Staples Tied to Increase in C-Section Wound Complications

CHICAGO — Staple closure at cesarean delivery was associated with more than a fourfold increased risk of wound separation compared with subcuticular suture, according to a large prospective randomized study.

Staple closure was a significant independent risk factor for wound separation after adjustment for gestational age, repeat cesarean delivery, obstetric complications, maternal comorbidities, a body mass index (BMI) of 30 kg/m2 or more, incision type, operative time, and insurance type (odds ratio, 4.66). The relative risk of wound separation with staples was also significant at 3.67. No other characteristic was predictive of wound complications in adjusted analysis.

Staple closure also required more scheduled and unscheduled office visits for wound care, Dr. Suzanne Basha said at the annual meeting of the Society for Maternal-Fetal Medicine. Previous randomized studies were not specifically designed to evaluate wound complications and have been limited by small patient numbers.

She presented data on 416 women who underwent cesarean delivery, either scheduled or in labor, at a mean gestational age of 38 weeks. The women had an average age of 29 years, 70% were white, and roughly 60% had a BMI of 30 or more.

The skin was closed with stainless steel staples in 197 women and with a 4-0 monocryl suture on a PS2 needle in 219 women. Adhesive closure strips were placed after staple removal and at the time of skin closure in the suture arm. Subcutaneous tissue was closed in both groups if it was greater than 2 cm, as this has been shown to decrease wound complications in several studies, said Dr. Basha, an ob.gyn. at Lehigh Valley Health Network in Allentown, Pa.

Based on telephone interviews conducted 2–4 weeks postoperatively by a single investigator, the wound separation rate was significantly higher at 17% in the staple group, compared with 5% in the suture group.

The composite wound complication rate, the study's primary outcome, was also significantly higher at 22% in the staple group vs. 9% in the suture group, Dr. Basha said. The composite rate included wound separation, wound infection or need for antibiotics, need for a follow-up visit for wound concerns, and hospital admission for wound concerns.

The staple and suture groups had similar rates of wound infection requiring antibiotics (5% vs. 4%), readmission for any reason (2% vs. 3%), or readmission for wound care (both 1%). Antibiotic use was about 99% in both groups.

Women in the staple group, however, were twice as likely to require an office visit for an incision problem vs. those in the suture group (10% vs. 5%), and were significantly more likely to require an office visit before their scheduled postpartum visit (36% vs. 11%).

The staple group was significantly more likely than the suture group to have a repeat cesarean delivery (50% vs. 39%), chorioamnionitis (9% vs. 4%), and a shorter median operative time (49 minutes vs. 56 minutes).