A randomised trial of caesarean wound coverage: exposed versus dressed
Document Type
Article
Publication Date
9-1-2020
Abstract
Objective To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure. Design Randomised trial. Setting University Hospital, Malaysia: April 2016-October 2016. Population 331 women delivered by caesarean section. Method Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal). Main outcome measures Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge. Results The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk RR] 0.4, 95% CI 0.1-2.1;P = 0.45) and patient satisfaction with wound management was 7 5-8] versus 7 5-8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups. Conclusion The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken. Tweetable abstract An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.
Keywords
Caesarean section, patient satisfaction, surgical site infection, wound dressing, wound infections
Divisions
obstetrics
Funders
Universiti Malaya (Grant No. UM.TNC2/IPPP/PPGP/638/BK033‐2016)
Publication Title
Bjog-an International Journal Of Obstetrics And Gynaecology
Volume
127
Issue
10
Publisher
Wiley
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA