title: Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the incidence of wound complications between suture and staple skin closure after cesarean delivery.
  
  
  METHODS
  This prospective, randomized clinical trial conducted at three hospitals in the United States between 2010 and 2012 included women undergoing cesarean delivery at 23 weeks of gestation or greater through a low-transverse skin incision. Women were randomized to closure of the skin incision with suture or staples after stratifying by body mass index and primary compared with repeat cesarean delivery. The primary outcome was incidence of wound complications, predefined as a composite of infection, hematoma, seroma, separation of 1 cm or longer, or readmission for wound complications. Analysis was according to the intention-to-treat principle; results were stratified by randomization group and adjusted for hospital by including it as a covariate.
  
  
  RESULTS
  A total of 746 women were randomized, 370 to suture and 376 to staple closure. The median gestational age was 39 weeks. Fifty-eight women (7.8%) had wound complications-4.9% in the suture group and 10.6% in the staple group (adjusted odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23-0.78); this was largely the result of the decreased incidence of wound separation in the respective groups (1.6% compared with 7.4%; adjusted OR 0.20, 95% CI 0.07-0.51).
  
  
  CONCLUSIONS
  Suture closure of the skin incision at cesarean delivery is associated with a 57% decrease in wound complications compared with staple closure.
  
  
  BACKGROUND
  Clinicaltrials.gov, www.clinicaltrials.gov, NCT01211600.
  
  
  METHODS
  I.
authors.affiliation: Departments of Obstetrics and Gynecology, Geisinger Health System, Danville, Lankenau Medical Center, Wynnewood, and Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, and Yale-New Haven Hospital, New Haven, Connecticut; and the Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: A Dhanya
authors.initials: AD
authors.lastname: Mackeen
authors.forename: Adeeb
authors.initials: A
authors.lastname: Khalifeh
authors.forename: Jonah
authors.initials: J
authors.lastname: Fleisher
authors.forename: Alison
authors.initials: A
authors.lastname: Vogell
authors.forename: Christina
authors.initials: C
authors.lastname: Han
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Sendecki
authors.forename: Christian
authors.initials: C
authors.lastname: Pettker
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.forename: Jason K
authors.initials: JK
authors.lastname: Baxter
authors.forename: Anna
authors.initials: A
authors.lastname: Sfakianaki
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000284:Administration, Oral; D000328:Adult; D002585:Cesarean Section / Q000379:methods; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D057194:Intention to Treat Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D049291:Seroma / Q000453:epidemiology; D013528:Surgical Staplers; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques