970: Improved patient satisfaction with tissue adhesive as compared to sterile strips after cesarean wound closure

Abstract

To determine if the use of tissue adhesive results in higher patient satisfaction as compared to sterile strips when used after closure of the cesarean skin incision. This was a planned follow up study to a randomized controlled trial of tissue adhesive versus sterile strip for cesarean delivery. The trial was an unblinded, multicenter randomized controlled trial to compare wound complications following use of tissue adhesive (2-octyl cyanoacrylate) versus sterile strips after closure of cesarean incision. Eligibility criteria included any cesarean delivery via Pfannenstiel skin incision. Subjects underwent a standardized protocol including preoperative antibiotics, skin preparation, closure of the subcutaneous space if ≥ 2cm and subcuticular closure. The primary outcome was wound complication defined as drainage, cellulitis, abscess, seroma, hematoma or isolated wound separation within 8 weeks of delivery. In this analysis, patient experience with the cesarean scar was assessed using a modified validated survey administered electronically or by phone between 6 and 8 weeks after delivery. The survey assessed scar pain, itchiness, color, stiffness, irregularity and overall satisfaction with the scar using a 10-point scale in which 1 represented the lowest symptom severity or highest satisfaction, and 10 represented the highest symptom severity or lowest satisfaction. Outcomes were evaluated using Student’s t -test. A total of 510 subjects (255 in each treatment arm) were randomized between June 2016 through April 2018. The rate of survey follow up was 81% (411) of the study participants. On average, women were 33 years of age with 44 (10.7%) nulliparous women and 188 (45.7%) undergoing primary cesarean delivery. The group was racially and ethnically diverse with 217 (52.8%) white, 112 (27.3%) black and 45 (10.9%) Hispanic participants. Patient scar assessment scores of pain, stiffness and irregularity were comparable between groups. However, tissue adhesive performed slightly better in regards to itchiness of scar and overall scar satisfaction (Table). The use of tissue adhesive for wound closure in cesarean delivery with Pfannenstiel skin incision modestly improved patient scar satisfaction scores when compared to sterile strips.