Advanced Multi-Layer Watertight Closure versus Conventional Closure in Total Hip and Knee Replacement Surgery

Figures & data

Figure 1 Depiction of advanced multi-layer watertight closure. (A) Fascial closure with Stratafix Symmetric. (B) Skin closure with Stratafix Spiral.

Table 1 Patient and Procedure Characteristics

	CC N=1394	aMLWC N=434	P-value
Discharge year for 1st surgery			<0.0001
2014	397 (28.5%)	0 (0%)
2015	249 (17.9%)	0 (0%)
2016	399 (28.6%)	0 (0%)
2017	349 (25%)	0 (0%)
2018	0 (0%)	358 (82.5%)
2019	0 (0%)	76 (17.5%)
Female	722 (51.8%)	224 (51.6%)	0.9476
Age, years	64.2 ± 9.6	65.7 ± 9.4	0.0032
Race			0.0025
American Indian, Alaska Native	4 (0.3%)	2 (0.5%)
Asian	39 (2.8%)	21 (4.8%)
Black or African American	33 (2.4%)	11 (2.5%)
Native Hawaiian, Pacific Islander	1 (0.1%)	5 (1.2%)
White	1286 (92.3%)	381 (87.8%)
Other Race	31 (2.2%)	14 (3.2%)
Smoker	43 (3.1%)	9 (2.1%)	0.2686
Body mass index	29.2 ± 4.9	29.5 ± 4.8	0.2982
Distinct procedures	1554 (100%)	553 (100%)	0.0227
Total Hip Arthroplasty	716 (46.1%)	286 (51.7%)
Total Knee Arthroplasty	838 (53.9%)	267 (48.3%)

Notes: Some patients had more than one joint procedure. Patient characteristics are at first procedure. Two-sided p-values are based on a chi-square test for categorical variables and an independent t-test for continuous variables.

Abbreviations: CC, conventional closure; aMLWC, advanced multi-layer watertight closure.

Table 2 Unadjusted Analysis of Outcomes

Outcome	CC N=1554	aMLWC N=553	P-value
SSI within 30 days	5 (0.3%)	4 (0.7%)	0.2535
SSI within 90 days	7 (0.5%)	5 (0.9%)	0.3196
Discharged to home	1488 (95.8%)	544 (98.4%)	0.0038
Reoperation within 365 days	37 (2.4%)	0 (0.0%)	<0.0001
Readmission within 30 days	29 (1.9%)	7 (1.3%)	0.4459
Readmission within 90 days	38 (2.4%)	11 (2.0%)	0.6242
Time to readmission, days (N= 52 CC, 24 aMLWC)^a	51.1 (52.3)	89.9 (63.2)	0.0062
ED visit within 30 days	48 (3.1%)	14 (2.5%)	0.5607
Time to first ED visit, days (N= 48 CC, 14 aMLWC)^a	7.8 (5.4)	10.2 (7.8)	0.1903
Length of stay, days	1.7 (0.7)	1.1 (0.4)	<0.0001
Procedure time, minutes	87.2 (19.1)	87.0 (15.0)	0.8596
Operating room time, minutes	133.9 (21.2)	134.8 (17.1)	0.2830
Change in pain score	0.74 (2.7)	0.50 (2.6)	0.1106

Notes: Results are expressed as n (%) for categorical outcomes and mean (standard deviation) for continuous outcomes. P-values are based on Fisher’s exact test for counts and independent t-tests for continuous variables, using the Satterthwaite correction if equality of variance was rejected at alpha=0.05. ^aComparison is between cases with occurrence only.

Abbreviations: CC, conventional closure; aMLWC, advanced multi-layer watertight closure; SSI, surgical site infection; ED, emergency department.

Figure 2 Kaplan Meier analysis for reoperation, readmission, Emergency Department visit. (A) Reoperation by closure cohort. (B) Readmission by closure cohort. (C) Emergency Department visit by closure cohort.

Table 3 Multivariable Model Results

Logistic Regression Outcome	Odds Ratio (95% CI) aMLWC vs CC	P-value
SSI within 30 days	1.75 (0.46, 6.64)	0.4127
SSI within 90 days	1.67 (0.52, 5.36)	0.3892
Readmission within 30 days	0.63 (0.27, 1.46)	0.2782
Readmission within 90 days	0.77 (0.39, 1.53)	0.4538
Discharge to Home	4.61 (1.78–11.94)	0.0016
ED visit within 30 days	0.79 (0.43, 1.45)	0.4466
Cox Regression Outcome	Hazard Ratio (95% CI) aMLWC vs CC	P-value
Reoperation within 365 days	0.03 (0.00, 0.51)	0.0147
Readmission within 30 days	0.63 (0.27, 1.45)	0.2773
Readmission within 90 days	0.77 (0.39, 1.52)	0.4490
ED visit within 30 days	0.79 (0.44, 1.45)	0.4514
Outcome	Adjusted Outcome Estimates: aMLWC vs CC	P-value
Length of Stay, days	1.10 vs.1.65	<0.0001
Procedure time, minutes	87.2 vs 86.8	0.6657
Operating room time, minutes	135.2 vs 133.6	0.0967
Change in pain score, points	0.70 vs 0.95	0.0941

Abbreviations: SSI, surgical site infection; aMLWC, advanced multi-layer watertight closure; CC, conventional closure; ED, Emergency department; CI, confidence interval.

Figure 3 Adjusted mean length of stay for conventional closure versus advanced multi-layer watertight closure procedures.

Notes: Models were adjusted for age, gender, body mass index, hip vs knee procedure, and smoking status.