Incidence and outcome characteristics of adverse event in surgery: an assessment based on systematic reviews of barbed suture

Systematic reviews (SRs) have affirmed the efficacy of barbed sutures (BS), but raise safety concerns, particularly in adverse events (AEs). We conducted a cross-sectional study to comprehensively collate SRs on BS, summarize the incidence of AEs, and analyze the characteristics of the reported indicators. A thorough search was conducted in PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc and VIP Database from inception to April 14, 2025, and the methodological quality was evaluated using AMSTAR-2. AE characteristics of the SR were evaluated utilizing a self-developed item evaluation form. A total of 52 SRs were included, encompassing 15 surgical procedures and 32 AEs. In terms of methodological quality, 1 SR was rated as high, 5 as moderate, 10 as low, and 36 as critically low. Notably, 92.0% of the SRs did not provide definitions for AEs, 76.0% did not consider severity grading, and none of the SRs assessed the adequacy of sample size. The use of BS significantly reduced the occurrence of needle pricks and biliary fistulas, in addition to increase the rates of suture breakage. Statistically insignificant results included wound dehiscence, blister, exudation, peri − incisional erythema, aseptic redness, hematoma, bleeding, urinary fistulae, stitch abscess, cellulitis, anastomotic stenosis and leak. Inconsistencies were observed in ecchymosis, vaginal cuff dehiscence, postoperative leakage rate after radical prostatectomy, infection, anastomotic bleeding, and overall postoperative complications across different SRs. Evidence from SRs has demonstrated advantages as well as certain disadvantages of BSs — such as an increase in the likelihood of suture breakage and wound-related complications. Current evidence remains inadequate and inconsistent, due to lack of definitions for AEs, severity grading, sample size assessments, and details on suture brand and location of use.