Brush Up on Your Suturing Skills for Cesarean Deliveries

Skin closure after a cesarean delivery is quicker with the use of staples, but are patients satisfied with the results of this closure method?

Jonah Fleisher, MD, a clinical associate of ob/gyn at Penn Medicine presented today at the 2014 ACOG Annual Clinical Meeting in Chicago the results of a prospective, multicenter, randomized clinical trial conducted to determine whether skin closure with sutures or staples resulted in greater patient satisfaction among patients who had cesarean delivery using a low transverse incision. The study’s primary author was A. Dhanya Mackeen, MD, MPH, of Geisinger Health System, Danville, Pennsylvania.

In the study, patients were asked whether they were satisfied with the closure method used and with skin cosmesis using a Likert scale. Physicians also assessed cosmesis, and this assessment was conducted by one of seven trained clinicians who were blinded to the method of skin closure.

Of 746 women randomized, satisfaction data were available for 606 women (81%). Patients who were randomized to suture closure, compared with those randomized to staple closure, reported significantly higher overall satisfaction with the closure method and with skin cosmesis (P<0.01 for both measurements), said Fleisher.

He concluded that sutures are associated with superior outcomes related to the scar’s appearance as well as to patient satisfaction ratings. Since both study groups were satisfied overall, the clinical implications may be less important when looking at only patient satisfaction and cosmesis.

However, the results do have some clinical implications when it comes to the rates of wound complications. Although data on wound complications in this study were not presented in detail, Fleisher did report that wound complication rates were 57% lower for the suture group than for the staple group. In addition, as expected, patients who experienced a wound complication reported lower levels of satisfaction with whatever closure method used than patients who did not experience a wound complication.

When asked whether these findings could be generalized to other gynecological surgeries, such as abdominal hysterectomy, Fleisher reported that the unique immunological and other changes related to pregnancy make it difficult to generalize these results to a nonobstetric patient population.