Closing Time: One Last Call for Patient Preference

Background:

Wound closure methods in total hip and knee arthroplasty are a controversial topic with no differences in outcomes between surgical staples (SS) and subcutaneous sutures with Dermabond (SCD). The use of SS or SCD is based on physician tendencies, availability of materials, and application time, but should also integrate a patient-centered approach. This study aimed to collect patient preference prevalence between SS and SCD and analyze differences in preference based on gender.

Methods:

Patients were surveyed on their wound closure preferences prior to surgery. The handout given collected preference and patient demographics. Risk ratios (RR) and risk difference (RD) with 95% confidence intervals (95% CI) were calculated along with Firth corrected logistic regressions.

Results:

163 participants were analyzed (53% female) (average age = 63.8), in which 12 participants selected SS as their preferred method. Males demonstrated no difference in relative risk (RR: 2.3 (95% CI: 0.7, 7.3), p =0.150) or absolute risk (RD: 5.9 (-2.2, 14.1), p = 0.156) in choosing SS over SCD. Patients that previously sustained SS for other surgeries demonstrated no difference in adjusted odds (Adjusted: 0.9 (95% CI: 0.2, 3.2), p = 0.839) in choosing SS over SCD.

Discussion:

More patients favored SCD over SS. There was no difference in preferences based on gender or previous surgical history. Current literature shows that successful wound closure is achieved with minimized risks for infection and other complications using both methods. Therefore, surgeons should adopt a patient-centric approach and perform the closure method that most patients prefer.