Wound morbidity with staples compared with suture for cesarean skin closure by diabetic status

Abstract

Objective: To determine if the risk of post-cesarean wound morbidity in patients undergoing staple versus suture closure is modified by diabetic status.

Methods: Secondary analysis of a randomized trial of skin closure with subcuticular 4-0 monocryl suture or surgical staples after cesarean delivery. The primary outcome was a composite of wound disruption or infection within 4–6 weeks. We compared the association between this outcome and skin closure method by diabetic status (also stratified by gestational or pregestational) using the Breslow–Day test for interaction.

Results: Of 350 patients, 179 were randomized to staples and 171 to suture. Of the 67 (19.1%) diabetic patients, 35 were gestational and 32 pregestational. The incidence of composite wound morbidity in non-diabetics was 16.7% for staples and 3.6% for suture (p ≤ 0.001, RR: 4.6, 95% CI: 1.8–11.8); it was 5.7% for staples and 15.6% for sutures in diabetics (p = 0.25, RR: 0.4, 95% CI: 0.1–1.7). The corresponding Breslow–Day p value indicated a significant difference between diabetics and non-diabetics (p = 0.002). Stratified further by gestational and pregestational diabetes, the RRs were 0.3 (95% CI: 0.03–2.4) and 0.5 (95% CI: 0.05–5.0) compared to non-diabetics, respectively. Each diabetic sub-group was significantly different from non-diabetics (Breslow–Day p values for homogeneity p = 0.005 and p = 0.045, respectively).

Conclusions: The use of staples compared with subcuticular suture for cesarean skin closure is associated with increased wound morbidity. While this is true for non-diabetics, further studies of diabetics are needed to evaluate for a null or opposite effect of closure type.

• Cesarean delivery
• diabetes mellitus
• gestational diabetes
• wound disruption

Acknowledgements

The authors thank Jan Grant, RN, for contributing to data collection in the primary study and the University of Alabama at Birmingham Residents in Obstetrics and Gynecology for assistance with patient enrollment.

This research was presented, in part, at the 33rd Annual Meeting of the Society for Maternal-Fetal Medicine in San Francisco, CA 14–16 February 2013.