References

Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014; 86:(1)24-33 https://doi.org/10.1016/j.jhin.2013.09.012

Totty JP, Moss JWE, Barker E The impact of surgical site infection on hospitalisation, treatment costs, and health-related quality of life after vascular surgery. Int Wound J. 2021; 18:(3)261-268 https://doi.org/10.1111/iwj.13526

Shanmugam VK, Fernandez SJ, Evans KK Postoperative wound dehiscence: Predictors and associations. Wound Repair Regen. 2015; 23:(2)184-190 https://doi.org/10.1111/wrr.12268

Taylor EW, Duffy K, Lee K Surgical site infection after groin hernia repair. Br J Surg. 2004; 91:(1)105-111 https://doi.org/10.1002/bjs.4365

Wójkowska-Mach J, Bulanda M, Cencora A Surgical site infections following vascular surgery. Przegl Epidemiol. 2007; 61:(4)683-691

Kuy S, Dua A, Desai S Surgical site infections after lower extremity revascularization procedures involving groin incisions. Ann Vasc Surg. 2014; 28:(1)53-58 https://doi.org/10.1016/j.aversusg.2013.08.002

Turtiainen J, Saimanen E, Partio T Surgical wound infections after vascular surgery: prospective multicenter observational study. Scand J Surg. 2010; 99:(3)167-172 https://doi.org/10.145749691009900312

Consensus document. Closed surgical incision management: understanding the role of NPWT.: Wounds International; 2016

Franklin J, Turner K, Hudson JS The evaluation of the implementation of the vascular preventative bundle and development of suggested interventions for improvement and sustainability. J Vasc Nurs. 2018; 36:(1)8-11 https://doi.org/10.1016/j.jvn.2017.09.002

Allegranzi B, Zayed B, Bischoff P New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016; 16:(12)e288-e303 https://doi.org/10.1016/S1473-3099(16)30402-9

De Vries FE, Wallert ED, Solomkin JS A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine (Baltimore). 2016; 95:(36) https://doi.org/10.1097/MD.0000000000004673

Strugala V, Martin R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications. Surg Infect (Larchmt). 2017; 18:(7)810-819 https://doi.org/10.1089/sur.2017.156

Svensson-Björk R, Saha S, Acosta S Costeffectiveness analysis of negative pressure wound therapy dressings after open inguinal vascular surgery: the randomised INVIPS-Trial. J Tissue Viability. 2021; 30:(1)95-101 https://doi.org/10.1016/j.jtv.2020.09.005

Matatov T, Reddy KN, Doucet LD Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients. J Vasc Surg. 2013; 57:(3)791-795 https://doi.org/10.1016/j.jversus.2012.09.037

Guest JF, Fuller GW, Vowder P. Cohort study evaluating the burden of wounds to the UK's National Health Service in 2017/2018: update from 2012/2013. BMJ Open. 2020; 10 https://doi.org/10.1136/bmjopen-2020-045253

Arous E, Judelson D, Simons J Increasing the number of integrated vascular surgery residency positions is necessary to address the impending shortage of vascular surgeons in the United States. J Vasc Surg. 2018; 67:(5)1618-1625 https://doi.org/10.1016/j.jvs.2017.12.031

Negative pressure wound therapy

Surgical site infection

Clinical/pre-clinical research

Single use negative pressure wound therapy in vascular patients: clinical and economic outcomes

02 September 2021

Practice

02 September 2021

Volume 5 · Issue 4

ISSN (print): 0969-0700

ISSN (online): 2052-2916

Digital issue

Abstract

Objective:

Surgical site complications (SSCs) such as dehiscence and infection are a common issue within vascular surgeries and are a key concern to payers and clinicians. It is estimated that occurrence of complications in vascular surgery can increment length of stay by 9.72 days and costs by £3776 per episode. The objective of this research was to determine the clinical and economic impact of the prophylactic use of single use negative pressure wound therapy (sNWPT) in postoperative femoral endarterectomy incisions within a single centre in the Netherlands.

Method:

Data were extracted retrospectively from the medical notes of patients consecutively treated for femoral endarterectomy between January 2013 and December 2019 in a single centre in the Netherlands. Since August 2016, patients were treated with the sNPWT device and their data were compared with that of patients treated before the introduction of the device. Data were extracted on SSCs and associated healthcare resource use, with comparisons made between the two patient groups.

Results:

The study included a cohort of 108 patients. Data of patients treated by standard care (n=64) showed 32 (50%) patients developed complications. This reduced significantly in patients treated with the sNPWT device (n=44) of whom eight (18.2%) developed a postoperative complication (p=0.0011). Average postoperative costs per patient were €3119 for those in the standard care group and €2630 where the sNPWT device was used.

Conclusion:

sNPWT provided clinical and economic benefits over standard care in the treatment of femoral endarterectomy patients, significantly reducing rate of complication and their associated costs.

Postoperative wound complications such as surgical site infections (SSIs) and surgical wound dehiscence are a key concern for clinicians and healthcare administrators due to their impact on the patient and the healthcare provider. Such complications are associated with excess morbidity and mortality for the patient and increased treatment costs arising from excess hospital stays.¹

SSIs in vascular surgery are relatively more common than average SSI rates across all surgical specialties; (7% vascular versus 5% all surgical).¹ Data from the UK estimate that the median excess hospital stay attributable to SSIs in vascular surgery is 9.72 days, with a median incremental cost of £3776 per episode.²

Similarly, wound dehiscence has been shown to be more common within vascular surgeries (5.7% vascular versus 3.0% all surgical).¹ In many cases, these wounds will require readmission and further surgical procedures to facilitate wound closure. Where such wounds are not promptly resolved, they can become chronic and complex, requiring ongoing care following discharge, often for many months. Data from the US in 2015, based on a study of over 25,000 wounds, estimated the mean cost of dehiscence at $40,323, with 9.4 days additional hospitalisation for each patient.³

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