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

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.