Closing Time: One Last Call for Patient Preference

Abstract

Background: Wound closure method in total hip and knee arthroplasty is a controversial topic with no differences in clinical outcomes between surgical staples (SS) and subcutaneous sutures with Dermabond (SCD). When clinically appropriate, providers should focus more on what the patient may prefer. This study aimed to collect data on patient preference between SS and SCD and analyze differences in preference based on gender and previous surgical histories. Methods: Patients were surveyed on their wound closure preferences prior to surgery. The handout given collected preference and patient demographics. Risk ratios and risk difference with 95% confidence intervals (95% CI) were calculated along with Firth-corrected logistic regressions. Results: A total of 163 participants were analyzed (53% female) (average age = 63.8 years), in which 12 participants selected SS as their preferred method. Males demonstrated no difference in relative risk (risk ratio: 2.3 [95% CI: 0.7, 7.3], P = .150) or absolute risk (risk difference: 5.9 [−2.2, 14.1], P = .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 = .839) in choosing SS over SCD. Conclusion: 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. Providers should adopt a patient-centric approach and perform the closure method that most patients prefer when medically warranted.

Keywords

• Patient preference
• Wound closure
• Surgical staples
• Total joint
• Dermabond