OBJECTIVES : To compare economic and clinical outcomes of patients undergoing cesarean section (C-section) with use of skin staples and waterproof wound dressings (SSWWD) vs. 2-octyl cyanoacrylate and polymer mesh tape (DERMABOND® PRINEO® Skin Closure System, DPSCS) for skin closure.

METHODS : Retrospective, observational study using the Premier Hospital Database. Study patients (aged≥18 years) underwent C-section during a hospital admission between 1/1/2012-10/31/2016 (first qualifying=index admission). Patients were classified into mutually-exclusive skin closure device groups based on billing records during index admission; those with billing record(s) for use of: DPSCS (DPSCS group), or skin staples and wound dressings (SSWWD group). Primary outcomes included: index admission’s length of stay (LOS) and total hospital costs. Exploratory outcomes included: infection (surgical site/obstetric/puerperal/cellulitis), wound complications (disruption/hematoma/non-healing/re-closure), and composite infection/wound complications during index admission; 30/60/90-day all-cause readmissions. The DPSCS and SSWWD groups were matched using preferential within-cluster, variable-ratio (1:3/weighted), greedy propensity score matching with a caliper. Matching variables included patient, delivery (e.g., prior C-section), hospital, and provider characteristics. Post-match multivariable regressions accounting for hospital-level clustering were used to compare outcomes between study groups.

RESULTS : Weighted to account for variable-ratio match, each group comprised 2,133 patients (4,266 total; mean age=30.3y). The groups were well-balanced on matching covariates. Compared to the SSWWD group, the DPSCS group had statistically significant: shorter LOS (3.5d vs. 3.7d, P=0.007), lower total hospital costs ($8,879 vs. $9,313, P=0.025), and lower rates of complications (infection, 0.7% vs. 1.6%, P=0.011; wound complication, 0.6% vs. 1.3%, P=0.036; composite, 0.9% vs. 2.0%, P=0.002). Between-group differences for 30/60/90-day all-cause readmissions were statistically insignificant, but rates trended lower in the DPSCS group.

CONCLUSIONS : Among patients undergoing C-section in real-world clinical practice, skin closure with DPSCS was associated with shorter LOS, lower total hospital costs, and lower probability of infection and wound complications when compared with SSWWD.