Abstract
BackgroundWound infection is a common complication following caesarean section. Factors influencing the risk of infection may include the suture material for skin closure, and closure of the subcutaneous fascia. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section.MethodsWomen undergoing caesarean birth at an Adelaide maternity hospital were eligible for recruitment to a randomised trial using a 2 × 2 factorial design. Women were randomised to either closure or non-closure of the subcutaneous fascia and to subcuticular skin closure with an absorbable or non-absorbable suture.Participants were randomised to each of the two interventions into one of 4 possible groups: Group 1 - non-absorbable skin suture and non-closure of the subcutaneous fascia; Group 2 - absorbable skin suture and non-closure of the subcutaneous fascia; Group 3 - non-absorbable skin suture and closure of the subcutaneous fascia; and Group 4 - absorbable skin suture and closure of the subcutaneous fascia.The primary outcomes were reported wound infection and wound haematoma or seroma within the first 30 days after birth.ResultsA total of 851 women were recruited and randomised, with 849 women included in the analyses (Group 1: 216 women; Group 2: 212 women; Group 3: 212 women; Group 4: 211 women).In women who underwent fascia closure, there was a statistically significant increase in risk of wound infection within 30 days post-operatively for those who had skin closure with an absorbable suture (Group 4), compared with women who had skin closure with a non-absorbable suture (Group 3) (adjusted RR 2.17; 95% CI 1.05, 4.45; p = 0.035). There was no significant difference in risk of wound infection for absorbable vs non-absorbable sutures in women who did not undergo fascia closure.ConclusionThe combination of subcutaneous fascia closure and skin closure with an absorbable suture may be associated with an increased risk of reported wound infection after caesarean section.Trial registrationProspectively registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12608000143325, on the 20th March, 2008.
Highlights
Wound infection is a common complication following caesarean section
There was very weak evidence to suggest that the combination of subcutaneous fascia closure and skin closure with a non-absorbable skin suture was associated with a reduced risk of infection, but this finding should be interpreted with caution as no statistical adjustment has been made for multiple comparisons
Comparison with published literature We have shown that there is some weak evidence to suggest that the combined intervention of subcutaneous fascia closure and skin suturing with absorbable monofilament suture (CaprosynTM), is associated with an increased risk of postoperative wound infection, in comparison with subcutaneous fascia closure and skin suturing with non-absorbable monofilament suture (ProleneTM)
Summary
Wound infection is a common complication following caesarean section. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section. Caesarean section is one of the most commonly performed surgical procedures for women worldwide [1]. Surgical site infections have been reported to occur in up to 12% of procedures [10, 13, 14] Wound complications such as haematoma, seroma and dehiscence can complicate recovery after caesarean section [15], all of which may have a negative impact on postnatal maternal health and wellbeing, a woman’s ability to care for her infant, and her overall experience of the postnatal period
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