Cesarean delivery of obese women is associated with a high risk of wound complications. Our objective was to determine whether high transverse skin incisions reduce the risk of cesarean wound complications in women with a body mass index (BMI) greater than 40.METHODS:
A retrospective cohort study was undertaken of parturients ages 18–45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Fisher's exact test was used for continuous variables and chi-square tests for categorical variables.RESULTS:
Nineteen women had high transverse incisions and were matched with 57 controls (low transverse incisions). The mean BMI was 49 for the treatment group and 42 for the control group. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (10.53% vs 17.54%, P=.72). Those having high transverse skin incisions had a higher number of hospital days (3.1 vs 2.4, P=.027), but there was no difference in other secondary outcomes.CONCLUSION:
High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.