Suture compared with staple skin closure after cesarean delivery: A randomized controlled trial

A. Dhanya MacKeen, Adeeb Khalifeh, Jonah Fleisher, Alison Vogell, Christina Han, Jocelyn Sendecki, Christian Pettker, Benjamin E. Leiby, Jason K. Baxter, Anna Sfakianaki, Vincenzo Berghella

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


OBJECTIVE:: To compare the incidence of wound complications between suture and staple skin closure after cesarean delivery. METHODS:: This prospective, randomized clinical trial conducted at three hospitals in the United States between 2010 and 2012 included women undergoing cesarean delivery at 23 weeks of gestation or greater through a low-transverse skin incision. Women were randomized to closure of the skin incision with suture or staples after stratifying by body mass index and primary compared with repeat cesarean delivery. The primary outcome was incidence of wound complications, predefined as a composite of infection, hematoma, seroma, separation of 1 cm or longer, or readmission for wound complications. Analysis was according to the intention-to-treat principle; results were stratified by randomization group and adjusted for hospital by including it as a covariate. RESULTS:: A total of 746 women were randomized, 370 to suture and 376 to staple closure. The median gestational age was 39 weeks. Fifty-eight women (7.8%) had wound complications-4.9% in the suture group and 10.6% in the staple group (adjusted odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23-0.78); this was largely the result of the decreased incidence of wound separation in the respective groups (1.6% compared with 7.4%; adjusted OR 0.20, 95% CI 0.07-0.51). CONCLUSIONS:: Suture closure of the skin incision at cesarean delivery is associated with a 57% decrease in wound complications compared with staple closure.

Original languageEnglish (US)
Pages (from-to)1169-1175
Number of pages7
JournalObstetrics and gynecology
Issue number6
StatePublished - Jun 2014
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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