# What are spine procedure infection rates with plus sutures? In spine procedures, one study found plus sutures had a 0.5% infection rate compared to 3.9% with standard sutures, though spine-specific data remains limited. # Abstract Seven studies reported infection outcomes using plus (triclosan-coated, impregnated, or containing) sutures in surgical settings. In spine procedures, Ueno et al. (2015) recorded an infection rate of 0.5% (1 in 200 patients) with triclosan-coated polyglactin 910 versus 3.9% (8 in 205 patients) with standard sutures (absolute reduction 3.4%, p = 0.020). In analyses encompassing mixed procedures, Edwards et al. (2023) observed a 29% risk reduction (relative risk 0.71, 95% confidence interval 0.64–0.79, p < 0.001) with plus sutures. Jalalzadeh et al. (2025) found plus suture infection rates of 12.1% compared with 14.7% for standard sutures (relative risk 0.75, 95% CI 0.65–0.86; number needed to treat = 40), and Scientific Surgery (2014) reported a relative risk of 0.73 (95% CI 0.59–0.91, p = 0.005). Chang et al. (2012) noted an odds ratio of 0.77 (95% CI 0.40–1.51, p = 0.45) that did not reach statistical significance, and two studies provided no spine-specific plus suture infection rates. No significant adverse effects attributable to plus sutures were noted. The spine-specific data, though limited, indicate that plus sutures may lower infection rates compared with standard sutures. ## Methods We analyzed 7 sources from an initial pool of 998, using 8 screening criteria. Each paper was reviewed for 5 key aspects that mattered most to the research question. More on methods. Papers identified with Elicit search n = 998 - Papers screened using: Spine Surgery Population, Antimicrobial Suture Use, Infection Outcomes, Human Clinical Data, Study Design, Infection Assessment, Data Extractability, Study Type and Detail n = 998 - Papers screened out n = 991 - Papers included for extraction n = 7 ## Data extraction We asked a large language model to extract each data column below from each paper. We gave the model the extraction instructions shown below for each column. - **Study Design**: Identify the specific type of study design (e.g., randomized controlled trial, quasi-experimental, prospective cohort). - **Patient Population Characteristics**: Extract key patient demographic and clinical characteristics. - **Suture Characteristics**: Describe specific suture details. - **Infection Rates and Characteristics**: Extract comprehensive infection data. - **Risk Factors and Statistical Analysis**: Identify key risk factors and statistical methods. # Results ## Characteristics of Included Studies | Study | Study Design | Spine Procedure Type | Sample Size | Plus Suture Type | Full text retrieved | |-----------------------------------------|--------------------------------------------------------|-----------------------------------------------------------------------|-------------|----------------------------------------------------|---------------------| | Ueno et al., 2015 | Retrospective, nonrandomized clinical study | Spinal surgical procedures (not further specified) | 405 | Triclosan-coated polyglactin 910 (Vicryl Plus) | No | | Yaldiz et al., 2015 | Retrospective analysis | Posterior stabilization for degenerative lumbar stenosis with >2 levels of laminectomy and facetectomy | 540 | Prolene (no antimicrobial coating) | No | | Edwards et al., 2023 | Systematic review and meta-analysis of 31 randomized controlled trials | Mixed (includes spine, not isolated) | 13,754 | Triclosan-coated (various types) | Yes | | Chang et al., 2012 | Systematic review and meta-analysis of 7 randomized controlled trials | Mixed (not specified) | 836 | Triclosan-impregnated (not specified) | No | | Castellà et al., 2019 | Quasi-experimental pretest/posttest with historical control | Spinal surgery (disc herniation, stenosis, etc.) | 139 | No mention found | Yes | | Jalalzadeh et al., 2025 | Systematic review and meta-analysis of 31 randomized controlled trials | Mixed (not specified) | 17,968 | Triclosan-containing (no mention found) | Yes | | "Scientific Surgery,” 2014 | Meta-analysis of 13 trials | Mixed (not specified) | 3,568 | Triclosan-coated (no mention found) | No | ## Effects ### Infection Rates with Plus Sutures | Study | Plus Suture Infection Rate | Standard Suture Infection Rate | Risk Reduction | |-----------------------------------------|-----------------------------|-------------------------------|--------------------------------------------------------------| | Ueno et al., 2015 | 0.5% (1/200) | 3.9% (8/205) | Absolute reduction: 3.4%; p=0.020 | | Yaldiz et al., 2015 | Not mentioned | Not mentioned | Not mentioned | | Edwards et al., 2023 | Not isolated for spine | Not mentioned | Relative risk 0.71 (95% CI 0.64–0.79), 29% reduction, p<0.001 | | Chang et al., 2012 | Not mentioned | Not mentioned | Odds ratio 0.77 (95% CI 0.40–1.51), p=0.45 | | Castellà et al., 2019 | Not mentioned | Not mentioned | Not applicable | | Jalalzadeh et al., 2025 | 12.1% (1,098/8,969) | 14.7% (1,324/8,999) | Relative risk 0.75 (95% CI 0.65–0.86), NNT = 40 | | "Scientific Surgery," 2014 | Not mentioned | Not mentioned | Relative risk 0.73 (95% CI 0.59–0.91), p=0.005 | ### Safety and Adverse Effects - No significant adverse effects attributable to plus (triclosan-coated) sutures were noted in the included studies. ## Synthesis - The findings suggest a potential advantage of using plus sutures over standard sutures in spine procedures, though the evidence remains limited and diverse in quality due to varying designs and populations across studies.