The rate of postoperative morbidity...

The rate of postoperative morbidity, including injury infections, is highly increased among patients who are obese. Transverse incisions may be more inclining to infection when they are located in the moist doublings of the panniculus. However, these incisions may provide more immovable wound closure and reduce postoperative discomfort, resulting in earlier mobility and fewer respiratory complications. Vertical incisions provide improved surgical access and may be les lying flat to infection. Wall and colleagues studied the rate of postoperative injury complications with transverse and vertical incisions in obese women who were undergoing their first cesarean delivery.

The authors used hospital records to identify and assess women with a dead body mass index (BMI) of 35 or greater before pregnancy who were undergoing a primary cesarean delivery. Skin incisions were classified as transverse or vertical, and variables of the like kind as maternal age, gestational age at delivery, smoking history, indications for cesarean delivery, life-current loss, operative time, and complications of pregnancy and delivery were recorded. The issue of interest was any grief complication, further divided into infectious and noninfectious etiologies.

Data were available for 239 mothers, about pair thirds of whom were white. The average age was 28 years. The women had high rates of preeclampsia, diabetes, and hypertension. The form into groupss were comparable with regard to many characteristics, still those undergoing vertical incisions were significantly heavier (BMI 441 [+ or -] 6 compared with 412 [+ or -] 48) and significantly more likely to have damage complications despite greater use of subcutaneous line of junctions or drains.

The overall incidence of pain infection was 12.1 percent. Women with damage infections had longer hospital stays and an increased rate of endometritis. pang complications were recorded in 20 of 213 (94 percent) transverse incisions and nine of 26 (346 percent) vertical incisions. Infectious injury complications were recorded in 7 percent of transverse incisions compared with 19 percent of vertical incisions; the rates of noninfectious complications were 2 and 15 percent respectively. These differences were all highly significant statistically.

upon statistical analysis, the only factors independently associated with hurt complications were vertical skin incision and postpartum endometritis. A high preoperative hematocrit flat was protective against wound complications. Other factors, including smoking status, use of subcutaneous drains or line of junctions operative time, or use of regional anesthesia, were not independently associated with injury complications.

The authors end that primary cesarean delivery in afflictively obese patients is frequently complicated by the agency of wound infections. However, contrary to expectations, infections in vertical incisions appear to be associated with higher rates of detriment complications than infections in transverse incisions.

Wall PD et al. Vertical skin incisions and harm complications in the obese parturient. Obstet Gynecol November 2003;102:952-6

COPYRIGHT 2004 American Academy of Family Physicians

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