Clinical and economic outcomes of cesarean deliveries with skin closure through skin staples plus waterproof wound dressings versus 2-octyl cyanoacrylate plus polymer mesh tape

PURPOSE

To compare clinical and economic outcomes of cesarean deliveries with skin closure through skin staples plus waterproof wound dressings (SSWWD) versus 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT). We hypothesized that cesarean deliveries with skin closure through 2OPMT may be associated with a lower rate of wound complications and infections as compared with skin closure through SSWWD; we also hypothesized that, accordingly, 2OPMT may be associated with lower hospital length of stay (LOS), hospital costs, and all-cause readmissions as compared with SSWWD.

METHODS

Retrospective, observational study using a research database derived from administrative records routinely contributed by hundreds of hospitals in the USA. We queried the database for patients aged 18-49 years who had an in-hospital low transverse cesarean delivery between 1 January, 2012 and 31 March, 2017. Using records of medical supplies used during deliveries, we identified deliveries for which skin closure was performed by either SSWWD (SSWWD group) or 2OPMT (2OPMT group). Our primary study outcome was a composite endpoint of infection/wound complication diagnosis during the hospital stays in which the deliveries were performed. Our secondary outcomes included: length of stay (LOS) and total hospital costs for the hospital stays in which the deliveries were performed, and all-cause readmissions (30/60/90 days post discharge) to the same hospital in which the delivery was performed. We compared outcomes between propensity-score matched groups using regressions accounting for hospital-level clustering and non-Gaussian empirical outcome distributions.

RESULTS

Each group comprised 2133 patients (4266 total patients; mean age = 30.3 years [SD = 4.6]). Compared with the SSWWD group, the 2OPMT group had statistically significant lower rates of complications (infection, 0.7 versus 1.6%, p = .011; wound complication, 0.6 versus 1.3%, p = .036; composite, 0.9 versus 2.0%, p = .002), shorter LOS (mean = 3.5 days [SD = 1.6] versus 3.7 days [SD = 1.8], p = .007), and lower total hospital costs (mean = $8879 [SD = $3157] versus $9313 [SD = $3311], p = .025). Between-group differences for 30/60/90-day all-cause readmissions were statistically insignificant.

CONCLUSIONS

This large observational study is the first of its kind and provides evidence that cesarean delivery skin closure with 2OPMT is associated with lower rates of in-hospital infection and wound complications, lower LOS, lower total hospital costs as compared with SSWWD.

Comparative evaluation of polycyanoacrylates

Cyanoacrylate esters (CA) and their corresponding polymers (PolyCA) are used as general and medical adhesives, biodegradable carriers for controlled drug delivery, and as agents for fingerprint development in forensic science. Most reports of cyanoacrylate are on ethyl or 2-octyl cyanoacrylate ester with little attention to other esters. It is the objective of this study to determine the differences amongst cyanoacrylate esters regarding their synthesis, chemical characterization, hydrolytic degradation, and thermal and mechanical properties. Cyanoacrylate polymers of short and long alkyls or oxy-alkyls, cyclic, and aromatic esters have been synthesized and evaluated. All monomers form polymers when exposed to triethylamine vapours possessing molecular weights in the range of 15,000-150,000Da, where the alkyl esters form high MW polymers. A wide range of hydrolytic degradation rates has been found, as monitored by the release of formaldehyde over time. Alkoxy CAs show faster hydrolytic degradation compared to alkyl CAs. Regarding mechanical properties, CAs are classified into primarily viscous (G'>G″) and primarily elastic (G″>G'). Alkoxy CA polymers have a higher loss modulus (G') than storage modulus (G″). Octyl CA polymer possess a G'≈G″ (phase angle ∼45°) providing appropriate balance between mechanical strength and plasticity. Most alkyl CAs are compact and brittle. Alkoxy CAs show enhanced plasticity, but they lack mechanical strength. In general, the T_g for alkoxy CAs is less than alkyl CAs. Alkoxy CAs depolymerise rapidly at temperatures >200°C. Overall, ester sidechains of CA esters strongly affect the polymer property.

STATEMENT OF SIGNIFICANCE

Polycyanoacrylates are an important class of biodegradable polymers mainly used as bioadhesives. The study describes comparative evaluation of different cyanoacrylate polymers with respect to their chemistry, degradation, safety, mechanical, and thermal properties. The study forms the basis for choosing appropriate combination of cyanoacrylate esters for various biomedical uses. Moreover, this study reveals properties of a few new polycyanoacrylates for the first time.