Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Journal of Perinatology volume 36, pages 819–822 (2016)Cite this article

Subjects

Abstract

Objective:

To compare wound complications between staples versus subcuticular suture for skin closure in obese women (body mass index (BMI)⩾30 kg m−2) after cesarean delivery (CD).

Study Design:

We conducted a retrospective cohort study to compare wound complications between staples and subcuticular suture closure in women, with a prepregnancy BMI⩾30 kg m−2 after CD between 2006 and 2011 at an inner-city teaching hospital. Wound complication was defined as a composite of wound disruption (hematoma or seroma) or infection diagnosed up to 6 weeks postpartum. Variables collected include age, parity, prior CDs, prior abdominal surgeries, incision type, chorioamnionitis, maternal comorbidities (hypertension, diabetes) and gestational age.

Results:

Of the 1147 women included in the study, women with staple closure were older and had higher BMIs (40.6±9.3 versus 36.1±5.4) and were more likely to be multiparous, have a prior CD, diabetes and hypertension compared with women with subcuticular suture. The overall occurrence of wound complications was 15.5% (178/1147). Women with staples had higher wound complications compared with sutures (22.0% versus 9.7%) with a 2.27 unadjusted relative risk (RR) (95% confidence interval (CI), 1.7 to 3.0) and 1.78 adjusted RR (95% CI, 1.27 to 2.49) after controlling for confounders in the final analysis, including vertical skin incisions.

Conclusions:

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Hamilton BE, Martin JA, Osterman MJK, Curtin SC, Matthews TJ. Births: Final Data for 2014. National Vital Statistics Reports, vol. 64, no. 12. National Center for Health Statistics: Hyattsville, MD, USA, 2015..

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (8): 806–814.

    Article  CAS  Google Scholar 

  3. World Health Organization (WHO). Obesity and Overweight Fact Sheet, No. 311, January 2015. Available at http://www.who.int/mediacentre/factsheets/fs311/en/ (retrieved 28 April 2015).

  4. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ . Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203 (3): 271.e1–271.e7.

    Article  Google Scholar 

  5. Conner SN, Verticchio JC, Tuuli MG, Odibo AO, Macones GA, Cahill AG . Maternal obesity and risk of post-cesarean wound complications. Am J Perinatol 2014; 31 (4): 299–304.

    PubMed  Google Scholar 

  6. Dahlke JD, Mendez-Figueroa H, Rouse DJ . Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 2013; 209 (4): 294–306.

    Article  Google Scholar 

  7. Quality and Safety in Women’s Healthcare. American College of Obstetricians and Gynecologists, Women’s Health Care Physicians; Committee on Patient Safety and Quality Improvement, 2nd edn. www.acog.org.

  8. Basha SL, Rochon ML, Quinones JN, Coassolo KM, Rust OA, Smulian JC . Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol 2010; 203 (285): e1–e8.

    Google Scholar 

  9. Clay FS, Walsh CA, Walsh SR . Staples vs subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2011; 204 (5): 378–383.

    Article  Google Scholar 

  10. Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO . Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol 2011; 117: 682–690.

    Article  Google Scholar 

  11. Figueroa D, Jauk VC, Szychowski JM . Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol 2013; 121 (1): 33–38.

    Article  Google Scholar 

  12. Mackeen AD, Khalifeh A, Fleisher J . Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol 2014; 123 (6): 1169–1175.

    Article  Google Scholar 

  13. Mackeen AD, Schuster M, Berghella V . Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol 2014; 212 (5): 621.e1–621.e10.

    Article  Google Scholar 

  14. Mackeen AD, Devaraj T, Baxter JK . Cesarean skin closure preferences: a survey of obstetricians. J Matern Fetal Neonatal Med 2013; 26 (8): 753–756.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA

    M N Zaki, M Truong & T Irwin

  2. Department of Epidemiology, University of Illinois at Chicago, Chicago, IL, USA

    M Pyra

  3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA

    M A Kominiarek

Authors
  1. M N Zaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Truong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Pyra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M A Kominiarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T Irwin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M N Zaki.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Presented in poster format on 18 April 2014 at the 66th Annual Congress of Japan Society of Obstetrics and Gynecology International Session; Tokyo, Japan and at the 33rd Annual Meeting of the Society of Maternal Fetal Medicine; San Francisco, CA, USA held during 11–16 February 2013.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaki, M., Truong, M., Pyra, M. et al. Wound complications in obese women after cesarean: a comparison of staples versus subcuticular suture. J Perinatol 36, 819–822 (2016). https://doi.org/10.1038/jp.2016.89

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2016.89

This article is cited by

Search

Advanced search

Quick links