title: Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate whether staples or subcuticular suture closure is associated with a higher risk of wound complications when used for transverse skin incisions after cesarean delivery.
  
  
  METHODS
  A systematic review and meta-analysis were performed through electronic database searches (MEDLINE, Cochrane, and Trial Registries).
  
  
  METHODS
  We searched electronic databases from 1966 to September 2010 for randomized controlled trials (RCTs) and prospective cohort studies comparing staples to subcuticular sutures after cesarean delivery. The primary outcome was occurrence of a wound complication (infection or separation). Secondary outcomes were components of the composite outcome, operating time, postoperative pain, cosmesis, and patient satisfaction. Heterogeneity was assessed using the χ test for heterogeneity, and I test. Pooled odds ratios (ORs) were calculated using a fixed-effects model. We assessed publication bias using funnel plots and Egger test.
  
  
  RESULTS
  Six studies met inclusion criteria: five RCTs and one prospective cohort study. Staple closure (n=803) was associated with a twofold higher risk of wound infection or separation compared with subcuticular suture closure (n=684) (13.4% versus 6.6%, pooled OR 2.06, 95% confidence interval [CI] 1.43-2.98). The number needed to harm associated with staple closure was 16. The increased risk persisted when analysis was limited to the RCTs (OR 2.43, 95% CI 1.47-4.02). There was no evidence of significant statistical heterogeneity among studies (χ=0.74, P=.327, I=13.7%) or publication bias (Egger test, t=-0.86, P=.439). Staple closure was associated with shorter duration of surgery, whereas the two techniques appeared equivalent overall with regard to pain, cosmesis, and patient satisfaction.
  
  
  CONCLUSIONS
  Staple closure is faster to perform but associated with a higher risk of wound complications.
authors.affiliation: From the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.forename: Roxane M
authors.initials: RM
authors.lastname: Rampersad
authors.forename: Jeanine F
authors.initials: JF
authors.lastname: Carbone
authors.forename: David
authors.initials: D
authors.lastname: Stamilio
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D011247:Pregnancy; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*