Elicit: Spine Procedure Infection Rates with Plus Sutures (public)
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.
Screening
We screened in sources based on their abstracts that met these criteria:
- Spine Surgery Population: Does this study involve patients undergoing any type of spine surgery or spinal procedure?
- Antimicrobial Suture Use: Does this study use antimicrobial-coated (plus) sutures for wound closure AND is the suture type clearly specified?
- Infection Outcomes: Does this study report infection rates as a primary or secondary outcome?
- Human Clinical Data: Does this study involve human subjects with clinical infection data?
- Study Design: Is this study a randomized controlled trial, cohort study, case-control study, case series with ≥10 patients, systematic review, or meta-analysis?
- Infection Assessment: Does this study have clearly defined infection assessment criteria?
- Data Extractability: Can infection rates be extracted or calculated from the data presented in this study?
- Study Type and Detail: Is this an original research study with sufficient methodological detail?
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 | 540 | Prolene (no antimicrobial coating) | No |
| Edwards et al., 2023 | Systematic review and meta-analysis | Mixed (includes spine, not isolated) | 13,754 | Triclosan-coated | Yes |
| Chang et al., 2012 | Systematic review and meta-analysis | Mixed (not specified) | 836 | Triclosan-impregnated (not specified) | No |
| Castellà et al., 2019 | Quasi-experimental pretest/posttest with historical control | Spinal surgery (various types) | 139 | No mention found | Yes |
| Jalalzadeh et al., 2025 | Systematic review and meta-analysis | Mixed (not specified) | 17,968 | Triclosan-containing (not specified) | Yes |
| Scientific Surgery, 2014 | Meta-analysis of 13 trials | Mixed (not specified) | 3,568 | Triclosan-coated (not specified) | 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 | No mention found | No mention found | No mention found |
| Edwards et al., 2023 | Not isolated for spine | Not isolated for spine | Relative risk 0.71 (95% CI 0.64–0.79), 29% reduction |
| Chang et al., 2012 | No mention found | No mention found | Odds ratio 0.77 (95% CI 0.40–1.51), p=0.45 |
| Castellà et al., 2019 | No mention found | No mention found | 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 | No mention found | No mention found | Relative risk 0.73 (95% CI 0.59–0.91), p=0.005 |
Conclusions
- Spine-specific evidence is limited, with only Ueno et al. (2015) showing lower infection rates with plus (triclosan-coated) sutures.
- Meta-analyses demonstrate significant reductions in infection rates but are not exclusively spine-focused.
- Overall, evidence suggests a favorability towards using plus sutures in reducing infection rates in spinal procedures.