Incidence of wound complications after cesarean delivery: is suture closure better?

Abstract

Background: Wound complications (WC) following cesarean delivery (CD) result in significant morbidity. A randomized trial in 2013, which demonstrated lower WC rates with suture closure compared to staple closure, resulted in a practice change within our academic institution.

Objective: To determine the impact of this practice change on WC rates and identify other modifiable risk factors for WC.

Study design: This is a retrospective cohort study of all women undergoing CD at the University of California, San Diego between 1 March 2011 and 28 February 2012 (primarily staple) and 1 March 2013 and 28 February 2014 (primarily suture). WC rates were compared between the two time intervals using Chi-square and Student’s t-tests. Risk factors (OR, 95%CI) for WC were assessed using multiple logistic regression modeling.

Results: Of 1580 women delivered by CD, rates of WC were higher with staple closure compared to sutures (10.1% versus 4.5%; OR 2.4, 1.4–4.1). Additionally, WC were more likely with vertical skin incisions (OR 3.6, 1.6–8.1), CD for failed labor (OR 2.9, 1.1–7.4) and diabetes (OR 2.1, 1.4–3.9).

Conclusions: After adjusting for confounders, there were over twofold increased odds of WC with staple closure. Vertical incisions, failed labor and diabetes also contributed to WC. Suture closure appears to decrease the risks of WC post CD.

Keywords:

• Cesarean delivery
• wound complications
• closure technique
• suture
• staples
• skin incision

Acknowledgements

The authors thank all participating patients and the obstetric care workers, and general practitioners involved in their obstetrical care at the University of California, San Diego.

Details of ethics approval

Approval of the study was obtained from the institutional review board at the University of California, San Diego on 2/20/2014. IRB project # 140270x.

Declaration of interest

The authors of this study have declared no disclosures or financial conflicts of interest.