 (Final data collection date for primary outcome measure)|
Active Comparator: Sutures
Orthopedic surgical wound closed with sutures
Orthopedic surgical wounds closed with sutures
Active Comparator: Staples
Orthopedic surgical wound closed with metallic staples
Orthopedic surgical wounds closed with metallic staples
To date, there is no clear consensus on the method that is best for closure of surgical wounds in orthopaedic surgery. Orthopaedic surgeons have a multitude of wound closure habits. A recent meta-analysis comparing staples to sutures in wound closure demonstrated a three-fold increase in infection in stapled wounds compared to sutured wounds. The studies used in the meta-analysis were primarily of poor methodological quality.
A large, well-designed randomized, controlled trial is needed to guide orthopedic surgeons in their choice of wound closure materials. This study would attempt to provide information on the use of sutures versus skin staples and the effect on the development of surgical site infections in adults undergoing orthopaedic procedures.
A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding of participants and outcome assessors. The primary outcome measure will be infections adjudicated by a blinded data safety monitoring committee. Suspected infections will be defined by: Use of antibiotics or reoperation for infection at the operative site within three months (six months for arthroplasty subgroup) The independent review, board blinded to treatment assignment, will adjudicate suspected infections based on clinical data. A cost analysis will also be performed to compare the costs associated with wounds closed with sutures and staples from a health care institution perspective.
All data will be analyzed by a blinded epidemiologist. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle). A further subgroup analysis will be conducted comparing trauma patients to elective patients. Non-infected revision surgery will also be compared to primary surgery.
It is hypothesized that wounds closed with sutures and staples will have similar infection rates as defined by the use of antibiotics or reoperation.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01146236
|Concordia Hip and Knee Institute|
|Winnipeg, Manitoba, Canada, R2K 2M9|
|Health Sciences Centre|
|Winnipeg, Manitoba, Canada, R3A 1R9|
|Pan Am Clinic|
|Winnipeg, Manitoba, Canada, R3M 3E4|
|Principal Investigator:||Jesse Shantz, MD, MBA||University of Manitoba|