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Pilot study: does mode of skin closure affect risk of infection after caesarean section?
  1. R F Lindemann1,
  2. S J Stock1,
  3. A O Robb2,
  4. F C Denison1
  1. 1Centre for Reproductive Biology, University of Edinburgh, Edinburgh, UK
  2. 2St John's Hospital, Livingston, UK

Abstract

Aims A pilot study to determine whether the method of skin closure affects wound infection rates following caesarean section (CS). To evaluate current practice and preference of skin closure methods following CS among obstetricians in Scotland.

Method A retrospective cohort study of women with CS at St John's Hospital, Livingston between 1 October 2009 and 31 December 2009 was performed. Data collected included age, booking body mass index (BMI), obstetric history, skin closure method, microbiology confirmed wound infection and other wound complications. Online questionnaires were distributed to all consultant obstetricians in Scotland.

Results 191 women had a CS (54% elective; 3% emergency pre-labour and 43% emergency in labour). 32 (16.2%) women developed a superficial wound infection and 22 (11%) other complications. Surgical notes were available for 158 women. There was no difference in rates of wound infection with skin closure by staples (10/158; 21%) compared to sutures (16/158; 29%) (p=0.29). BMI and other wound complications were the only predictors of wound infection (p=0.01). 51% (51/100) of consultants completed the questionnaire. Consultants preferred skin closure by sutures in women with a BMI <25 kg/m2 and staples with interrupted skin sutures in women with a BMI >40 kg/m2. The main factors influencing consultant's mode of skin closure were cosmetic outcome and lower risk of infection.

Conclusion BMI was an important predictor for wound infection following CS. Rates of wound infection of 21% and 29% after skin closure by staples and sutures, respectively will inform future studies to determine the optimal method of skin closure at CS.

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