title: Cesarean skin closure preferences: a survey of obstetricians.
abstract: OBJECTIVE
  In light of the limited evidence directing cesarean skin closure techniques, we evaluated the factors guiding obstetricians' preferences for closure method.
  
  
  METHODS
  From 07/11 to 12/11, an online survey was sent to obstetricians in ACOG Regions I and II. Obstetricians were asked to indicate their cesarean skin closure preferences when considering various factors and to rank the importance of these factors in their decision. Practice type, experience and usual method of closure were also assessed.
  
  
  RESULTS
  Responses were received from 470 of 1400 surveyed (34% response rate), of which 422 were analyzed. Similar proportions reported primarily using sutures (39%) or staples (48%); 13% use both methods equally. More obstetricians at community hospitals primarily use sutures (48% versus 39%, p < 0.001), while more at university hospitals primarily use staples (57% versus 30%, p < 0.001). Listed in decreasing order of importance, sutures were preferred when considering patient satisfaction, keloid susceptibility, cosmesis, first Pfannenstiel incisions or cost. Staples were preferred when considering wound infections, obese patients, chorioamnionitis, HIV/AIDS or busy labor floors (p < 0.001).
  
  
  CONCLUSIONS
  The limited evidence to guide cesarean skin closure forces obstetricians to rely on personal experience. Our survey indicates that despite this limitation, obstetricians have specific preferences for cesarean skin closure method.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. dhanya80@hotmail.com
authors.forename: A Dhanya
authors.initials: AD
authors.lastname: Mackeen
authors.forename: Tara
authors.initials: T
authors.lastname: Devaraj
authors.forename: Jason K
authors.initials: JK
authors.lastname: Baxter
mesh_terms: D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000379:methods*; D003625:Data Collection; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000523:psychology*; D013536:Suture Techniques / Q000523:psychology*