Abstract
Purpose
To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing.
Methods
The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES).
Results
A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II.
Conclusion
Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.
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Abbreviations
- BMI:
-
Body mass index
- CS:
-
Cesarean section
- SBSES:
-
Stony Brook Scar Evaluation Scale
- SSI:
-
Surgical site infection
- VAS:
-
Visual analog scale
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Conflict of interest
The authors reported no conflict of interest. All of the authors had substantial contributions to conception, design, acquisition, analysis and interpretation of data. The research was funded by the authors.
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Trial registration: Clinical Trials.gov, NCT01713751.
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Ibrahim, M.I., Moustafa, G.F., Al-Hamid, A.S.A. et al. Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing. Arch Gynecol Obstet 289, 981–986 (2014). https://doi.org/10.1007/s00404-013-3098-z
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DOI: https://doi.org/10.1007/s00404-013-3098-z