Comparison of the Use of Sutures Versus Staples in Posterior Spine Surgery Complicated by Surgical Site Infection

Introduction: Surgical site infection (SSI) is a leading cause of morbidity following posterior spine surgery. The optimal choice of skin closure technique depending on patient- and procedure-specific characteristics remains to be elucidated.

Methods: The Neurosurgery Enterprise Registry (NER) at Mayo Clinic was queried for patients who underwent posterior spine surgery complicated by SSI from 2017-2023. Patients were divided into two groups based on the surgical technique used for skin closure: (1) Closure with sutures; (2) Closure with staples. Baseline patient characteristics and perioperative outcomes were analyzed using data from the NER and the patients’ electronic health records.

Results: A total of 212 patients were identified, with sutures being used in 163 patients (76.9%), and staples in 49 patients (23.1%, p < 0.001). Female patients comprised 41.1% of the sutures group and 69.4% of the staples group (p < 0.001). The mean age in the sutures group was 58.9 ± 15.9, and 60.3 ± 16.8 in the staples group (p =0.1), and the mean number of treated levels was 3.3 ± 3.3 in the sutures group, and 3.1 ± 2.9 in the staples group (p=0.8). Preexisting comorbidities, such as diabetes mellitus (p=0.9), hypertension (p=0.5), and obesity (p=0.6), did not significantly differ between the two groups. No significant differences were noted regarding cervical (p=0.8), thoracic (p=0.5), and lumbar procedures (p=1), treatment in ≥ 3 levels (p=0.9), fusion (p=0.4), and mean operative time (p=0.1). Postoperatively, length of stay (LOS, p=0.7), 30-day (p=0.5), 90-day (p=0.5), and 1-year (p=0.5) readmissions, as well as 30-day (p=1), 90-day (p=0.3), and 1-year (p=0.6) returns to the operating room (ROR) did not significantly differ between the two groups.

Conclusion : In our institution, no significant differences were observed in the use of sutures versus staples for skin closure after posterior spine surgery regarding baseline patient characteristics and perioperative outcomes in patients whose postoperative course was complicated by SSI. Our analysis shows that the choice of skin closure technique was not significantly affected by patient or procedure characteristics, and it did not significantly affect other perioperative outcomes in these patients.