CHICAGO – Suture closure of the skin incision after cesarean delivery was associated with significantly improved patient satisfaction, compared with staple closure, according to findings in a prospective, randomized, multicenter study of 746 women.
Suture closure also was associated with improved patient and physician assessments of cosmesis, compared with staple closure, Dr. Jonah Fleisher reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.
The median interquartile range of overall "satisfaction with method of closure" scores on the validated Patient and Observer Scar Assessment Scale (POSAS) differed significantly for 299 suture patients and 307 staple patients for whom the data were available (scores of 10 vs. 9, respectively), as did median "satisfaction with appearance of skin incision" scores (also 10 vs. 9, respectively), said Dr. Fleisher of Geisinger Health System, Danville, Pa.
Courtesy Dr. Jonah Fleisher
Dr. Jonah Fleisher reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.
The cosmetic-specific question was included to help adjust for the multifactorial nature of the overall satisfaction score, which could be affected by the patient’s degree of pain, healing time, need for extra office visits, and frequency of complications, among other factors.
The two measures correlated positively, and both subjective and objective components of the POSAS favored suture closure, he noted.
Study participants were women undergoing cesarean delivery via low-transverse skin incisions at any of three participating centers. After fascia closure, the women were allocated to either the suture (type was surgeon’s choice) or metal staple closure group. Staples were removed between postoperative days 4 and 10.
About 1.3 million cesarean deliveries are performed each year in the United States, Dr. Fleisher said.
"Those scars that are formed as a result are very important to patients, both as far as cosmetic and general satisfaction ... and it turns out they are important to obstetricians, too," he added, noting that data to guide decision making are lacking.
In the current study, the differences between the suture and staple groups were significant, but patients in both groups had high rates of satisfaction.
"Given these considerations, I would suggest that we ought to incorporate wound complications rates into the decision of which method to use," he said.
An article that addresses the wound complication rates in this study is currently in press and scheduled for publication in the American Journal of Obstetrics & Gynecology in June. The data show a 57% lower complication rate with suture closure vs. staple closure, Dr. Fleisher said.
"The bottom line is, for all these reasons, we have moved to recommending suture closure in all transverse C-sections," he said.
As for whether the findings apply to other types of surgical operations, such as abdominal hysterectomy, Dr. Fleisher said there are many changes in pregnancy, including immunologic changes, that don’t necessarily apply to nonobstetric situations.
"There is some literature in the general surgery area about this, and some literature in gynecologic surgery, but given the immunologic changes – I think we’re seeing that even the adhesion data is not necessarily the same in those two contexts. ... I wouldn’t want to generalize from this to nonobstetric indications," he said.
This study was supported by Ethicon. Dr. Fleisher reported having no disclosures.