RCT Finds Sutures Better than Staples for Closing C-Section Incision

Posted by The Evidence Blog on July 22, 2014

A recently published randomized controlled trial (RCT) found that women who have their cesarean section (C-section) incision closed with sutures have fewer wound complications than those who receive closure with staples.1

Cesarean delivery is the most common major surgery in the United States, with more than 1.3 million C-sections performed each year. Despite the prevalence of C-sections, the best method for closing the skin incision has yet to be established. After the surgery, the incision is typically closed by either sewing the skin together with a continuous suture that dissolves over time or with the placement of several metal staples that are removed later. A 2013 study examining which method obstetricians preferred, reported that more than 50% of doctors chose staples because they are quicker and easier to use, particularly on deeper incisions.2,3

This latest RCT, known as the CROSS study (NCT01211600), was conducted at Thomas Jefferson University Hospital (Philadelphia, PA), Lankenau Medical Center (Wynnewood, PA), and Yale-New Haven Hospital (New Haven, CT). The CROSS study compared wound complication rates after cesarean delivery between women prospectively randomized to receive incision closure with either sutures (n=370) or staples (n=376). All women received prophylactic antibiotics preoperatively. The researchers looked at the number of wound complications, including infection, wounds that re-opened, and those with a fluid accumulation around the closure area. Women allocated to the suture closure group were 57% less likely to have wound complications compared with women in the staples closure group. The overall wound complication rates were 4.9% and 10.6% in suture and staple closure groups, respectively—a statistically significant difference driven by a decreased incidence of wound separation. There was no significant difference between the 2 closure groups in infection rate or length of hospital stay. The researchers noted that suturing took an average of 9 minutes longer than stapling.

The CROSS study findings mirror the results of the smaller SVS study (NCT01008449), conducted at the University Hospital (Birmingham, AL) and published in 2013.4 SVS investigators concluded that the extra time to suture the incision was offset by the additional time required to remove staples and added that staples, not including a staple removal kit, were approximately 2.5 times more expensive than absorbable sutures.

  1. Mackeen AD, Khalifeh A, Fleisher J, Vogell A, et al. Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1169-1175. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=Mackeen+AD%2C+Khalifeh+A%2C+Fleisher+J%2C+Vogell+A. Accessed July 19, 2014.
  2. Osterman MJ, Martin JA.; Division of Vital Statistics. Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996–2011. Hyatsville, MD: National Center for Health Statistics; 2013. NCHS Data Brief No. 124. Available at: http://www.cdc.gov/nchs/data/databriefs/db124.pdf. Accessed July 19, 2014.
  3. Mackeen AD, Devaraj T, Baxter JK. Cesarean skin closure preferences: a survey of obstetricians. J Matern Fetal Neonatal Med. 2013;26(8):753-756. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/23211124. Accessed July 19, 2014.
  4. Figueroa D, Jauk VC, Szychowski JM, Garner, et al. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2013;121(1):33-38. Full text available at: http://journals.lww.com/greenjournal/Fulltext/2013/01000/Surgical_Staples_Compared_With_Subcuticular_Suture.7.aspx. Accessed July 19, 2014.

Topics: Hayes Blog

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