Wound Infection in Obese Women After Cesarean Delivery
Condition: Surgical Site Infection
MeSH terms: Infections; Communicable Diseases; Surgical Wound Infection
Study type: Interventional

Summary: 
      The purpose of this study is to determine the surgical site infection rate and patient
      satisfaction for absorbable versus non absorbable suture in closure of skin at cesarean
      section in obese women.
    

Detailed description: 
      Cesarean section (CS) is the commonest major operation performed on women in the world.
      Approximately one in 4 women in the United States is delivered by cesarean section, and it is
      well established that operative abdominal delivery is associated with a significant risk of
      infection compared with vaginal delivery. These risks are increased with preexisting
      operative site infection, breaks in sterile technique, prolonged preoperative admissions that
      may result in colonization with resistant microbes, prolonged operative duration, use of
      electrocautery, obesity, advanced age, inadequate host immunocompetence.

      Obese women may have increased susceptibility to infections because of the effects of obesity
      on the immune system, skin barriers, wound healing, mobility, and coexisting chronic diseases
      including diabetes, which could increase infection risk by itself. Cohort studies have shown
      that women with a body mass index (BMI)>30kg/m^2 have a two to three folds increased risk of
      post cesarean infections, such as wound infection, urinary tract infection UTI),
      endometritis, or pneumonia, compared with non-obese women. Other studies found that obesity
      doubled the risk specifically for post-cesarean wound infection.

      Wound complications are a major source of morbidity after CS and contribute to prolonged
      hospital stay and rates of readmission. Age, (BMI), length of incision, and timing of
      prophylactic antibiotic administration have all been associated with post cesarean surgical
      site infection (SSI).

      A surgical site infection is an infection that occurs after surgery in the part of the body
      where the surgery took place. SSI can sometimes be superficial infections involving the skin
      only. Other surgical site infections are more serious and can involve tissues under the skin,
      organs, or implanted material. SSI has a great impact on the economy and health care
      resources. Infection has always been a feature of modern surgery and continues to be a
      significant problem for health care practitioners across the world.

      The ideal skin closure would be safe and effective, associated with minimal patient
      discomfort, and have a good cosmetic result. It would also be inexpensive and require fewer
      health care resources by being fast and easy to apply, require minimal follow-up evaluation,
      and be associated with a low rate of complications.

      Methods for closing the skin at the time of cesarean delivery include stainless steel
      staples, subcuticular absorbable staples, subcuticular suture, adhesive closure strips, and
      tissue adhesives (cyanoacrylates). Each of the methods has its postulated benefits for wound
      outcomes; however, none of these have been compared in a prospective trial.

      The role of skin closure suture material on wound complication rates in Obstetrics is poorly
      studied. And when we are talking about obese patients we did not find any recommendation
      regarding the suture material of skin closure although most of Obstetricians use different
      sutures materials.

      Does closure of skin by absorbable compared to non absorbable suture affect the rate of
      surgical site infection in obese patients undergoing caesarian section? Our hypothesis is
      that no difference between absorbable compared to non absorbable suture.
    

Intervention name(s): Absorbable suture group; Non absorbable suture group
Intervention type(s): Procedure; Procedure
Intervention description(s): Skin is closed with subcuticular stitches using [Polyglactin 910 absorbable, synthetic, braided suture]; Skin is closed with subcuticular stitches using Polypropylene non absorbable monofilament suture
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Cesarean Section; Obese Women; Surgical Site Infection