The Effect of Transverse Skin Incision Location on Wound Morbidity After Cesarean Delivery for Patients With Morbid Obesity [ID: 1377795

Abstract

INTRODUCTION: The objective of this study was to assess whether placement of transverse skin incision below or above the panniculus for cesarean delivery in patients with morbid obesity is associated with postoperative wound complications. METHODS: We identified a cohort of all women with body mass index (BMI) higher than 40 who delivered by cesarean at our institution from 2016 to 2020, had complete postpartum records, singleton gestation, and transverse skin incision. Medical records were abstracted after IRB exemption. The primary outcome was composite wound morbidity (infection, disruption, or dehiscence). Secondary outcomes included operative time, neonatal outcome, and blood transfusion. Analysis was performed with χ2 and logistic regression including BMI percentile, diabetes, smoking, unscheduled surgery, and prior cesarean. RESULTS: Two hundred sixty-three patients had a low transverse incision and 65 had a high transverse incision. 14.6% of patients had wound morbidity. There were two reoperations and no fascial dehiscences or deep site infections. Patients with a high transverse incision had higher mean BMI (53.0 versus 45.9, P<.001) and were less likely to be in labor (relative risk 0.52, 0.28–0.96) but were otherwise similar to patients with a low incision. High transverse incision was associated with composite wound morbidity (adjusted odds ratio 5.12, 2.36–11.09) and increased operative time (61 versus 54 minutes, P=.02) but not other secondary outcomes. Results did not significantly differ when analysis was restricted to patients with BMI greater than 50. CONCLUSION: Wound morbidity was more frequent after high transverse skin incision for cesarean delivery. Prospective studies are needed to determine whether incision location or other factors caused this increase.