Comparison of Negative Suction Subcutaneous Drain versus Simple Closure in Caesarean Section among High-Risk Patients to Prevent Postoperative Wound Complication

Abstract

Background and Aim: High-risk women, particularly those with obesity and diabetes, are prone to wound complications after Caesarean section. This randomized controlled trial aimed to compare negative suction subcutaneous drainage and simple closure in reducing seroma formation and surgical site infection in this population. Materials and Methods: This study was conducted at Shaikh Zayed Hospital, Lahore, Obstetrics and Gynecology Department over a period of 6 months from July 2024 to December 2024. Eighty women scheduled for elective Caesarean section with BMI ≥30 kg/m² and controlled diabetes were randomized to receive either negative suction drainage or simple closure. Preoperative care was standardized. Outcomes were assessed clinically and statistically analyzed with SPSS 26.0; p<0.05 was considered significant. Results: Baseline characteristics were comparable between groups. Seroma formation occurred in 5 (12.5%) women with negative suction drainage versus 13 (32.5%) with simple closure (p=0.032). Surgical site infection was observed in 3 (7.5%) patients in the drainage group and 11 (27.5%) in the simple closure group (p=0.019). Stratified analysis showed the most pronounced benefit of drainage among women aged 31–45 years (seroma: 2 (9.5%) vs. 11 (42.3%), p=0.012; SSI: 1 (4.8%) vs. 10 (38.5%), p=0.013) and in normoglycemic patients (seroma: 1 (7.1%) vs. 7 (41.2%), p=0.045; SSI: 0 (0%) vs. 5 (29.4%), p=0.048). No significant differences in wound complications were found when stratified by parity or in patients with pre-existing or gestational diabetes. Conclusion: Negative suction subcutaneous drainage significantly reduced the frequency of seroma formation and surgical site infection compared to simple closure, particularly in older and normoglycemic high-risk women undergoing elective Caesarean section.