title: Cesarean delivery complications in women with morbid obesity.
abstract: OBJECTIVE
  To compare cesarean complication rates between women with body mass index (BMI) 40-49.9 kg/m(2) and BMI ≥ 50 kg/m(2) and associations with surgical techniques.
  
  
  METHODS
  This retrospective cohort study from 2009 to 2014 included women who underwent cesarean with delivery BMI ≥ 50 and an equal number with BMI 40-49.9. Wound infections and/or separations were compared. We also examined wound complication rates between skin closure techniques and self-retaining retractor use.
  
  
  RESULTS
  Among 498 patients (249 with BMI ≥ 50 and 249 with BMI 40-49.9) there were no differences in estimated blood loss >1000 mL, blood transfusion, deep vein thrombosis or endometritis. Among those with outpatient follow-up (144 with BMI ≥ 50 and 162 with BMI 40-49.9), those with BMI ≥ 50 had a significantly higher rate of wound separations (p = 0.01) but not infections. There were no differences in wound complication rates between skin closure techniques or self-retaining retractor use, though the study was not powered for these comparisons.
  
  
  CONCLUSIONS
  Wound complications, particularly separations, increase with BMI ≥ 50 compared to a lesser degree of morbid obesity. Skin closure techniques and self-retaining retractor use were not associated with cesarean wound complications in patients with morbid obesity.
authors.affiliation: a Department of Obstetrics , Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa , Honolulu , HI , USA .
authors.forename: Kelly
authors.initials: K
authors.lastname: Yamasato
authors.affiliation: a Department of Obstetrics , Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa , Honolulu , HI , USA .
authors.forename: Kurt
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: a Department of Obstetrics , Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa , Honolulu , HI , USA .
authors.forename: Ann L
authors.initials: AL
authors.lastname: Chang
authors.affiliation: b Department of Obstetrics and Gynecology , Oregon Health & Science University , Portland , OR , USA , and.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: c Department of Obstetrics and Gynecology , University of Buffalo , Buffalo , NY , USA.
authors.forename: Pai-Jong
authors.initials: PJ
authors.lastname: Tsai
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009767:Obesity, Morbid / Q000145:classification / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000150:complications*; D058106:Wound Closure Techniques; D055815:Young Adult
keywords: Body mass index; cesarean section; delivery; morbid; obesity; obstetric; pregnancy; surgical stapling; sutures