OBJECTIVES: To compare economic and clinical outcomes of patients undergoing spine surgery with use of barbed sutures (specifically, STRATAFIX Knotless Tissue Control Devices) vs. conventional sutures alone for wound closure.

METHODS: Retrospective study using the Premier Hospital Database. Study patients (aged≥18 years) underwent spine surgery (fusion|laminectomy) during a hospitalization between 1/1/2013-6/30/2017 (first=index admission). Patients were classified into mutually-exclusive groups based on billing records during index admission: those with billing record(s) for any use of STRATAFIX (barbed suture group); those with billing record(s) for use of conventional sutures only (conventional sutures group). Primary outcomes included: index admission’s length of stay (LOS) and hospital costs (including sub-categories). Exploratory outcomes included: operating room time; wound complications (infection, dehiscence, non-healing wound) during the index admission or a readmission within 90d thereafter; 30/60/90d all-cause readmissions. The barbed and conventional suture groups were matched using variable-ratio (1:4/weighted), greedy propensity score matching with a caliper. Matching variables included primary procedure/diagnosis grouping (directly matched), patient, hospital, and provider characteristics. Post-match regressions accounting for hospital-level clustering were used to compare outcomes between study groups.

RESULTS: Each group comprised 2,743 patients (5,486 total patients; mean age=61.3y). The groups were well-balanced on matching covariates. Compared to the conventional suture group, the barbed suture group had significantly lower operating room costs ($7,456 barbed vs. $8,948 conventional, P=0.049). Differences were statistically insignificant for the other outcomes: LOS (3.3d vs. 3.2d, P=0.684); total hospital costs ($31,623 vs. $32,019, P=0.787); operating room time (249 vs. 275 mins, P=0.207); wound complications (2.8% vs. 3.1%, P=0.544); all-cause readmissions (30d=6.0% vs. 6.1%; 60d=6.6% vs. 7.3%; 90d=7.3% vs. 8.2%; all P>0.05).

CONCLUSIONS: Among patients undergoing spine surgery in real-world practice, wound closure with barbed sutures was associated with significantly lower operating room costs, potentially related to a trend towards shorter operating room time, when compared with conventional sutures alone.