The Clinical and Economic Value of Triclosan-Coated Surgical Sutures in Abdominal Surgery

Marco Ceresoli,Alessandra Piemontese,Vito Paragò,Francesca Carissimi,Thibaut Galvain,Giovanni Tommaselli,Luca Gianotti

doi:10.3390/app10031090

Marco Ceresoli, Alessandra Piemontese + Show 5 more

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https://doi.org/10.3390/app10031090

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Abstract

Surgical site infection (SSI) is a frequent complication of surgical procedures. The aim of this study was to analyze the clinical evidence for SSI prevention with triclosan-coated sutures (TCS) in abdominal surgery and to investigate the economic impact of TCS in this type of procedure compared with conventional absorbable sutures (CS). A literature review was carried out to identify meta-analyses that were published between 1990 and 2019 that assessed the use of TCS in abdominal surgery. A budget impact analysis was performed from an Italian hospital perspective based on the most recently published evidence to simulate the financial impact of TCS in a general surgery unit. Uncertainty was explored through scenario analysis, as well as deterministic and probabilistic sensitivity analyses. Nine meta-analyses and two additional randomized clinical trials were retrieved. All meta-analyses described a reduction (range 19%–44%) in the risk of SSI when TCS were used. The use of TCS was associated with an overall annual net saving for the general surgery unit of €14,785 and a reduction of 3.2 SSIs compared with CS. Sensitivity analyses resulted in a positive annual saving associated with TCS in 98% of scenarios. TCS are a valuable, cost-saving SSI prevention strategy. TCS additional costs would be offset by the reduction in SSIs.

Highlights

A surgical site infection (SSI) is defined as an infection that occurs within 30 days of surgery if no implant is left in place or within 90 days if an implant is left in place [1]
A 33% reduction from the Henriksen et al meta-analysis was used in the budget impact analysis (OR: 0.67; 0.46–0.98; p = 0.04), as established from the results of the literature review [28]
We considered that when the incidence of an outcome of interest was common (>10%), the adjusted OR

Summary

Introduction

A surgical site infection (SSI) is defined as an infection that occurs within 30 days of surgery if no implant is left in place or within 90 days if an implant is left in place [1]. Despite established preventive measures [2], SSI remains the most frequent complication following abdominal surgery—defined as any surgical procedure on the abdominal cavity followed by abdominal wall closure—with an incidence rate of 10%–20% in contaminated and dirty surgery [3]. SSI is a surgical complication that affects the length of stay, it has a significant impact on the patient’s perceived quality of life. SSI is an important risk factor for readmission, reintervention, and the development of incisional hernia [4,5], resulting in increased healthcare-related costs [6].

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