As usual, naive media, including The New York Times, accepted the study's findings without reservations. Also as usual, I did not.
I actually read the full version of the paper, which appeared in the June issue of Obstetrics and Gynecology.
My major concern is this (from the paper): Staples were removed on postoperative days 4–10 at the discretion of the health care provider. In fact, staples were removed at a median of 6 days. That means half of the patients, who had an average BMI of 32.5, had their staples removed in 6 or fewer days.
Of the stapled group, 216 (57.6%) patients returned after discharge for removal and 160 (42.4%) had their staples removed before hospital discharge which averaged 4.5 days.
I would never remove staples from an abdominal incision in fewer than 7-10 days, especially in an obese patient. The only reasons to remove staples before discharging a patient would be to avoid scheduling an office visit within a week or so after the hospitalization or to save the doctor's office the cost ($1.95 to $9.99) of purchasing a disposable staple remover.
The most common wound complication was separation of the skin. From the paper: The majority of patients who had a wound separation either healed spontaneously or had Steri-Strips placed. Two patients required wound packing (one in the suture group, one in the staple group).
Although wound separation occurred in significantly more of the stapled patients (7.4% vs. 1.6%) the median length of skin separation in the stapled group was 2 cm—less than 1 inch—and not a big deal.
The authors acknowledge that the skin wound separations caused almost no problems for the patients.
More from the paper: The decreases in the individual rates of wound infection, hematoma, seroma, or readmission for a wound complication in the suture compared with the staple group were not statistically significant.
What this paper shows is that if you remove staples before wounds have had enough time to complete the initial phase of healing, separation of the skin, which is not a serious problem, will occur in some patients.
Bottom line: If you don’t take staples out too soon, it's OK to use them to close the skin, and as the paper found, you will save an average of 9 minutes of OR time.
PS: There were two interesting misrepresentations in the NY Times article about the paper. One, The study, which received funding from Ethicon, a maker of sutures… failed to mention that Ethicon also makes skin staplers. Two, Stitching takes about nine minutes longer than stapling. But in a C-section, Dr. Berghella [the study's senior author] said, where local anesthesia is generally used, that time difference is unimportant. Local anesthesia for a C-section? The article was obviously written by a man. He must have meant spinal or epidural.