title: Incidence of wound complications after cesarean delivery: is suture closure better?
abstract: BACKGROUND
  Wound complications (WC) following cesarean delivery (CD) result in significant morbidity. A randomized trial in 2013, which demonstrated lower WC rates with suture closure compared to staple closure, resulted in a practice change within our academic institution.
  
  
  OBJECTIVE
  To determine the impact of this practice change on WC rates and identify other modifiable risk factors for WC.
  
  
  METHODS
  This is a retrospective cohort study of all women undergoing CD at the University of California, San Diego between 1 March 2011 and 28 February 2012 (primarily staple) and 1 March 2013 and 28 February 2014 (primarily suture). WC rates were compared between the two time intervals using Chi-square and Student's t-tests. Risk factors (OR, 95%CI) for WC were assessed using multiple logistic regression modeling.
  
  
  RESULTS
  Of 1580 women delivered by CD, rates of WC were higher with staple closure compared to sutures (10.1% versus 4.5%; OR 2.4, 1.4-4.1). Additionally, WC were more likely with vertical skin incisions (OR 3.6, 1.6-8.1), CD for failed labor (OR 2.9, 1.1-7.4) and diabetes (OR 2.1, 1.4-3.9).
  
  
  CONCLUSIONS
  After adjusting for confounders, there were over twofold increased odds of WC with staple closure. Vertical incisions, failed labor and diabetes also contributed to WC. Suture closure appears to decrease the risks of WC post CD.
authors: a Department of Reproductive Medicine , University of California, San Diego , La Jolla , CA , USA.
authors: Nicole
authors: N
authors: Tierney
authors: a Department of Reproductive Medicine , University of California, San Diego , La Jolla , CA , USA.
authors: D Yvette
authors: DY
authors: LaCoursiere
authors: a Department of Reproductive Medicine , University of California, San Diego , La Jolla , CA , USA.
authors: Steven
authors: S
authors: Hebert
authors: a Department of Reproductive Medicine , University of California, San Diego , La Jolla , CA , USA.
authors: Thomas F
authors: TF
authors: Kelly
authors: a Department of Reproductive Medicine , University of California, San Diego , La Jolla , CA , USA.
authors: Emily S
authors: ES
authors: Lukacz
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D013536:Suture Techniques / Q000706:statistics & numerical data*
keywords: Cesarean delivery; closure technique; skin incision; staples; suture; wound complications