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National Collaborating Centre for Women's and Children's Health (UK). Surgical Site Infection: Prevention and Treatment of Surgical Site Infection. London: RCOG Press; 2008 Oct. (NICE Clinical Guidelines, No. 74.)

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Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.

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Appendix FCost-effectiveness of closure methods

Six cost studies163,166,194,198,199,200 of wound closure methods were included in the economic review. Where closure methods are equally effective, the cheapest method is the most cost-effective.

F.1. Characteristics of included studies

The six studies163,166,194,198,199,200 included material costs and costs for use of operating rooms and medical personnel time. No costs for treating wound infection were included.

A study198 included a cost analysis alongside a clinical study conducted in Italy. Tissue adhesive (octylcyanoacrylate) was compared with standard sutures in breast surgery. No SSIs were reported for either closure method.

Another study163 compared the closure of laparoscopic trocar wounds with tissue adhesive (octylcyanoacrylate), adhesive paper tape or suture (poliglecaprone) in The Netherlands. The wound infection rate was highest in the octylcyanoacrylate group but the difference between the groups was not statistically significant. The costs of materials used and the costs for use an operating room and medical personnel were included. No costs for treatment of wound infections were included.

A third study166 compared skin closure after phlebectomy with monofilament sutures, tape or tissue adhesive (octylcyanoacrylate) in Austria. No statistically significant difference was found in the clinical outcomes.

A fourth study194 compared absorbable suture with tissue adhesive (octylcyanoacrylate) for closure of trocar sites in a US study. Wound complications rates were similar for the two groups.

A fifth study199 undertaken in the USA in patients undergoing elective laparoscopic surgery compared octylcyanoacrylate adhesive with suturing, and was based on a quasi-randomised trial. No statistically significant difference was found between wound infection rates in the two groups.

The last study200 compared clips with subcuticular Vicryl® sutures in patients with fracture neck of femur. This was a small, non-randomised, prospective study carried out in the UK.

F.2. Findings

The first study198 reported that the total mean costs were lower for tissue adhesives than for sutures for wound closure in breast surgery. The material cost for tissue adhesive was higher than for standard sutures. However, the cost of postoperative visits increased the overall cost for sutures, compared with no visits for the tissue adhesives.

Adhesive paper tape was found to be significantly cheaper than the tissue adhesive (octylcyanoacrylate) and suture (poliglecaprone) in the second study.163 The material cost of octylcyanoacrylate was €13.90 for one ampoule, one package of poliglecaprone was €2.47, and one package of adhesive paper tape was €1.15. The time needed to close a wound was significantly less for adhesive paper tape and tissue adhesive than suture (26 seconds and 33 seconds, respectively, versus 65 seconds).

Adhesive tape was found to be the lowest costing closure method in the third analysis.166 It was the fastest method of wound closure (58 seconds versus 64 seconds for sutures and 1 minute and 14 seconds for tissue adhesive). The material costs were also lowest for adhesive tape.166

The fourth study194 comparing absorbable suture with tissue adhesive reported that the mean closure time for tissue adhesives was shorter than with sutures (3 minutes and 42 seconds compared with 14 minutes and 5 seconds). Although the costs of suture materials were much less than for the tissue adhesive ($4.12 versus $20.30), the operating room cost was high, at $35 per minute, and so tissue adhesive was the least expensive option.

The fifth study199 comparing octylcyanoacrylate adhesive with suturing reported that the median time to close the wound was less with tissue adhesive than sutures (2.5 minutes versus 6 minutes, P < 0.001). Although the material cost of tissue adhesive was higher, as less time was required in the operating room tissue adhesive was cost saving compared with sutures.

The last study200 comparing clips with subcuticular Vicryl sutures reported that dressing changes were needed less frequently in the suture group: on average five changes were needed compared with three for clips. Three infections were identified, all in patients where clips were used, but the number was too small to test any statistical significance. The costs for sutures were lower at £5, compared with £18.10 for the clips. These costs included application, removal and dressings.

F.3. Conclusion

Tissue adhesive was consistently the most expensive for material costs. On the other hand, adhesive tape was consistently the cheapest for material costs and closure also takes the least time. Sutures require the greatest time for wound closure and also require a postoperative outpatient visit for removal.

There is evidence that wound closure using tissue adhesives generates cost savings when compared with sutures for skin closure owing to shorter time for wound closure and no need for a postoperative outpatient visit. Furthermore, there is evidence that wound closure with adhesive tape generates cost savings when compared with tissue adhesives or sutures, as adhesive tape was found to be faster to apply and less costly.

Finally, there is evidence that sutures are less expensive than clips.

Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK53716
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