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Value of a self-made subcutaneous negative-pressure drain in cesarean delivery: a propensity score-matched cohort
Jie Cheng Bi1, Ni Bei1, Ying Liu1
1Department of Obstetrics, The Third Affiliated Hospital of Guangxi Medical University, The Second Nanning People's Hospital, Nanning, China.
Objective:
To evaluate the preventive value of a self-made subcutaneous negative-pressure drain (5 mL or 10 mL syringe with a scalp vein needle) for wound complications after cesarean delivery.
Methods:
This retrospective cohort study included 259 women who underwent cesarean delivery (79 received the drain, 180 did not). Propensity score matching (1:1 nearest-neighbor, caliper = 0.2 SD) balanced baseline covariates (age, predelivery BMI, parity, prior surgeries, intrapartum transfer to cesarean, gestational age). After matching, 71 patients remained per group. The primary outcome was wound erythema/edema or fat liquefaction. Secondary outcomes included postoperative fever, length of stay, antibiotic duration, cost, and operative time. For binary outcomes, Fisher's exact test was used; for continuous variables, the Wilcoxon rank-sum test was used; multivariable linear regression was applied for adjusted analyses.
Results:
After matching, no baseline variable differed significantly between groups (all P > 0.05), although residual imbalance persisted for several variables (absolute standardized mean difference up to 0.359). The incidence of the primary outcome was 2.82% (2/71) in the study group vs. 5.63% (4/71) in controls (P = 0.681; OR 0.49, exact 95% CI 0.043-3.534). Postoperative fever was numerically more frequent in the study group (12.68% vs. 2.82%), but the difference was not statistically significant (Fisher's exact test, P = 0.055). Multivariable regression showed no significant effects on operative time (β = 1.75, P = 0.636), hospital stay (β = -0.11, P = 0.612), antibiotic duration (β = 4.34, P = 0.441), or cost (β = 1,621.44, P = 0.286).
Conclusion:
In this small retrospective cohort of an unselected cesarean population (not stratified by BMI or emergency/elective status), we found no evidence that the self-made subcutaneous negative-pressure drain reduces wound complications or improves other clinical/economic outcomes. Given the small number of events, the wide confidence intervals, and residual confounding, these findings are inconclusive: a clinically meaningful benefit or harm cannot be excluded, and routine use of this device cannot be recommended on the basis of the current evidence. Adequately powered prospective studies in predefined high-risk subgroups are needed.