The use of barbed sutures during scoliosis fusion wound closure: a quality improvement analysis.

BACKGROUND: Growing evidence in the orthopaedic arthroplasty literature supports the use of running bidirectional barbed suture (barbed suture) for closure of knee arthrotomies. More rapid wound closure and suture line integrity are described as its major advantages. No studies of barbed suture for the closure of posterior spinal wounds exist. The purpose of this project is to compare wound closure times and hospital charges using traditional closure versus barbed suture closure of posterior spine wounds created during scoliosis surgery. METHODS: A quality improvement project was initiated at a single tertiary-referral children's hospital spine program evaluating traditional layered interrupted suture closure (group 1) and running bidirectional barbed suture closure (Quill SRS) (group 2). Data regarding wound closure time, length of incision, fusion levels, suture cost, and hospital charges were prospectively collected over a 1-month period. RESULTS: Ten incisions comprised group 1 and 15 comprised group 2. The average wound closure times were 29.5 and 17 minutes, respectively, P=0.006. The wound lengths between the groups were statistically comparable (P=0.15). Taking into account the wound length, the average closure time in group 1 was 1.29 cm/min compared with 1.97 cm/min in group 2 (P<0.01). When accounting for the extra cost associated with the use of barbed sutures ($62.54; P<0.0001), the impact of a more rapid closure resulted in a difference in hospital charges of $884.60 per case (P=0.0013). CONCLUSIONS: Barbed suture closure of spinal fusion incisions results in a 40% reduction in closure time, resulting in an $884.60 decrease in hospital charges related to operating room time. This may represent significant yearly cost savings in a high-volume spine fusion center and warrants further investigation comparing patient-related outcomes. SIGNIFICANCE: This quality improvement analysis provides preliminary economic justification for using barbed suture for scoliosis fusion wound closure resulting in decreased operating room times and subsequent hospital charges. LEVEL OF EVIDENCE: Level II-therapeutic study, prospective nonrandomized cohort.

ApoE: the link between Alzheimer's-related glucose hypometabolism and Aß deposition?

Alzheimer's disease (AD) is a complex, multifactorial progressive neurodegenerative disease. Pathologically, AD is characterized by extracellular deposits of amyloid beta (Aß) protein and intracellular accumulation of neurofibrillary tangles (NFTs) of tau. The central role of Aß protein in the AD etiology is well-established, and its increased deposition in AD brain is attributed to its decreased clearance from the brain. It is noteworthy that apolipoprotein E (ApoE), the most significant risk factor for late-onset AD, has been shown to play a vital role in brain Aß clearance and the ability of ApoE to do this depends mainly upon its lipidation status. Thus, lower ApoE lipidation status leading to decreased Aß clearance may underlie the increased Aß deposition observed in AD brain. In addition to the pathophysiological Aß deposits, AD is also characterized by certain metabolic changes. Among them, decreased cerebral glucose metabolism is one of the distinct characteristics of AD brain and is also observed in patients with Mild Cognitive Impairment (MCI) who subsequently develop AD. Thus, decreased cerebral glucose metabolism is an early event in AD pathology and may precede the neuropathological Aß deposition associated with AD. In this context, we hypothesize here that the decreased glucose metabolism in pre-AD and early AD stages, may lead to lower ApoE lipidation status, which in turn may lead to decreased clearance and hence, increased deposition of Aß protein in AD brain.