FPIN's Help Desk Answers

Staples vs. Sutures After Cesarean Delivery

 

Am Fam Physician. 2018 Jul 1;98(1):50.

Clinical Question

Which type of skin closure after cesarean delivery has better cosmesis: staples or subcuticular sutures?

Evidence-Based Answer

Patients believe that staples and subcuticular sutures provide similar cosmetic outcomes after cesarean deliveries. However, the risk of wound complications (e.g., infection, separation, hematoma, seroma) is doubled with staples. (Strength of Recommendation: A, based on meta-analyses of randomized controlled trials [RCTs].)

Evidence Summary

A 2011 meta-analysis of five RCTs and one prospective cohort study compared wound closure with staples (N = 803) or subcuticular sutures (N = 684) in women undergoing primary, repeat, elective, or urgent cesarean delivery.1 The primary outcome was wound complication, defined as infection or separation occurring two weeks to four months postpartum. Overall cosmesis was reported qualitatively because the studies used different measurement scales. Compared with subcuticular sutures, staples increased the risk of wound complication (13% vs. 6.6%; pooled odds ratio = 2.1; 95% confidence interval [CI], 1.4 to 3.0). The number needed to harm was 16, but only three of the studies blinded the outcome assessors. Cosmesis was qualitatively reported as a secondary outcome in three of the studies. Two of these studies (N = 215) reported cosmesis as assessed by blinded assessors to be equivalent for both techniques. In the third study (n = 50), the unblinded assessor favored closure with sutures.

In 2016, an updated meta-analysis included five additional RCTs for a total of 10 (N = 2,327) and excluded the cohort study from the previous meta-analysis.2 The studies compared incision closure after cesarean delivery using staples vs. subcuticular sutures, with a primary outcome of wound complication (e.g., infection, separation, hematoma, seroma) and a secondary outcome of cosmesis. In pooled data from all 10 studies, the staples group had an increased risk of wound complications compared with the sutures group (relative risk = 1.9; 95% CI, 1.5 to 2.5).

Address correspondence to Kinder Fayssoux, MD, at kfayssoux@eisenhowerhealth.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

1. Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis [published correction appears in Obstet Gynecol. 2011;117(6):1440]. Obstet Gynecol. 2011;117(3):682–690.

2. Wang H, Hong S, Teng H, Qiao L, Yin H. Subcuticular sutures versus staples for skin closure after cesarean delivery: a meta-analysis. J Matern Fetal Neonatal Med. 2016;29(22):3705–3711.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

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