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• W2011752690 abstract "ObjectiveThe optimal technique for skin closure in the obese patient at the time of cesarean delivery (CD) is unknown. We hypothesized that subcuticular skin closure in the obese patient results in a lower rate of post-operative wound complications when compared to closure with staples.Study DesignThis is a retrospective review of medical records from July 2008 to December 2008 at University Hospital, Newark, NJ. Women with a body mass index (BMI) ≥30 kg/m2 at the time of CD were identified. Patients were excluded if HIV positive, had Hepatitis B or C, chorioamnionitis, endometritis, received antibiotics other than perioperative prophylaxis, or if the record was incomplete. Patients were grouped by closure technique. Wound complication was defined as seroma, hematoma, wound opening, cellulitis or abscess. Chi-square, Fisher's exact and Wilcoxon-rank sums tests were used. Multivariate analysis including type of skin closure, BMI, presence of labor, and duration of surgery was performed.Results226 obese patients underwent CD during the study period, 171 patients met the inclusion criteria. 92(54%) had subcuticular closure, 79(46%) had staple closure. BMI, gestational age at delivery and duration of surgery did not differ between the groups. Staple use was more common in non-laboring patients (66% vs 29% p <0.0001). The rate of wound complication in the staple group was 20.3% compared to 6.5% in the suture group (p =0.01). The rate of complications in patients with a previous CD was not higher than in patients without a prior CD(16.5% vs 9.8% p=0.25). In the multivariate analysis only type of skin closure was significant (aOR = 0.296, 95% CI 0.109-0.807). This held true when we excluded patients with diabetes (N=21). When excluding patients who did not return for care (N=35), the rate of wound complications was still greater in the staple group (23% vs 9% p=0.036), with the effect still seen in the multivariate analysis (aOR 0.360, 95% CI 0.130-0.994).ConclusionsSubcuticular skin closure may be associated with a lower rate of wound complications in the obese gravida. ObjectiveThe optimal technique for skin closure in the obese patient at the time of cesarean delivery (CD) is unknown. We hypothesized that subcuticular skin closure in the obese patient results in a lower rate of post-operative wound complications when compared to closure with staples. The optimal technique for skin closure in the obese patient at the time of cesarean delivery (CD) is unknown. We hypothesized that subcuticular skin closure in the obese patient results in a lower rate of post-operative wound complications when compared to closure with staples. Study DesignThis is a retrospective review of medical records from July 2008 to December 2008 at University Hospital, Newark, NJ. Women with a body mass index (BMI) ≥30 kg/m2 at the time of CD were identified. Patients were excluded if HIV positive, had Hepatitis B or C, chorioamnionitis, endometritis, received antibiotics other than perioperative prophylaxis, or if the record was incomplete. Patients were grouped by closure technique. Wound complication was defined as seroma, hematoma, wound opening, cellulitis or abscess. Chi-square, Fisher's exact and Wilcoxon-rank sums tests were used. Multivariate analysis including type of skin closure, BMI, presence of labor, and duration of surgery was performed. This is a retrospective review of medical records from July 2008 to December 2008 at University Hospital, Newark, NJ. Women with a body mass index (BMI) ≥30 kg/m2 at the time of CD were identified. Patients were excluded if HIV positive, had Hepatitis B or C, chorioamnionitis, endometritis, received antibiotics other than perioperative prophylaxis, or if the record was incomplete. Patients were grouped by closure technique. Wound complication was defined as seroma, hematoma, wound opening, cellulitis or abscess. Chi-square, Fisher's exact and Wilcoxon-rank sums tests were used. Multivariate analysis including type of skin closure, BMI, presence of labor, and duration of surgery was performed. Results226 obese patients underwent CD during the study period, 171 patients met the inclusion criteria. 92(54%) had subcuticular closure, 79(46%) had staple closure. BMI, gestational age at delivery and duration of surgery did not differ between the groups. Staple use was more common in non-laboring patients (66% vs 29% p <0.0001). The rate of wound complication in the staple group was 20.3% compared to 6.5% in the suture group (p =0.01). The rate of complications in patients with a previous CD was not higher than in patients without a prior CD(16.5% vs 9.8% p=0.25). In the multivariate analysis only type of skin closure was significant (aOR = 0.296, 95% CI 0.109-0.807). This held true when we excluded patients with diabetes (N=21). When excluding patients who did not return for care (N=35), the rate of wound complications was still greater in the staple group (23% vs 9% p=0.036), with the effect still seen in the multivariate analysis (aOR 0.360, 95% CI 0.130-0.994). 226 obese patients underwent CD during the study period, 171 patients met the inclusion criteria. 92(54%) had subcuticular closure, 79(46%) had staple closure. BMI, gestational age at delivery and duration of surgery did not differ between the groups. Staple use was more common in non-laboring patients (66% vs 29% p <0.0001). The rate of wound complication in the staple group was 20.3% compared to 6.5% in the suture group (p =0.01). The rate of complications in patients with a previous CD was not higher than in patients without a prior CD(16.5% vs 9.8% p=0.25). In the multivariate analysis only type of skin closure was significant (aOR = 0.296, 95% CI 0.109-0.807). This held true when we excluded patients with diabetes (N=21). When excluding patients who did not return for care (N=35), the rate of wound complications was still greater in the staple group (23% vs 9% p=0.036), with the effect still seen in the multivariate analysis (aOR 0.360, 95% CI 0.130-0.994). ConclusionsSubcuticular skin closure may be associated with a lower rate of wound complications in the obese gravida. Subcuticular skin closure may be associated with a lower rate of wound complications in the obese gravida." @default.
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• W2011752690 title "167: Skin closure in the obese gravida at the time of cesarean delivery" @default.
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