Continuous vs. interrupted subcutaneous suturing following cesarean section: a randomized controlled trial

Abstract

To assess the preferable technique of subcutaneous suturing during cesarean delivery (CD) and risk of surgical site infection. This is a randomized controlled trial, conducted in a single tertiary medical center between January 2020 and July 2022. Women undergoing elective CD, with a subcutaneous tissue layer of >2 cm were eligible for recruitment. In alignment with the ERAS guideline, patients were randomized to either 2-0 vicryl, continuous subcutaneous tissue closure (c-STC) or interrupted 2-0 vicryl subcutaneous tissue closure (i-STC). Absorbable clips were used for skin. The primary outcome was reported surgical site infection (SSI) within the first 30 days after birth. Secondary outcomes included re-admission rate within 6 weeks postpartum due to SSI, postoperative febrile morbidity, antibiotic use for SSI, CD-to-SSI time interval, rate of bacteremia/sepsis, post-op duration of hospitalization and pain assessed using a visual analogue scale. Sample size was calculated based on a retrospective study performed at our center that showed a 40% difference in rates of SSI between continuous and interrupted subcutaneous tissue closure. To decrease rates of SSI by 40% we calculated we would require 600 patients in each group. The final analysis included 1238 women of whom 607 patients in the c-STC group and 631 patients in the i-STC group. There were no differences in baseline medical and obstetric parameters (table 1). The rate of SSI was significantly lower following i-STC compared to c-STC (2.4% vs. 3.8%, P=0.038). Accordingly, secondary outcomes including re-admission rates (0.8% vs. 1.5%, P=0.014), post-operative febrile morbidity (3% vs. 4.3%, P=0.029), and need for antibiotic treatment (2.7% vs. 4.1%, P=0.041) were significantly lower following i-STC. There were no additional significant differences between the outcomes of both groups (table 2). Our findings suggest that interrupted subcutaneous suturing technique during CD yields a lower rate of surgical site infections and related outcomes compared to subcutaneous continuous suturing.View Large Image Figure ViewerDownload Hi-res image Download (PPT)