Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Obese pregnant individuals (BMI ≥ 30 kg/m2) face an increased risk of cesarean delivery and postoperative complications, including wound morbidity and hospital readmissions. Preventing cesarean-related wound complications is critical for reducing maternal morbidity, mortality, and healthcare costs. While prior meta-analyses have favored subcuticular sutures over staples in the general population, recent randomized trials suggest that metal staples may yield comparable or lower wound complication rates in obese individuals. However, conflicting findings in recent meta-analyses, influenced by methodological limitations, highlight the need for an updated systematic review and meta-analysis. This study aims to comprehensively evaluate outcomes associated with post-cesarean skin closure using metal staples versus subcuticular sutures in obese patients.

METHODS: We conducted a systematic search of MEDLINE, EMBASE, Scopus, Web of Science, and gray literature sources from inception through November 2022. Randomized trials comparing metal staples with sutures for wound closure in obese individuals after cesarean delivery were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Prediction intervals estimated the range of potential future study results, and fragility indices assessed result robustness. The primary outcome was wound complications, defined as surgical site infection, wound separation, or hematoma/seroma formation. Secondary outcomes included surgical site infection and wound separation.

RESULTS: Of 10,132 articles identified, 8 were included in the meta-analyses. Wound closure with metal staples was not associated with an increased probability of wound complications compared to suture (8 articles, 1748 pregnancies; OR, 1.20; 95% CI, 0.69-2.09; FI 20). Wound closure with metal staples decreased odds of surgical site infection (4 articles, 726 pregnancies; OR 0.47; 95% CI, 0.26-0.84; FI 1). There was no difference in the likelihood of wound separation between skin closure with metal staples versus subcuticular suture (4 articles, 726 pregnancies; OR, 0.98; 95% CI, 0.59-1.63; FI 15).

CONCLUSION: In this meta-analysis, no significant differences were observed in the odds of wound complications, surgical site infection, or wound separation between metal staples and subcuticular sutures for post-cesarean skin closure in obese patients, supporting the consideration of either method.