- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02865083
The Effect of a Self-Retaining Pannus Retractor in Obese Patients Undergoing Cesarean Section (Traxi)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Surgical site infections (SSI) are an important cause of morbidity following cesarean sections. The rate of surgical site infections following cesarean section in the United States is estimated between 3-15%, depending on the population studied, definitions of surgical site infection used, and length of time studied and is often underestimated. Morbidities include longer length of hospital stay, hospital readmission, wound opening and re-exploration, need for home health care, increased health care costs and loss of productivity. The risk of developing a SSI after a Cesarean section is increased with certain patient characteristics, such as obesity and duration of surgery and is decreased with the use prophylactic antibiotics prior to the skin incision.
Obesity is a significant public health problem and the incidence continues to increase in the United States. It has been shown to be associated with increased risk of SSI after cesarean section in several studies. Olsen et al reviewed 1,605 patients who underwent cesarean section and found increased BMI at admission was an independent risk factor for SSI. In another study of 19,416 women in Israel who had cesarean deliveries, women who had a BMI ≥30 kg/m2 had an increased risk for infection (odds ratio [OR} =2.2; 95% Confidence Interval [CI]. Leth, et al. also found obesity as a risk factor associated with wound infection. In this study of 2,492 consecutive women who had cesarean sections in Denmark, infection rates increased with increasing BMI, with women with a BMI kg/m2 30.0-34.9 having an infection rate of 19.1% and women with a BMI of 35.0-39.9 kg/m2 and of ≥40 kg/m2 both having infection rates of 31.1%. Hypotheses for the increased rate of wound infections in obese patients include decreased vascularity of adipose tissue, increase in wound area, and poorer penetration of prophylactic antibiotics to adipose tissue. Adequate surgical exposure and good visualization are paramount in abdominal surgery. Retraction of the pannus cephalad is often required for adequate visualization and access to the lower abdomen and thus the lower uterine segment. Several studies have been shown that pfannensteil or joel-cohen incisions are superior to vertical incisions due to increased risk of classical cesarean delivery in the case of the obese gravida. Limited studies have been completed to assess supra umbilical incisions.
Other methods of pannus retraction are currently utilized in obstetrics surgery, mostly with surgical tape or Montgomery straps. However, there are currently no clinical trials comparing types of pannus retractors. Potential benefits from the Traxi retractor are decreased operating time, decreased need for additional operating room personnel, and increased ease of delivery of neonate. In addition, the Traxi is designed to stay on for 24 hours in order to elevate the pannus, this will decrease exposure to moisture and possibly other bacteria as the skin begins to heal.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Pregnant women with a BMI greater than or equal to 30 kg/m squared, aged 14-50 years old, undergoing non-emergent cesarean section for delivery and require pannus displacement for surgery.
Physicians Inclusion would include any physician who routinely perform C-sections
Exclusion Criteria:
- Patients undergoing emergency Cesarean-section Pre-existing concurrent infection including chorioamnionitis State of immunosuppression (ie. HIV, cancer) Long-term steroid use (>2 days) Patients with a BMI <30 kg/m2, or those with a BMI >/=30kg who do not require pannus retraction.
If there is a rash in the area of retraction Adhesive/tape allergy. Physicians exclusion would include any physician who does not routinely perform C-sections.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Treatment
Subjects will receive use of the Traxi pannus retractor when undergoing cesarean section
|
traxi® Panniculus Retractor is a retraction device used for retraction of the panniculus during surgical procedures.
traxi retracts and holds the panniculus for the duration of the operation, freeing the surgeons hands and those of the staff to better care for the patient.
|
No Intervention: Standard
Patients will receive use of the standard of care option which is the montgomery straps
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Wound Disruption Rates
Time Frame: 24 hours from placement of device
|
To determine if there is a difference in wound disruption rates, in obese patients who have Cesarean sections when the Traxi retractor is used during Cesarean sections, when compared to traditional pannus retractor techniques, montogmery straps.
|
24 hours from placement of device
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration of Surgery or Length of Time From Skin Incision to Delivery of the Infant
Time Frame: At time of surgery
|
To determine if there is a difference in duration of surgery or length of time from skin incision to delivery of the infant between the treatment group and the control/standard group.
|
At time of surgery
|
Change in Hemoglobin
Time Frame: 24 hours after surgery
|
To determine if there is a difference in change in hemoglobin between the control/standard group and the treatment group.
|
24 hours after surgery
|
Estimated Blood Loss
Time Frame: At time of surgery
|
To determine if there is a difference in estimated blood loss between the treatment group and the control/standard group.
|
At time of surgery
|
Postoperative Length of Stay
Time Frame: 3-4 days
|
To determine if there is a difference in postoperative length of stay between the treatment group and the control/standard group.
|
3-4 days
|
Other Complication Rate
Time Frame: 6 weeks
|
To determine if there is a difference in other complication rates between the treatment group and the control/standard group.
|
6 weeks
|
Need for Hospital Readmission or Emergency Room Visits
Time Frame: 6 weeks
|
To determine if there is a difference in need for hospital readmission or emergency room visits between the treatment group and the control/standard group.
|
6 weeks
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 26533
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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Clinical Trials on Traxi Pannus Retractor
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Prisma Health-UpstateClemson UniversityCompletedObesity Complicating Childbirth | Fetal AnomalyUnited States
-
Melissa WisePrisma Health-UpstateCompletedObesity | Pregnancy Complications | Fetal Anomaly | PannusUnited States
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Geisinger ClinicClinical InnovationsWithdrawn
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Charite University, Berlin, GermanyCompletedSurgical Site Infection
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St. Louis UniversityCompletedPregnancy | ObeseUnited States
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Eastern Virginia Medical SchoolCompletedSleep Apnea, Obstructive | TonsillitisUnited States
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Umraniye Education and Research HospitalUnknown
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Beth Israel Deaconess Medical CenterBrigham and Women's Hospital; Clinical Innovations, LLCRecruitingCesarean Section Complications | Obesity, MorbidUnited States
-
Abbey Hardy-FairbanksApple Medical CorporationCompletedPregnancy | Complications; Cesarean SectionUnited States
-
Fatih Sultan Mehmet Training and Research HospitalCompleted