Subcutaneous tissue closure technique during cesarean delivery: Don’t interrupt, better continue

Objectives: To determine the rates of surgical site infections following continuous as compared to interrupted subcutaneous tissue closure technique ‎during cesarean delivery. Design: Retrospective study. Setting: Tertiary, university-affiliated medical center. Population: Term pregnant women who underwent elective or emergent cesarean delivery at our center during the years 2008-2018. Methods: Group allocation was based on type of subcutaneous tissue closure. The study group included women who underwent either elective or emergent cesarean delivery with continuous subcutaneous tissue closure, while the control group comprised those with interrupted subcutaneous tissue closure. We excluded women with suspected infectious morbidity prior to cesarean delivery. Main outcome measures: Rate of surgical site infection (SSI) comparing women who had undergone continuous as compared to interrupted subcutaneous suturing. Results: Final analysis included 6,281 women. We performed continuous subcutaneous tissue closure in ‎37.4% (1,867/4,988) of scheduled cesarean deliveries, and 45.8% (592/1,293) ‎of emergent cesarean deliveries. The rate of SSI was significantly lower following continuous as compared to interrupted subcutaneous tissue closure, in both elective ‎(2.7% vs. 4.5%, respectively, P=0.031) ‎and emergent cesarean delivery ‎(3.2% vs. 5.4%, respectively, P=0.036), in nulliparous and multiparous women. Similarly, secondary outcomes such as re-admission rates within 6 weeks due to SSI, post-operative maternal fever, and need for antibiotic treatment were significantly lower following continuous subcutaneous closure technique. Conclusions: Continuous subcutaneous closure technique during cesarean delivery yields a lower rate of surgical site infections compared to the interrupted technique.