Wound complications in obese women after cesarean: a comparison of staples versus subcuticular suture

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Abstract

OBJECTIVE:

To compare wound complications between staples versus subcuticular suture for skin closure in obese women (body mass index (BMI) ≥ 30 kg m-2) after cesarean delivery (CD).

STUDY DESIGN:

We conducted a retrospective cohort study to compare wound complications between staples and subcuticular suture closure in women, with a prepregnancy BMI ≥ 30 kg m-2 after CD between 2006 and 2011 at an inner-city teaching hospital. Wound complication was defined as a composite of wound disruption (hematoma or seroma) or infection diagnosed up to 6 weeks postpartum. Variables collected include age, parity, prior CDs, prior abdominal surgeries, incision type, chorioamnionitis, maternal comorbidities (hypertension, diabetes) and gestational age.

RESULTS:

Of the 1147 women included in the study, women with staple closure were older and had higher BMIs (40.6 ± 9.3 versus 36.1 ± 5.4) and were more likely to be multiparous, have a prior CD, diabetes and hypertension compared with women with subcuticular suture. The overall occurrence of wound complications was 15.5% (178/1147). Women with staples had higher wound complications compared with sutures (22.0% versus 9.7%) with a 2.27 unadjusted relative risk (RR) (95% confidence interval (CI), 1.7 to 3.0) and 1.78 adjusted RR (95% CI, 1.27 to 2.49) after controlling for confounders in the final analysis, including vertical skin incisions.

CONCLUSIONS:

In obese women, skin closure with staples at the time of CD is associated with a higher rate of wound complications compared with subcuticular suture. Skin closure with subcuticular suture over staples should be considered in obese women undergoing a CD regardless of skin incision type.

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