American Journal of Obstetrics and Gynecology | 2019
Forceps and episiotomy: Do they go hand‐in‐hand or should they go their separate ways?: 985
Abstract
STUDY DESIGN: This was a retrospective cohort study from March 1, 2017 February 28, 2018 evaluating wound complication rates between polyglactin and polydioxanone suture at time of cesarean delivery. Data from cesarean deliveries occurring in women >18yo, >24+0 weeks gestation, with low transverse skin and fascial incisions were collected. The primary outcome was any wound complication in the first 56 postoperative days. Wound complication was a composite outcome comprising any of the CDC classifications of surgical site infection, and/or hematoma, seroma, wound separation, wound or fascial dehiscence. Outcomes were compared between polydioxanone and polyglactin fascial closures using t-tests for continuous variables and chi-square testing for discreet variables. A multivariable regression was performed adjusting for characteristics that differed between the two groups or were associated with postoperative infectious complications. RESULTS: 1,405 cesarean deliveries were performed at two large academic hospitals in Indianapolis, IN from March 1, 2017 e February 28, 2018. Among those who met inclusion and exclusion criteria (n1⁄41301), 881 were in the polyglactin group, and 420 were in the polydioxanone group. This discrepancy was due to a number of cesarean sections that still received polyglactin after September 1, 2017 despite the practice change. The two groups differed in select demographics, co-morbidities, and perioperative characteristics. In the univariate analysis, the overall wound complication rates were not clearly different (7.4% in the polyglactin group vs 9.3% in the polydioxanone group, p1⁄40.281). Multivariable regression confirmed that fascial suture type was not associated with wound complications (Odds Ratio 1.24, 95% Confidence Interval 0.78-1.79), but other factors were (Table). CONCLUSION: There is probably no difference in the risk of wound complications following transverse fascial closure at time of cesarean section with polydioxanone suture compared to polyglactin suture. Obesity, tobacco use, and laboring were associated with an increased risk of postoperative wound complications, while Hispanic women had a decreased risk.