(151) Clinical and Economic Outcomes of Cesarean Deliveries with Skin Closure through Conventional Sutures Plus Waterproof Wound Dressings versus 2-octyl Cyanoacrylate Plus Polymer Mesh Tape

Background: Cesarean section is one of the most common operating room procedures in the world. Skin closure is a critical step in the closure of the cesarean wound and affects patients' healing and risk of wound complications.

Objectives: To compare clinical and economic outcomes of cesarean deliveries with skin closure through conventional (smooth) sutures plus waterproof wound dressings (CSWWD) versus 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT).

Methods: Retrospective, observational study using a database derived from clinical and billing records from over 900 US hospitals. Eligible patients were aged 18-49 who underwent cesarean delivery between 1-October-2015 and 30-June-2022. Using records of medical supplies used during deliveries, we identified deliveries for which skin closure was performed by either CSWWD or 2OPMT. Outcomes included: a composite wound complication endpoint of surgical site infection or wound dehiscence diagnosis within 30 days after cesarean delivery; post-surgical length of stay (LOS), and total hospital costs for the hospital stays in which the deliveries occurred. We compared outcomes between the groups after stable balance weighting the CSWWD 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) were well-balanced on all characteristics (standardized mean differences | < 0.10|). Compared with the CSWWD group, the 2OPMT group had statistically significant lower rates of wound complications (1.16% vs. 1.63%, risk difference 0.47% [ 95% CI 0.20%-0.74%], odds ratio 0.71 [95% CI 0.58-0.86], p=0.001), shorter mean post-surgical LOS (1.56 vs. 1.73 days, p< 0.001), and lower mean total hospital costs ($9,499 vs. $10,362, p< 0.001).

Conclusions: In this large observational study, cesarean delivery skin closure with 2OPMT was associated with lower rates of in-hospital wound complications, lower post-surgical LOS, and lower total hospital costs as compared with CSWWD.