Economic and clinical outcomes of cesarean deliveries with skin closure using 2-octyl cyanoacrylate plus polymer mesh tape versus conventional smooth sutures plus waterproof wound dressings.

Abstract

Objective: Cesarean delivery is the most common major operating room procedure performed in the United States. Wound closure after cesarean delivery includes suturing for uterine closure and to close the fascial-and sometimes subcutaneous-tissue layer followed by skin closure. Optimal skin closure is critical as it affects the risk of both cesarean wound infection and dehiscence. To our knowledge, however, no clinical or real-world studies comparing 2OPMT with conventional sutures for skin closure following cesarean delivery have been published to date. We sought to compare the economic and clinical outcomes of cesarean deliveries with skin closure using 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT) versus conventional smooth sutures plus waterproof wound dressings (CS-WWD).

Methods: This was a retrospective, observational study using a database derived from hospital electronic health records and billing data from over 1,000 U.S. hospitals (PINC AI^™ Healthcare Database). Eligible patients were aged 18-49 who underwent cesarean delivery between 1 October 2015 and 30 June 2022. From records of medical supplies used during deliveries, we identified deliveries for which skin closure was performed using either 2OPMT or CS-WWD. Outcomes included: post-surgical length of stay (LOS), total hospital costs for the cesarean delivery stay, 30-day readmissions of various acuity to the same hospital in which the cesarean delivery occurred, and two 30-day clinical/wound complication outcomes (occurrence during the initial cesarean delivery stay or within 30 days thereafter), which included: (a) a composite endpoint of cesarean wound surgical site infection and/or dehiscence; and (b) a composite endpoint of cesarean wound surgical site infection and/or dehiscence, puerperal infection, endometritis, urinary tract infection, hematoma of the skin, cellulitis, and/or other unspecified skin infection. We compared outcomes between the groups after stable balance weighting the CS-WWD group to mimic the 2OPMT group on numerous patient, provider, and hospital characteristics.

Results: After weighting, the CSWWD (N = 13,551) and 2OPMT (N = 16,068) groups were well-balanced on all characteristics (standardized mean differences for balancing covariates <|0.10|). Compared with the CS-WWD group, the 2OPMT group had statistically significant shorter mean post-surgical LOS (1.56 days for 2OPMT vs. 1.73 days for CS-WWD, p < 0.001), lower mean hospital costs for the cesarean delivery stay ($9,499 vs. $10,362, p < 0.001), lower incidence proportions of 30-day inpatient readmission (1.43% vs. 1.83%, p = 0.009), 30-day emergency room visits (5.22% vs. 6.18%, p < 0.001), 30-day composite of inpatient readmission/emergency room visits (6.47% vs. 7.70%, p < 0.001), 30-day visits of other kinds, such as outpatient (5.32% vs. 9.50%, p < 0.001), 30-day overall readmission/visits comprising all categories above (11.00% vs. 15.90%, p < 0.001), and lower 30-day incidence proportion of cesarean wound surgical site infection and/or dehiscence (1.13% vs. 1.72%, p < 0.001) and cesarean wound surgical site infection and/or dehiscence, puerperal infection, endometritis, urinary tract infection, hematoma of the skin, cellulitis, and/or other unspecified skin infection (2.17% vs. 3.23%, p < 0.001).

Conclusions: In this large observational study, cesarean deliveries with skin closure using 2OPMT were associated with lower post-surgical length of stay, lower total hospital costs for the cesarean delivery stay, lower incidence proportions of 30-day readmissions, and lower incidence proportions of 30-day clinical/wound complications as compared with CS-WWD.