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Continuous or interrupted subcutaneous tissue closure during cesarean section: The jury is still out

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Dr. Anita Kant, Chairman & Head Department of Gynae & Obstetrics, Asian Institute of Medical Sciences, Faridabad    24 December 2022

Continuous subcutaneous tissue closure method during cesarean delivery was superior to the standard interrupted subcutaneous tissue closure technique in preventing surgical site infections (SSIs), according to a study of more than 6000 women published in the January 2023 issue of the International Journal of Gynecology & Obstetrics.1 These findings had earlier been presented at The Pregnancy Meeting, the 40th Annual Meeting of The Society for Maternal-Fetal Medicine (SMFM) in February 2020.2

 

Researchers retrospectively compared the rate of SSIs, which was the primary outcome of the study, with continuous subcutaneous tissue closure technique vis-à-vis interrupted subcutaneous tissue closure during cesarean section in this study. For this, they enrolled 6281 women who underwent either elective or emergent cesarean section at term between 2008 and 2018. Women who were suspected to have pre-existing infection were not included in the study. SSI was defined as localized tenderness ± fever (>38oC) along with presence of at least one of the following: purulent discharge from the superficial incision, culture positive or incision opened by the surgeon.

 

A total of 1867 (37.4%) women out of 4988 who underwent elective cesarean delivery and 592 (45.8%) of 1293 women who had emergent cesarean section had continuous subcutaneous tissue closure. In both groups, the SSI rate was markedly lower in women who had continuous SC tissue closure compared to those who had interrupted subcutaneous tissue closure. In the elective cesarean delivery group, the SSI rate with continuous tissue closure was 2.7% vs 4.5% with interrupted subcutaneous tissue closure. A similar observation was made in the emergent cesarean delivery group, where the SSI rate with continuous tissue closure was 3.2% vs 5.4% with interrupted subcutaneous tissue closure.

 

Compared with the interrupted subcutaneous closure, the rehospitalization rate within 90 days of undergoing the cesarean section, which was the secondary outcome of the study, was significantly lower after continuous subcutaneous closure in both elective (0.9% vs. 1.7%) and emergent (1.5% vs. 3.2%) cesarean delivery groups vs after interrupted subcutaneous closure. Very few women in the continuous closure group had postoperative fever or needed antibiotics. Similar observations favoring continuous closure were observed when the participants were categorized into nulliparous or multiparous groups.

 

This study suggests that adopting a continuous subcutaneous closure technique during cesarean section lowers the SSI rates compared to the routinely employed interrupted subcutaneous tissue closure technique. However, the authors also state the need to further verify these findings in a randomized-controlled trial.2

 

References

 

  1. Lauterbach R, et al. Continuous versus disrupted subcutaneous tissue closure in cesarean section: A retrospective cohort study. Int J Gynaecol Obstet. 2023 Jan;160(1):113-119. doi: 10.1002/ijgo.14322.
  2. Lauterbach R, et al. 888: Continuous versus interrupted subcutaneous tissue closure during cesarean delivery. Am J Obstet Gynecol. 2020 Jan:222(1 Suppl):S554.

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