OBJECTIVES: Despite a large number of randomized trials and reviews evaluating the effectiveness of antimicrobial sutures (AMS), the clinical and cost impact of using AMS vs. non-coated sutures (NCS) are not well documented and were therefore evaluated in this study. METHODS: A systematic review and meta-analysis of all published evidence comparing AMS to NCS from 01/01/2005 to 02/2016 was conducted. Surgical site infection (SSI) was the primary outcome. A sub-analysis further evaluated risk of SSI based on surgical wound classification (SWC), as defined by the Centers for Disease Control and Prevention. For this sub-analysis, studies were categorized as: Group 1: Clean, Group 2: Clean/contaminated, Group 3: Contaminated and Dirty-infected, Group 4: Undefined or including a mix of wound types. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using United Kingdom (UK)-based cost of SSI and sutures. RESULTS: From an initial 66 citations, 32 unique data points from 28 distinct manuscripts were included in the final assessment. Of the 28 studies, 68% were randomized and 61% reported blinding of physicians and evaluators. The odds ratio (OR) for SSI in the TCS vs control was significant at 0.617 (95% confidence interval (CI): 0.526 to 0.724, p=0.029). There was significant heterogeneity (I= 33%). Whereas there was a clear trend of increased effectiveness by SWC type, a meta-regression did not identify SWC as a significant predictor of SSI, most likely because of the small number of studies in Group 3. Using these estimates of SSI risks, the average savings per surgery ranged from £122.0 (95% CI: £66.6 to £190.3 for clean wound to £411.54 (95% confidence interval: £202.1 to £677.8) for dirty wound surgeries. CONCLUSIONS: Using UK-based healthcare costs and published rates of SSI, use of AMS result in significant savings for all surgical wound types.