Shafquat Zaman1, Ali Yasen Y Mohamedahmed1, Elizabeth Peterknecht2, Reza Md Zakaria3, Saeed Y Y Mohamedahmed4, Shahab Hajibandeh5, Shahin Hajibandeh6. 1. Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK. 2. Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK. elizabeth.peterknecht1@nhs.net. 3. Department of Obstetrics and Gynaecology, Glangwili General Hospital, Carmarthenshire, UK. 4. Department of Obstetrics and Gynaecology, Atbara Teaching Hospital, Atbara, Sudan. 5. Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK. 6. Department of General Surgery, Wye Valley NHS Trust, Hereford, UK.
Abstract
PURPOSE: To evaluate comparative outcomes of skin closure with clips and sutures after caesarean section (CS). METHODS: We conducted a systematic search of electronic information sources and bibliographic reference lists. Wound infection, wound separation, haematoma, seroma, re-admission, closure time, length of hospital stay, patient scar assessment scale (PSAS) and the observer scar assessment scale (OSAS) were the evaluated outcome parameters. RESULTS: We identified 16 randomised controlled trials reporting a total of 4926 patients who had skin closure with sutures (n = 2724) or clips (n = 2202) following CS. Use of clips was associated with a significantly higher rate of wound separation (risk ratio (RR): 2.33, P = 0.004) and longer length of hospital stay (mean difference (MD): 1.21, P = 0.03) but shorter closure time (MD: 5.35, P = 0.00001) when compared to sutures group. There was no significant difference between the two groups in the risk of wound infection (RR: 1.12, P = 0.75), haematoma formation (RR: 2.46, P = 0.23), seroma (RR: 1.17, P = 0.73), re-admission rate (RR: 1.28, P = 0.73), PSAS (MD: 0.44, P = 0.73) and OSAS (MD: 0.32, P = 0.55). Trial sequential analysis showed the meta-analysis was conclusive for wound infection, wound separation and closure time; however, it was inconclusive for length of hospital stay, PSAS and OSAS due to risk of type 2 error. CONCLUSION: This meta-analysis of best available evidence (level 1) demonstrated that although skin closure with subcuticular sutures is more time-consuming than clips, it is associated with a significantly lower risk of wound separation and shorter length of hospital stay.
PURPOSE: To evaluate comparative outcomes of skin closure with clips and sutures after caesarean section (CS). METHODS: We conducted a systematic search of electronic information sources and bibliographic reference lists. Wound infection, wound separation, haematoma, seroma, re-admission, closure time, length of hospital stay, patient scar assessment scale (PSAS) and the observer scar assessment scale (OSAS) were the evaluated outcome parameters. RESULTS: We identified 16 randomised controlled trials reporting a total of 4926 patients who had skin closure with sutures (n = 2724) or clips (n = 2202) following CS. Use of clips was associated with a significantly higher rate of wound separation (risk ratio (RR): 2.33, P = 0.004) and longer length of hospital stay (mean difference (MD): 1.21, P = 0.03) but shorter closure time (MD: 5.35, P = 0.00001) when compared to sutures group. There was no significant difference between the two groups in the risk of wound infection (RR: 1.12, P = 0.75), haematoma formation (RR: 2.46, P = 0.23), seroma (RR: 1.17, P = 0.73), re-admission rate (RR: 1.28, P = 0.73), PSAS (MD: 0.44, P = 0.73) and OSAS (MD: 0.32, P = 0.55). Trial sequential analysis showed the meta-analysis was conclusive for wound infection, wound separation and closure time; however, it was inconclusive for length of hospital stay, PSAS and OSAS due to risk of type 2 error. CONCLUSION: This meta-analysis of best available evidence (level 1) demonstrated that although skin closure with subcuticular sutures is more time-consuming than clips, it is associated with a significantly lower risk of wound separation and shorter length of hospital stay.