OBJECTIVES : Approximately 22.9 million Cesarean Sections (C-Sections) were performed globally in 2012, accounting for 18.6% of all births. The rate in China is even higher at 40.5%. Surgical Site Infections (SSIs) and wound dehiscence are two of the most common complications, and may cause undue burden for patients. A novel closure technique was introduced at our institution in August 2015 to address these unmet needs. Thus, the objective is to compare the clinical and economic outcomes of the Heart-Shaped Suturing Technique (HSST) with Conventional Suturing Technique (CST) for cesarotomy closure.

METHODS : A retrospective cohort analysis was conducted using the electronic medical records of the Obstetrics and Gynecology Department at the First Affiliated Hospital of Xiamen University in China. Study patients were divided into a Conventional Suturing Technique (CST) group (n=2,540; delivery between 1/2014-8/2015), and a Heart-Shaped Suturing Technique (HSST) group (n=2,598; delivery between 9/2015-3/2017). The primary endpoint was the frequency of post-operative wound complications. Exploratory outcomes included the duration and cost of hospitalization.

RESULTS : There were no statistically significant differences in baseline characteristics (i.e., demographics, gestational age, number of pregnancies, number of prior C-sections, etc.) between the two groups. Using CST, a total of 12 patients experienced SSIs and/or required secondary closure vs. 2 patients when using HSST, corresponding to a wound complication rate of 0.47% and 0.077%, respectively (p<0.01). The average Length of Stay (LOS) was longer for CST (3.8 days) vs. HSST (3.5 days), although this did not reach significance. Compared with uncomplicated cases, patients with poor incisional healing had prolonged hospital stays (additional 14.8 days) and bigger hospital bills (extra 11,681 RMB).

CONCLUSIONS : The wound complication rate following C-section was significantly lower using HSST when compared to the conventional approach at our institution. Wound complications also caused longer LOS and were associated with an increase in hospitalization costs.