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DOI: 10.1055/s-0040-1716889
The Association of Cesarean Skin Incision Length and Postoperative Wound Complications
Funding This study was supported by the U.S. Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant no.: HD64729). The azithromycin used in the parent study was provided by Pfizer through an investigator-initiated grant.![](https://www.thieme-connect.de/media/ajp/202205/lookinside/thumbnails/10-1055-s-0040-1716889_200355-1.jpg)
Abstract
Objective This study was aimed to evaluate the relationship between cesarean skin incision length and wound complications.
Study Design Planned secondary analysis of a multicenter double-blind randomized trial of adjunctive azithromycin versus placebo (in addition to standard cefazolin) in women ≥24 weeks undergoing cesarean delivery during labor or ≥4 hours after membrane rupture. Skin incision length (cm) was measured just prior to skin closure. The primary outcome was a composite of wound complications (wound infection, separation, seroma, hematoma, or dehiscence) up to 6 weeks of postpartum. Individual components of the composite were examined as secondary outcomes. Outcomes were compared between groups defined by the lowest (≤25th), middle (25–75th) and highest (>75th) incision length quartiles. Logistic regression was used to adjust for potential confounding variables.
Results Of the 2,013 women enrolled in the primary trial, 1,916 had recorded incision lengths and were included in this secondary analysis. The overall rate of composite wound complications was 7.8%. Median incision length was 15.0 cm (interquartile range: 14.0–16.5) with the lowest quartile defined as ≤14, middle as >14 to ≤16.5, and highest as >16.5 cm. Mean BMI, parity, use of staples, and duration of surgery differed significantly between the three incision length groups. In unadjusted analysis, the longest incision lengths were associated with an increased risk of the wound composite and wound infections (odds ratio [OR] = 2.27, 95% confidence interval [CI]: 1.43–3.60 and OR = 2.30, 95% CI: 1.27–4.15, respectively) compared with the shortest incision lengths. However, after multivariable adjustments, these associations were nullified. Additional analyses considering incision length as a continuous variable and using 10th/90th percentile cut-offs still did not suggest any associations with outcomes.
Conclusion Increasing skin incision length is not independently associated with an increased risk of postoperative wound complications.
Key Points
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After multivariable adjustments, skin incision length was not independently associated with an increased risk of postoperative wound complications.
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A reasonable incision length needed to safely perform the procedure should be used.
Note
This work was presented at the 38th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting, Dallas, TX, January 29 to February 3, 2018 (Abstract no.: 548).
Publikationsverlauf
Eingereicht: 06. Mai 2020
Angenommen: 20. August 2020
Artikel online veröffentlicht:
01. Oktober 2020
© 2020. Thieme. All rights reserved.
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