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Niyigena A, Gato S, Alayande B, Miranda E, Hedt-Gauthier B, Goodman AS, Nkurunziza T, Mazimpaka C, Hakizimana S, Ngamije P, Kateera F, Riviello R, Boatin AA. Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda. BMC Pregnancy Childbirth 2023; 23:858. [PMID: 38087238 PMCID: PMC10717631 DOI: 10.1186/s12884-023-06159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient's perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. METHODS Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression. RESULTS Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30-45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04). CONCLUSION We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.
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Affiliation(s)
- Anne Niyigena
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda.
| | - Saidath Gato
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | | | | | | | | | | | - Christian Mazimpaka
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Sadoscar Hakizimana
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Patient Ngamije
- Kirehe District Hospital, Ministry of Health, Kirehe, Rwanda
| | - Fredrick Kateera
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Robert Riviello
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Adeline A Boatin
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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DCunha P, Silpa KP, Gadwalker SM, Moharana AK, Ts D. Clinical Equivalence of Trusynth® and Vicryl® Polyglactin 910 Sutures for Subcutaneous Tissue Closure During Cesarean Delivery: A Single-Blind Randomized Controlled Trial. Cureus 2023; 15:e39982. [PMID: 37416026 PMCID: PMC10321360 DOI: 10.7759/cureus.39982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Background Post-cesarean complications such as surgical site infection (SSI), bleeding, and dehiscence may occur after cesarean delivery. Subcutaneous tissue closure will reduce these complications. With this background, this study assessed the clinical equivalence of Trusynth® and Vicryl® polyglactin 910 sutures for subcutaneous tissue closure. Methods In this randomized, single-blind study (from January 5, 2021 to December 24, 2021), a total of 113 women with a singleton pregnancy scheduled for cesarean section were included in the study and randomized to Trusynth® (n=57) and Vicryl® (n=56) group. The primary endpoint was the incidence of subcutaneous abdominal wound disruption within six weeks of cesarean delivery. The secondary endpoints included postoperative complications (SSI, hematoma, seroma, and skin disruptions), operative time, intraoperative handling characteristics, postoperative pain, hospital stay, time taken to return to normal activities, suture removal, microbial deposits on sutures, and adverse events. Results No incidence of subcutaneous abdominal wound disruption was recorded. Non-significant differences in intraoperative handling parameters (except memory, p=0.007), postoperative pain, skin disruption, SSI, hematoma, seroma, hospital stay, and time to return to normal activities were observed between Trusynth® and Vicryl® groups. Conclusion Both Trusynth® and Vicryl® polyglactin 910 sutures can be regarded as clinically equivalent. These are safe and effective for subcutaneous tissue closure during cesarean section with minimal risk of subcutaneous abdominal wound disruptions.
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Affiliation(s)
- Prema DCunha
- Obstetrics and Gynecology, Father Muller Medical College, Mangaluru, IND
| | - Kranti P Silpa
- Obstetrics and Gynecology, CARE Hospitals, Telangana, IND
| | | | | | - Deepak Ts
- Clinical Affairs, Healthium Medtech, Bengaluru, IND
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Sailakshmi M, Misra S, Hs S, Acharya S, Moharana AK, Ts D. Clinical Equivalence of Monoglyde® and Monocryl® Absorbable Poliglecaprone-25 Sutures: A Single-Blind, Randomized Study. Cureus 2023; 15:e38938. [PMID: 37309337 PMCID: PMC10257932 DOI: 10.7759/cureus.38938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES Poliglecaprone-25 is a synthetic monofilament suture commonly used for post-cesarean subcuticular skin closure. The present study was designed to assess the effect of subcuticular skin closure using Monoglyde® vs. Monocryl® poliglecaprone-25 absorbable sutures on the risk of wound composite outcomes in the first 30 days post-partum [surgical site infection (SSI), wound dehiscence, hematoma or seroma]. STUDY DESIGN This is a prospective, single-blind, randomized (1:1), multicentric, two-arm study performed between September 2020 and December 2021 at two different centers across India. Women (18-40 years) with a singleton pregnancy requiring cesarean delivery were randomized to Monoglyde® (n=62) or Monocryl® (n=62) suture groups. The primary endpoint is the incidence of wound composite outcomes in the first 30 days post-partum (SSI, wound dehiscence, seroma, or hematoma). In addition, the secondary outcomes, incidence of wound composite outcome at all visits (till four months), suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures (in case not absorbed or infection), operative time, intraoperative suture handling, postoperative pain, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were noted. RESULTS Non-significant difference between the groups regarding demographic characteristics and primary endpoint; the incidence of wound composite outcome was observed. Moreover, no significant difference in suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures, operative time, intraoperative suture handling, pain, return to normal day-to-day activities, modified Hollander cosmesis, and subject satisfaction score were registered between the groups. CONCLUSIONS This study establishes the clinical equivalence of Monoglyde® and Monocryl® poliglecaprone-25 sutures, and both sutures can be used for subcuticular skin closure following cesarean delivery with minimal risk for wound complications.
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Affiliation(s)
- Mpa Sailakshmi
- Obstetrics and Gynecology, RajaRajeswari Medical College and Hospital, Bengaluru, IND
| | - Sukanta Misra
- Obstetrics and Gynecology, Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences, Kolkata, IND
| | - Sathyashree Hs
- Obstetrics and Gynecology, RajaRajeswari Medical College and Hospital, Bengaluru, IND
| | - Soukhin Acharya
- Obstetrics and Gynecology, Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences, Kolkata, IND
| | | | - Deepak Ts
- Clinical Affairs, Healthium Medtech, Bengaluru, IND
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Aguirre-Allende I, Alkorta-Zuloaga M, Iglesias-Gaspar MT, Urreta-Ballobre I, García-Domínguez A, Arteaga-Martin X, Beguiristain-Gómez A, Medrano-Gómez MÁ, Ruiz-Montesinos I, Riverola-Aso AP, Jiménez-Agüero R, Enríquez-Navascués JM. Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial). BMC Surg 2023; 23:9. [PMID: 36639756 PMCID: PMC9837932 DOI: 10.1186/s12893-023-01911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
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Affiliation(s)
- Ignacio Aguirre-Allende
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maialen Alkorta-Zuloaga
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maria Teresa Iglesias-Gaspar
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Iratxe Urreta-Ballobre
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Amaia García-Domínguez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Xabier Arteaga-Martin
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Adolfo Beguiristain-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Miguel Ángel Medrano-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Inmaculada Ruiz-Montesinos
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Ana Paula Riverola-Aso
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Raúl Jiménez-Agüero
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - José María Enríquez-Navascués
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
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Huang Y, Yin X, Wei J, Li S. Comparison of the effect of skin closure materials on skin closure during cesarean delivery. PLoS One 2022; 17:e0270337. [PMID: 35771895 PMCID: PMC9246200 DOI: 10.1371/journal.pone.0270337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the effect of skin closure materials on skin closure during cesarean delivery. Methods We searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score. Results Twenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple. Conclusion In conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.
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Affiliation(s)
- Ye Huang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinbo Yin
- Department of Pathology, Children Hospital and Women Health Center of Shanxi, Taiyuan, Shanxi, China
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junni Wei
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Suhong Li
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Pathology, Children Hospital and Women Health Center of Shanxi, Taiyuan, Shanxi, China
- * E-mail:
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Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Langenbecks Arch Surg 2021; 407:37-50. [PMID: 34232372 DOI: 10.1007/s00423-021-02239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
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.
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