# The Clinical and Economic Value of Triclosan-Coated Surgical Sutures in Abdominal Surgery
## 4 Discussion
\begin{table}
\begin{tabular}{l} \hline \hline
**Preoperative Measures** \\ \hline Shower before surgery with either plain or antimicrobial soap \\ Mupirocin 2\% decolonization in \(S\). _aureus_ nasal carrier in cardiac and orthopedic surgery \\ Not remove patient hair, or if necessary, prefer clipper to shaver \\ Antibiotic prophylaxis in 120 min preceding surgical incision \\ Adequate surgical hand scrubbing \\ Oral administration of multiple nutrient-enhanced formula before surgery \\ Not interrupt immunosuppressive treatment \\ \hline
**Intraoperative Measures** \\ \hline Skin preparation with alcohol-based chlorhexiidine gluconate solution \\ Use wound protective devices \\ Consider prophylactic negative pressure therapy in high-risk wound \\ Not use plastic adhesive incise drapes \\ Not use antimicrobial sealants after surgical site skin preparation \\ Administration of oxygen with 80\% FiO2 \\ Use warming device \\ Use protocol for intensive blood glucose control \\ Wound irrigation with aqueous povidone iodine solution before closure \\ Not perform antibiotic wound irrigation \\ Use of tridosan-coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery \\ \hline
**Postoperative Measures** \\ \hline Not prolong antibiotic prophylaxis in postoperative period \\ Not continue antibiotic prophylaxis due to presence of drain \\ Administration of oxygen with 80\% FiO2 for 2–6 h post-op \\ Appropriate wound evaluation and management \\ Not use advanced dressing of any sort, prefer standard dressing \\ \hline \hline \end{tabular}
\end{table} 
Table 4: World Health Organization recommendations for SSI prevention, 2016 version. A budget impact analysis was performed to evaluate the economic impact of adopting TCS into clinical practice from the perspective of a general surgery unit in an Italian hospital. The model demonstrated that the incremental cost of adopting TCS was offset by the cost of SSI episodes that were avoided. Despite an upfront incremental acquisition cost of \(\epsilon\)600, the use of TCS resulted in an overall annual net saving of \(\epsilon\)14,785 for the institution. Furthermore, sensitivity analyses demonstrated that, across a broad variation in the ranges for each parameter, the annual savings remained positive with a 98% probability that TCS was cost-saving. [PERSON] et al. [44], by using a deterministic decision-tree, a stochastic cost model, and the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCS versus CS, estimated a significant mean saving of \(\epsilon\)91.25 per surgical procedure from using antimicrobial sutures across all surgical wound types. This is aligned with the findings in this analysis, where the overall saving was split for single hospitalization with a saving of \(\epsilon\)147.85. This was further supported by three trials that were published between 2007 and 2013 that evaluated the clinical efficacy and economic impact of TCS and which demonstrated a net economic saving resulting from adopting TCS rather than CS [26; 45; 46]. The relevance of this study to the Italian healthcare system lies in the use of Italian-specific input data for SSI risk and SSI cost. This analysis could therefore be valuable to support decision-making processes at the hospital level in Italy. The robustness of the model is increased by the performed sensitivity analyses; however, the limitations of the model lie in some of the inputs being extrapolated from literature research, not being real-world data, or being inflated to current values from outdated data like the SSI cost. To alleviate this, additional analyses, based on recent real-world data from one or more Italian hospitals could be performed to demonstrate the real budget impact of adopting TCS into Italian clinical practice.