FPIN's Help Desk Answers
Staples vs. Sutures After Cesarean Delivery
Am Fam Physician. 2018 Jul 1;98(1):50.
Which type of skin closure after cesarean delivery has better cosmesis: staples or subcuticular sutures?
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].)
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).
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.
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