Fewer Cesarean Wound Complications With Sutures vs Staples

Laurie Barclay, MD

May 07, 2014

There were 57% fewer wound complications after cesarean section with suture closure of the incision compared with staple closure, according to findings of a prospective, randomized controlled trial published online May 6 in Obstetrics and Gynecology.

"Despite being the most common major operation performed annually in the United States, there is a paucity of data to guide best practices for closure of the cesarean delivery skin incision," write A. Dhanya Mackeen, MD, MPH, from the Departments of Obstetrics and Gynecology, Geisinger Health System, Danville, Lankenau Medical Center, Wynnewood, Pennsylvania, and colleagues. "Most commonly, a cesarean delivery is performed through a suprapubic low-transverse skin incision. At the end of the operation, the skin incision is typically closed with the placement of either a continuous subcutaneous suture that dissolves over time or multiple metal staples that are removed at a later date."

The investigators recruited 746 women undergoing cesarean delivery at 23 weeks of gestation or greater (median, 39 weeks) through a low-transverse skin incision between 2010 and 2012 at 3 US hospitals.

All participants received prophylactic antibiotics before skin incision. The investigators predefined wound complications as a composite of infection, hematoma, seroma, separation of at least 1 cm, or readmission for wound complications.

Suture Closure Had Less Wound Separation

Wound complications occurred in 58 women (7.8%). In the suture group. 4.9% of the women developed wound complications compared with 10.6% in the staple group (adjusted odds ratio [OR], 0.43; 95% confidence interval [CI], 0.23 - 0.78).

The researchers note that the driving force behind the reduced rate of wound complications with suture group was a reduction in wound separation compared with the staple group (1.6% vs 7.4%; adjusted OR, 0.20; 95% CI, 0.07 - 0.51).

The study lacked sufficient power to assess rates of specific types of wound complications, such as wound infection, hematoma, seroma, or readmission for a wound complication.

The time needed for sutures was 9 minutes longer than that required for staples.

"[O]ur study showed a 57% decreased incidence of wound complications when the cesarean delivery skin incision was closed with suture rather than with staples," the study authors write. "Although closure with staples is significantly faster than closure with suture, in cases in which speed is not a serious concern, we recommend that the horizontal cesarean delivery skin incision be closed with suture in an effort to decrease caesarean delivery morbidity related to wound complications."

After the study was designed and initiated, Ethicon Inc agreed to provide funds to assist with patient recruitment and follow-up but had no influence on study design, study execution, data analysis, or publication. The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2014;123:1169-1175. Abstract


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