(238) Metal staples do not increase wound complications after cesarean delivery in obese patients: a meta-analysis

Objective:
To assess the rate of wound complications when using metal staples versus sutures for post-cesarean wound closure in obese individuals.

Study Design: We conducted a systematic search of electronic databases from inception to December 31, 2022, to identify relevant randomized controlled trials (RCTs). Eligible studies were RCTs comparing metal staples and sutures for wound closure following cesarean delivery in obese individuals. We performed a meta-analysis using random-effects models to report odds ratios (OR) with 95% confidence intervals (CI). Additionally, we assessed 95% prediction intervals to indicate the range of the true effect estimates of future studies. We also conducted a fragility index and a reverse fragility index to assess the robustness of our findings.

Results: This systematic review and meta-analysis included data from 8 RCTs involving 1,748 participants. We found that metal staples were not inferior to subcuticular sutures for post-cesarean wound closure in obese patients regarding wound complications (OR 1.20; 95% CI 0.69-2.09) and wound separation (OR 0.98; 95% CI 0.58-1.65). However, skin closure with metal staples, compared to sutures after cesarean delivery in obese individuals, on average reduced surgical site infection by 54% (OR 0.46; 95% CI 0.25-0.83). Fragility analyses revealed that the statistically insignificant results for wound complications and wound separation were robust, while the statistically significant reduction in surgical site infection with metal staples was fragile.

Conclusion:
Our findings suggest that metal staples are not inferior to suture for post-cesarean wound closure in obese patients in terms of wound complications and wound separation. However, the optimal method of wound closure for obese patients remains uncertain. Our study highlights the need for further research in this area to establish the most effective technique for post-cesarean wound closure in obese patients.