Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Objective To investigate optimal timing of dressing and staples removal after cesarean delivery (CD). Methods This prospective clustered clinical trial enrolled women undergoing CD between January 1, 2013, and October 31, 2014, at Hadassah-Hebrew University Hospital, Jerusalem. Women were assigned to one of five clusters differing in timing of dressing and staples removal. We assessed scar healing at 6 weeks. Results 920 women completed telephone questionnaires. Wound healing did not differ significantly among the clusters: the healing complication rate was 21% in the control group (n=46) and ranged from 18% to 26% (n=27-50) in clusters two to five (P=0.49). More healing complications were observed in women with a body mass index (BMI) of more than 35 kg/m(2) versus 35 kg/m(2) or less (P=0.016), urgent versus elective CD (P=0.013), preterm premature rupture of the membranes (PPROM) versus intact membranes (P=0.016), and chorioamnionitis at delivery versus no chorioamnionitis (P=0.001). 586 (64%) women underwent physician assessment at staples removal and at 6 weeks post CD. Conclusions Timing of dressing and staples removal has no effect on CD scar healing in low- and high-risk parturients. A BMI of more than 35 kg/m(2), urgent CD, PPROM, and chorioamnionitis were associated with mal-healing, regardless of cluster. Clinicaltrials.gov: NCT01724255.