37: Comparison of staples versus subcuticular suture in class III obese women undergoing cesarean delivery: a randomized controlled trial


      To compare stainless steel staples versus subcuticular suture for skin closure at time of cesarean delivery in Class III obese women with body mass index (BMI) of ≥ 40 kg/m2.

      Study Design

      We conducted a randomized controlled trial at two teaching hospitals between 2015 and 2016 in which women with BMI ≥ 40 kg/m2 undergoing cesarean delivery were randomly assigned to stainless steel staples or subcuticular suture for skin closure. The primary outcome was composite wound complication up to 6 weeks after delivery and included superficial or deep separation and infection. Secondary outcomes included operative time, blood loss, and pain and satisfaction scores.


      A total of 242 women were enrolled. 119 in the staple group and 119 in the subcuticular suture group were analyzed. Maternal demographics and characteristics were similar in both groups. The composite wound complication rate was 19.3% in the staple group and 17.6% in the subcuticular suture group (p=0.74) with an overall wound complication rate of 18.5% in the entire study cohort. There were no differences in the rates of infection, superficial or deep wound separation among the two study groups. In a univariate analysis of predictors of wound complications, only current tobacco use was found to be a significant predictor of wound complications in this severely obese patient population (RR 4.97 [1.37-18.03], p=0.02). While self-reported pain, concern about wound healing, and satisfaction scores were equal among the two groups, significantly fewer women with staple closure would choose the same closure method in a future pregnancy (p=0.01).


      In Class III obese women undergoing cesarean delivery, there was no difference in composite wound outcome up to 6 weeks postpartum between those who had staples and those who had subcuticular sutures for skin closure. Patient satisfaction was higher amongst those women with subcuticular suture closure.