Open AccessMeta‐analysis of the potential economic impact following introduction of absorbable antimicrobial sutures
Author(s) -
Leaper D. J.,
Edmiston C. E.,
Holy C. E.
Publication year - 2017
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.10443
Subject(s) - medicine , blinding , meta analysis , odds ratio , antimicrobial , randomized controlled trial , surgical site infection , surgery , confidence interval , relative risk , chemistry , organic chemistry
Background Despite several randomized trials, systematic reviews and meta‐analyses that have demonstrated the effectiveness of antimicrobial (triclosan‐coated or ‐impregnated) sutures ( TCS ), the clinical and economic impact of using these sutures compared with conventional non‐antimicrobial‐coated absorbable sutures ( NCS ) remains poorly documented. Methods An independent systematic review and meta‐analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical‐site infection ( SSI ) was the primary outcome. The results of the meta‐analysis were used in a decision‐tree deterministic and stochastic cost model, using the National Health Service ( NHS England)‐based cost of inpatient admissions for infections and differential costs of TCS versus NCS . Results Thirty‐four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random‐effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 0·61, 95 per cent c.i. 0·52 to 0·73; P < 0·001). There was significant heterogeneity ( I 2 = 49 per cent). Using random‐effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: £91·25 (90 per cent c.i. 49·62 to 142·76) (€105·09 (57·15 to 164·41); exchange rate 15 November 2016) across all wound types. Conclusion The reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.