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

Zaki, Mary N.; Truong, Mireille; Pyra, Maria; Kominiarek, Michelle A.; Irwin, Tracy

doi:10.1038/jp.2016.89

Cited by 22 publications

(12 citation statements)

References 11 publications

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“…Women with incisions closed using subcuticular suture were significantly less likely to develop a wound complication (RR 0.49, 95% CI 0.28 to 0.87) and had a longer operative time (MD 7 min, 95% CI, 3.10-11.31) compared to women with incisions closed with staples (Mackeen et al 2015). A similar result was obtained by Zaki et al when analyzing wound complications in women with a prepregnancy BMI of 30 or greater: use of staples was associated with a higher rate of wound complications than use of subcuticular suture (adjusted RR 1.78, 95% CI 1.27 to 2.49) (Zaki et al 2016). No significant difference in wound complications has been shown when comparing subcuticular suture to subcuticular absorbable staples (Schrufer-Poland et al 2016), monofilament suture to braided multifilament suture (Methodius G. , or subcuticular suture to skin glue (Daykan et al 2017).…”

Section: Wound Closuresupporting

confidence: 67%

A review of post-caesarean infectious morbidity: how to prevent and treat

Pierson

Scott

Briscoe

et al. 2018

Journal of Obstetrics and Gynaecology

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Post-caesarean infectious complications result in significant maternal morbidity and mortality as well as increased readmissions and increased health care cost worldwide. This review provides a discussion of several risk factors that have been identified which predispose women to post-surgical infection. We also provide an overview of strategies for infection prevention including antibiotics, surgical techniques and negative pressure wound therapy. Criteria for diagnosis of wound infection are provided, as well as appropriate treatment regimens. Given the impact of maternal post caesarean infection, it is important for women's health care providers to understand how to prevent these infections, as well as recognise and treat them.

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Section: Wound Closuresupporting

confidence: 67%

A review of post-caesarean infectious morbidity: how to prevent and treat

Pierson

Scott

Briscoe

et al. 2018

Journal of Obstetrics and Gynaecology

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“…The research was carried out in ten different countries, on four continents, mainly in North America. Twenty-three studies were conducted in the United States [10,11,28,29,[31][32][33][34]36,39,40,42,43,[46][47][48][50][51][52][53][55][56][57], and the remaining studies were carried out in Egypt [22,30,32,41], Denmark [44], India [35], Japan [25], Canada [54], Australia [21,58], and New Zealand [49]. Moreover, one study concerned women living in England or Ireland [38] and one in Scotland [46].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Most of the studies included both elective and unplanned caesarean sections (n = 14) with the exception of three studies that included emergency caesarean sections as the exclusion criterion [29][30][31]. In five cases, the surgical procedure was generally referred to as a caesarean section [10,26,34,38,41].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Hypertension, like diabetes, is a disease that often coexists with obesity. Seven randomized trials investigate the effect of these diseases on wound healing [11,24,[26][27][28]34,40], and take into account the premature rupture of the membranes, concomitant infections of the membranes or smoking. An American retrospective study found that 1 in 3 women who are morbidly obese will develop complications in the surgical wound, and smoking increases the risk of these complications by more than double (RR 2.7 [95% CI 1.08-6.54] p = 0.03) [24].…”

Section: Relationship Between Preoperative Factors and Wound Complicamentioning

confidence: 99%

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A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

Słabuszewska-Jóźwiak

Szymański

Jóźwiak

et al. 2021

JCM

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(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.

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“…As mentioned in Section 6.3, subcuticular closure with suture reduces chances of wound complications in obese women [73]. Skin closure with staples is associated with a higher chance of wound complication (infection, separation) in obese women within 6 weeks of delivery [83]. However, this effect did not persist in women with class III obesity (BMI ≥ 40 kg/m 2 [84].…”

Section: Prevention Of Surgical Site Infectionsmentioning

confidence: 99%

Obesity: Unique Challenges at the Time of Cesarean Delivery

Roloff¹,

Cao²,

Okekpe³

et al. 2020

Recent Advances in Cesarean Delivery

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The obesity epidemic has touched all aspects of obstetric care, including the practice of cesarean delivery. Obesity is an independent risk factor for cesarean delivery, and the increased prevalence of obesity has contributed to the overall rise in primary cesarean delivery seen over the past few decades. Because of the frequent existence of co-morbidities such as hypertension and diabetes, obesity is a plausible contributor to rising maternal mortality. In addition, obese women who undergo both primary and repeat cesarean delivery have a higher chance to develop surgical and post-operative complications, including wound infection and thromboembolic events. Surgical complications increase steadily with increasing maternal weight. In this chapter, we will review the incidence and contributing factors that lead to cesarean delivery in obese patients, peri-operative complications, and strategies to reduce these risks in obese women undergoing cesarean delivery.

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

Abstract: 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.

Cited by 22 publications

References 11 publications

A review of post-caesarean infectious morbidity: how to prevent and treat

A review of post-caesarean infectious morbidity: how to prevent and treat

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

Obesity: Unique Challenges at the Time of Cesarean Delivery

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