Impact of Skin Closure with Staples Versus Sutures on Perioperative Outcomes Following Lower Extremity Bypass Surgery.

Abstract

Objectives: Wound complications are one of the major sources of morbidity after open vascular procedures especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Since no data clearly demonstrates superiority of one method over the other, we aimed to compare outcomes of staples versus sutures for skin closure after LEB.

Methods: The Vascular Quality Initiative database was queried for patients who underwent LEB from August 2014 to March 2024. Patients were stratified according to skin closure method: staples vs sutures (which included either absorbable subcuticular or nonabsorbable interrupted sutures). The primary outcome was surgical site infection (SSI). Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS) and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modelling analyzed primary and secondary outcomes.

Results: A total of 18,268 LEB procedures were included [staples [5,676 (31.07%)]; sutures [12,592 (68.93%)]. Compared to suture closure, staples utilization was associated with 57% higher odds of SSI [196 (3.46%) vs 259 (2.06%); OR 1.57, 95% CI 1.21 - 2.04, p=0.001], 30% higher odds of RTOR [860 (15.17%) vs 1,449 (11.53%); OR 1.30, 95% CI 1.12 - 1.50, p=0.001] and PLOS [1,630 (28.72%) vs 2,835 (22.51%); OR 1.30, CI 1.16 - 1.45, p<0.001]. However, there was no significant difference in 30-day mortality among both closure methods (p>0.05).

Conclusions: In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared to sutures in patients who underwent LEB. Although staple closure might be easier and more time efficient, meticulous wound closure with sutures should be the preferred closure method for lower extremity bypass.