Sutures cause fewer complications than staples with cesarean deliveries

When Suzanne Basha, M.D. began her career as an obstetrician/gynecologist, she was surprised to find nothing in the literature that provided evidence about which method was better to close a wound after a cesarean.

"It seemed to me that I was seeing more patients return with complications after a cesarean birth when staples were used instead of sutures but I couldn't find any studies that supported a recommendation for the use of either method," Basha said.

Basha and her colleagues at the Lehigh Valley Health Network in Allentown, Pa., conducted a study of 425 patients who were randomized. Women undergoing cesarean delivery in labor as well as scheduled cesarean delivery were eligible. Surgical and postpartum care was otherwise at the discretion of the provider. Wound complication data was complete for 98% of subjects (219 suture and 197 staples) and included wound separation, wound infection, antibiotic use, need for a wound-related physician visit, and readmission. Data were collected via telephone interview two to four weeks postoperatively by a single investigator.

Maternal demographic data was similar in both groups. Use of staples resulted in a higher wound separation rate (16.8 v. 4.6%, p< 0.001), higher composite wound complication rate (21.8 v. 9.1%, p< 0.001), and increased post-operative physician visits (36.0 v. 10.6%, p< 0.001); these associations persisted after adjusted analysis. Staple closure was associated with a more than four-fold increased risk of wound separation (adjusted OR 4.66, 95%CI 2.07, 10.52, p< 0.001). Median operative time was eight minutes shorter in the staple group (49 vs. 57 min p< 0.0001).

The study demonstrates that the use of staples for cesarean delivery closure is associated with an increased risk of wound complications and post-operative physician visits. Subcuticular suture may therefore be the preferred method of skin closure for cesarean delivery.