The Human Cost of Poor Suture Practice

two surgeons performing suture practice on a patient

Unfortunately, the consequences of poor suture techniques are usually not immediately apparent to the practitioner. Once a patient is stitched up and sent on their way, it is only later that the consequences become apparent. The reality is that any time there is poor suture practice, those who suffer are the patients.

The costs of bad practice are high. Poor suture techniques can lead to infection, scarring and longer recovery times – all of which negatively impact both patients and the healthcare system as a whole. Infections are, perhaps, the biggest concern for medical practitioners and patients alike. Infected wounds can have tremendous implications for patients’ overall health, as well as their mental and financial well being.

Surgical site infections (SSIs) occur in roughly 2% of surgical procedures, but according to de Lissovoy et al, SSIs “account for some 20% of health care-associated infections.”1 They found that for most patients, an incidence of SSI extended patients’ hospital stay by an average of 9.7 days and an increased financial burden of $20,842 per admission.

After discharge, the complications for patients persist. Perencevich et al found in a study of the 8-week postoperative period where SSIs were detected that “patients required significantly more outpatient visits, emergency room visits, radiology services, readmissions, and home health aide services.”2 Additionally, the financial cost difference for patients suffering postoperative SSIs versus those who did not develop an infection was significant. For those who developed an SSI, their cost was on average $5,155 compared to only $1,773 for those who did not develop an infection.

Improper suture techniques can lead to SSIs. Proper suturing requires that practitioners align the edges of an incision correctly and use the right amount of tension to close the wound. Pulling too tightly can result in ripples in the skin, leaving exposed edges and increasing the possibility of infection. 

Having the right tension and alignment is vital for avoiding poor outcomes for patients. That’s why it’s especially important for nursing and medical students to use high quality suture pads for their suture training. Practicing on lifelike materials is the only way to ensure correct handling of the tissue. 

Human skin is both durable and fragile, and it’s important for students to learn how to handle it gently. Working on lifelike suture pads allows students to get a clear sense of how much tension is needed without brutalizing the area that has been incised. A high quality practice skin will navigate the careful balance of being tough enough to hold the tension of the suture and tearing just like real skin if too much pressure is applied. 

Scarring is another significant consequence of improper suture techniques. While scarring is difficult to avoid, it’s likelihood can be significantly reduced if students learn how to apply appropriate amounts of tension by practicing on tissue that closely resembles human skin. Even better, the opportunity to practice subcuticular sutures on suture training pads that include the dermis layer. This technique significantly reduces the possibility of scarring and is especially important when suturing more noticeable areas. Buried sutures placed below the upper layer of skin prevent scarring by not piercing the actual skin.

Ultimately, using high quality suture training pads allows for better practice, better skills and better patient outcomes. Learning proper techniques before suturing a live patient improves student confidence and skill retention. The results are less scarring, less infection and quicker recovery times. 

  1. de Lissovoy G, Fraeman K, Hutchins V, et al: Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37(5):387-397, 2009.
  2. Perencevich E, Sands K. Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerg Infect Dis 9(2):196-203, 2003.