Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials Iavazzo C, Gkegkes ID, Vouloumanou EK, Mamais I, Peppas G, Falagas ME CRD summary This review concluded that staples were associated with fewer wound infections compared with sutures in the evaluated types of surgery. A limited number of studies reported that the use of staples was associated with more pain. Given the potential for publication bias and the limited quality of almost half of included studies, these conclusions should be interpreted with caution. Authors' objectives To compare sutures versus staples for the management of surgical wounds. Searching PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to June 2010; search terms were reported. Reference lists of relevant publications were screened for additional articles. Conference abstracts were excluded, as were studies published in languages other than English, Spanish, German, French, Italian or Greek. Study selection Randomised controlled trials (RCTs) that compared sutures with staples for the management of traumatic or surgical wound were eligible for inclusion. Studies that evaluated deep tissue suturing alone were excluded, as were studies evaluating sutures versus staples in orthopedic operations. The review outcomes of interest were pain, wound closure time, infection, cosmetic outcomes and patient satisfaction. Included studies evaluated interventions for various surgical wounds such as obstetrics and gynaecological operations, general surgery, head and neck operations, vascular surgery and emergency care surgery. The duration of follow-ups ranged from seven days to 11 months. Most studies were of adult patients, whilst a small proportion of studies were of paediatric patients. Where reported, the mean age of treatment groups ranged from 4.5 to 71.4 years. The authors did not state how many reviewers assessed studies for inclusion. Assessment of study quality The quality of studies was assessed using the Jadad scale, a five point scale evaluating randomisation, blinding and withdrawals. Studies scoring greater than two points were classified as adequate quality. It appears that at least two reviewers performed quality assessment, with disagreements resolved by discussion. Data extraction For continuous outcomes, data were extracted on mean and standard deviations to enable the calculation of mean differences with 95% confidence intervals (CIs). For dichotomous outcomes, data were extracted on event rates to enable the calculation of odds ratios (ORs) with 95% confidence intervals. The authors did not state how many reviewers performed data extraction. Methods of synthesis Where appropriate, the studies were combined in a meta-analysis; otherwise the studies were synthesised narratively. The pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals were calculated using a random-effects model. Statistical heterogeneity was assessed using Χ² and Ι². Results of the review Twenty RCTs were included in the review (2,111 patients; 1,233 underwent suture closure and 878 underwent staple Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2018 University of York Page: 1 / 3