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Background:
There is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures.
Objectives:
To estimate the cost-effectiveness of single use negative pressure wound therapy (sNPWT) compared to standard o...
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Aim:
To investigate the cost-effectiveness of Volar Locking Plate (VLP) compared to External Fixation (EF) for unstable dorsally displaced distal radius fractures in a 3-year perspective.
Methods:
During 2009-2013, patients aged 50-74 years with an unstable dorsally displaced distal radius fracture were randomised to VLP or EF. Primary outcome w...
Objective:
To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section.
Design:
A cost-effectiveness analysis conducted alongside a clinical trial.
Setting:
Five obstetric departments in Denmark.
Population:
Women with a pregestational b...
Citations
... The non-surgical options include ultrasoundguided needle aspiration which provides less invasive ways for treating PFC but often necessitates multiple procedures and higher reoccurrence rates. Other forms of treatment may include the use of medicines and expressing the breast often; this may only work for minor abscesses that are not so malignant, large abscesses may necessitate more complicated treatments [5].It is not easy to choose whether to operate or not and other residual treatment procedures are also important such as size of the abscess, wishes of the patient, and presence of other illnesses [6]. Deficiencies in previous treatment algorithms have demonstrated moderate success rates for various treatment methods, it is thus pertinent to adopt a patient specific approach in treatment planning. ...
Background: Mammary abscesses are infections that are enclosed without involving the surrounding tissues they are common with breast cancer patients through uncontrolled or poorly controlled mastitis. Hence, this work seeks to assess the management of surgical and conservative approaches for treating breast abscesses. Objective: The objective of the study was to ascertain the treatment methods used in management of breast abscesses and to determine the results and adverse outcomes of those that are applied. Methodology: A prospective analytical study was conducted in the Department of Surgery at Ghurki Trust & Teaching Hospital, Lahore, Pakistan, from February 2023 to March 2024. A total of 270 patients were initially enrolled, with 200 completing the 3-month follow-up. Patients were divided into two groups based on the treatment modality. Group I (Surgical Treatment) and Group II (Conservative/Minimally Invasive Treatment). SPSS version-20 was used to analyse results Patient groups were compared using the chi-squared test for categorical variables, for continuous variables, such as age, an independent samples t-test was utilized to compare the means between the two groups (p≤0.05) was considered. Results: Surgical treatment (Group I) demonstrated a significant reduction in reoperations and respiration compared to conservative treatments (Group II), where a notable percentage of patients (41.7%) needed further intervention. Notably, the rate of deformity due to scarring and contracture was higher in the conservative/minimally invasive group, affecting 30% of these patients, compared to 14.3% in the surgical group. Moreover, there was no carcinoma reported in group II in contrast with group I of the surgically operated patients 5% of them were found to have carcinoma. Conclusion: Surgical treatment for breast abscesses, particularly larger ones, offers more definitive resolution with fewer long-term complications compared to conservative management. Personalized treatment planning is essential to optimize patient outcomes and reduce morbidity.
... [9][10][11][12] Despite increased use of NPWT, the wide adoption of prophylactic ci-NPWT has been slow due to the high cost and complexity of use associated with standard systems. [13][14][15] The NPseal© (Guard Medical, Miami, FL, USA) is a self-contained, mechanically powered negative pressure dressing (MP-NPD) that can achieve therapeutic negative pressure when applied over primarily-closed surgical wounds. Our colorectal surgery division has used this device successfully on a wide variety of surgical incisions. ...
... To date there is limited conclusive evidence showing obvious cost-effectiveness in patients undergoing ci-NPWT application after intestinal stoma closure. 15,32 Studies have shown that absolute costs of standard NPWT are higher than conventional dressings, but may be offset by decreased overall long-term costs and improved quality adjusted life years (QALY). 14,15 Additionally, the MP-NPD dressing used in this study is cheaper than standard NPWT systems in use, with prices under 150 U.S. dollars per bandage for small to large dressings. ...
... 15,32 Studies have shown that absolute costs of standard NPWT are higher than conventional dressings, but may be offset by decreased overall long-term costs and improved quality adjusted life years (QALY). 14,15 Additionally, the MP-NPD dressing used in this study is cheaper than standard NPWT systems in use, with prices under 150 U.S. dollars per bandage for small to large dressings. While cost-effectiveness still needs to be demonstrated, the lower price of the MP-NPDs could facilitate broader incorporation of prophylactic ci-NPWT into common surgical practice after stoma reversal, and for a variety of other surgical wounds. ...
Background
The use of closed-incision negative pressure wound therapy (ci-NPWT) has been shown to reduce postoperative wound complications and surgical site infections after stoma closures. However, use of this approach has not been widely adopted due to high cost of the devices. We present a first experience with a self-contained mechanically powered negative pressure dressing (MP-NPD) applied to primarily closed stoma reversal wounds. The study assessed 30-day SSI and wound complication rates using this novel dressing system compared to standard dressings.
Methods
This was a retrospective investigator-initiated study, in which consecutive patients that underwent stoma reversal with primary wound closure dressed with MP-NPD from May 2021-March 2022. 30-day outcomes from the study group were then compared to a control group derived from pooled data extracted from well-designed RCTs comparing patients undergoing primary wound closure versus purse string closure after stoma reversal.
Results
Forty-six patients were identified for the study group and 216 patients in the control group were compared. Patient demographics and surgical variables were similar among the groups. Zero (0%) patients in the study cohort developed superficial SSI within 30 days of their surgery, which was significantly less than the control group (0% vs. 25.9%; p < 0.001). Post-op length of stay (LOS) was shorter in the study group versus control group (4.1 vs. 7.5 days; p < 0.001).
Conclusion
Intestinal stoma reversal wounds closed primarily and dressed with the MP-NPD dressings had significantly reduced stoma site SSI rates, compared to patients undergoing primary closure alone.
... Prowadzone badania dowodzą, że terapia z wykorzy staniem podciśnienia (negative pressure wound therapy -NPWT, vacuum assisted closure -VAC) jest metodą poprawiającą w istotny sposób wyniki leczenia ran po zabiegach kardiochirurgicznych [10-12]. Obserwuje się również korzystny wpływ terapii podciśnieniowej stosowanej u chorych obciążonych licznymi czynnika mi ryzyka zakażenia jako sposób wspomagający goje nie ran czystych i profilaktyka powikłań infekcyjnych [13][14][15]. ...
Choroba Leśniowskiego-Crohna jest czynnikiem ryzyka występowania zakażenia miejsca operowanego. W pracy przedstawiono przypadek 62-letniej pacjentki z powikłaną chorobą Leśniowskiego-Crohna. Z powodu ostrego rzutu choroby, miejscowego zaawansowania choroby, obecności przetok i ropni okołostomijnych, a także przepukliny okołostomijnej u pacjentki wystąpiło głębokie zakażenie miejsca operowanego, wymagające trzykrotnej reoperacji. W przypadku licznych, dużych ran obejmujących znaczną powierzchnię powłok brzusznych z obecnością stomii zastosowanie terapii podciśnieniowej z płukaniem pozwala na optymalizację procesu leczenia i gojenia rany. Odseparowanie skażonego środowiska stomii od łożysk ran wydaje się kluczowym elementem powodzenia leczenia. Odpowiedni dobór płynu płuczącego umożliwia intensyfikację leczenia zakażenia w pierwszej fazie wystąpienia zakażenia miejsca operowanego oraz sprzyja dalszemu postępowi gojenia ran.
... No âmbito das cirurgias vasculares incluídas, os estudos de 2018 e 2019 reportam-se, especificamente, à cirurgia cardíaca por esternotomia (Vieira et al., 2018), à revascularização do miocárdio (Nherera et al., 2018) e à revascularização do miocárdio com enxertos bilaterais da artéria mamária interna (Ruggieri et al., 2019). Enquanto os estudos de 2020 a 2021 se dirigem à cirurgia vascular através de incisão na região inguinal (Gombert et al., 2020) e à cirurgia vascular através de incisão na região inguinal para revascularização dos membros inferiores e cirurgia endovascular de aneurisma (Sexton et al., 2020;Björk et al., 2021). ...
... Após as cirurgias vasculares a pessoa encontra-se suscetível à ILC, à deiscência, ao seroma e ao desenvolvimento de complicações clínicas (Gombert et al., 2020). (Nherera et al., 2018;Sexton et al., 2020). ...
Introdução: A incidência de infeção no local cirúrgico [ILC] após cirurgia vascular é elevada e pode ter um resultado devastador. O tratamento convencional consiste na realização de um penso com função protetora, de modo a minimizar o risco de infeção. A utilização de Terapia da Ferida por Pressão Negativa [NPWT] em feridas cirúrgicas encerradas surge como um possível método que apresenta vantagens, em relação ao tratamento convencional no período pós-operatório. Objetivo: Determinar a eficácia na prevenção de infeção da ferida cirúrgica entre a utilização de NPWT e os métodos convencionais, nas pessoas submetidas a intervenções cirúrgicas vasculares. Metodologia: Foi conduzida uma revisão integrativa da literatura. Procedeu-se à pesquisa de artigos entre 2018 e 2022 nas bases de dados CINAHL Complete e MEDLINE Complete através da plataforma EBSCOhost. Foram identificados 93 artigos e após aplicados os critérios de inclusão e exclusão, e analisada a qualidade metodológica, foram selecionados 6 artigos. Resultados: A análise demonstra menor taxa de infeção e complicações com o tratamento NPWT quando comparado ao tratamento convencional. O tratamento NPWT está associado a um menor custo, a maior qualidade de vida e à diminuição do tempo de internamento e reinternamento hospitalar, quando comparado com o tratamento convencional. Conclusão: Conclui-se que o tratamento NPWT é mais eficaz na prevenção de infeção na ferida cirúrgica do que o tratamento convencional, no contexto de cirurgia vascular.
... Several studies confirmed that contracture of wound area and reduction of the healing with the use of NPWT [13][14][15][16]. The decreased length of stay found in the present study can significantly contribute to cutting down on healthcare costs [17]. The decreased length of hospital stay has been reported also by previous studies that evaluated NPWT for infected surgical wounds. ...
Background
Infection of leg wounds is a common complication following great saphenous vein harvesting (GSV) for coronary bypass grafting (CABG). This complication can result in increased risk of patient morbidity and mortality by causing septicemia, and gangrene, subjecting the patients to amputation. This study aimed to assess the efficacy of negative pressure wound therapy (NPWT) compared to conventional wound care in infected leg wounds following GSV harvesting for myocardial revascularization.
Results
The NPWT group had a significantly lower rate of deep vein thrombosis ( p = 0.013), osteomyelitis ( p < 0.001), bed sores ( p < 0.001), shorter duration of tissue edema ( p < 0.001), and lesser discharge ( p < 0.001). Also, the length of hospital stay was significantly shorter in the NPWT group ( p < 0.001). Multivariable analysis revealed that traditional wound care (without NPWT, p < 0.001) and wound stage IV ( p = 0.001) significantly and independently prolonged the length of hospital stay.
Conclusions
The use of NPWT in advanced complicated infected leg wounds could improve patients’ outcomes and satisfaction by decreasing the rate of complications and the length of hospital stay.
... 4 There is also proof recommending that prophylactic usage of prophylactic negative pressure wound therapy might be a cost-saving intervention when compared with standard dressings mainly in the higher-risk woman. 5 The frequency of surgical site wound infection in women undergoing breast surgery differs based on the type of procedure being undertaken. 6 In a retrospective analysis of 18 696 mastectomies, Olsen et al showed a surgical site wound infection rate of 5% in women experiencing mastectomy only increasing to 10.3% in women experiencing mastectomy plus implant. ...
... Nherera et al recommend that the decrease in surgical site problems brought about by negative pressure wound therapy makes it a suitably cost-effective substitute for conventional dressings. 5 Heard et al showed that a 15% decrease in surgical site wound infection might make negative pressure wound therapy cost-effective. 38 Our outcomes recommend that surgical site wound infection could be decreased by more than 50% in breast surgery with negative pressure wound therapy usage. ...
We performed a meta‐analysis to evaluate the effect of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery. A systematic literature search up to April 2022 was performed and 2223 women with closed incisions in breast cancer surgery at the baseline of the studies; 964 of them were using the prophylactic application of negative pressure wound therapy, and 1259 were using standard dressings. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery using the dichotomous method with a random or fixed‐effect model. The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problems (OR, 0.62; 95% CI, 0.43‐0.90, P = .01), lower surgical site wound infection (OR, 0.59; 95% CI, 0.36‐0.96, P = .03), lower wound dehiscence (OR, 0.54; 95% CI, 0.39‐0.75, P < .001) and lower wound necrosis (OR, 0.44; 95% CI, 0.27‐0.71, P < .001), in women with closed incisions in breast cancer surgery compared with standard dressings. However, prophylactic application of negative pressure wound therapy did not show any significant difference in wound seroma (OR, 0.73; 95% CI, 0.32‐1.65, P = .45), and hematoma (OR, 0.73; 95% CI, 0.33‐1.59, P = .001) compared with standard dressings in women with closed incisions in breast cancer surgery. The prophylactic application of negative pressure wound therapy women had a significantly lower total wound problems, surgical site wound infection, wound dehiscence, and wound necrosis and no significant difference in wound seroma, and hematoma compared with standard dressings in women with closed incisions in breast cancer surgery. The analysis of outcomes should be with caution because of the low sample size of 5 out of 12 studies in the meta‐analysis and a low number of studies in certain comparisons.
... Previous studies demonstrate that in order for sNPWT dressings to become cost-effective. [35][36][37] Moreover, in the present study, SSO and SSI rates were reduced significantly in the treatment group. It is clear that the use of sNPWT PICO for closing surgical wounds would cost more than conventional dressings because of the cost of the device. ...
... However, this perception may have been based more on unit price considerations than on comparisons of total treatment costs. 26 These conclusions have been confirmed in 2 economic studies 35,37 comparing the cost-effectiveness of NPWT with conventional dressings. Specifically, the absolute cost of this therapy is 6 times greater than that of standard dressings, but the reduced rate of SSOs results in increased savings and improved health-related quality of life. ...
Objective:
A randomized controlled trial (RCT) was undertaken to evaluate whether the prophylactic application of a specific single-use negative pressure (sNPWT) dressing on closed surgical incisions after incisional hernia (IH) repair decreases the risk of surgical site occurrences (SSOs) and the length of stay.
Background:
The sNPWT dressings have been associated to several advantages like cost savings and prevention of SSOs like seroma, hematoma, dehiscence, or wound infection (SSI) in closed surgical incisions. But this beneficious effect has not been previously studied in cases of close wounds after abdominal wall hernia repairs.
Methods:
An RCT was undertaken between May 2017 and January 2020 (ClinicalTrials.gov registration number NCT03576222). Participating patients, with IH type W2 or W3 according to European Hernia Society classification, were randomly assigned to receive intraoperatively either the sNPWT (PICO)(72 patients) or a conventional dressing at the end of the hernia repair (74 patients). The primary endpoint was the development of SSOs during the first 30 days after hernia repair. The secondary endpoint included length of hospital stay. Statistical analysis was performed using IBM SPSS Statistics Version 23.0.
Results:
At 30 days postoperatively, there was significatively higher incidence of SSOs in the control group compared to the treatment group (29.8% vs 16.6%, P < 0.042). There was no SSI in the treatment group and 6 cases in the control group (0% vs 8%, P < 0.002). No significant differences regarding seroma, hematoma, wound dehiscence, and length of stay were observed between the groups.
Conclusion:
The use of prophylactic sNPWT PICO dressing for closed surgical incisions following IH repair reduces significatively the overall incidence of SSOs and the SSI at 30 days postoperatively.
... 83) In the higher risk subgroups, more cost savings were realized: in people with a body mass index (BMI) of 35 or above, this was £7955, and in people with an American Society of Anaesthesiologists physical status classification of greater than 3, this was £7248. 83) A further study by Nherera et al. 85) calculated the cost-effectiveness of sNPWT compared to standard of care in patients following CABG procedure to reduce SSCs defined as dehiscence and sternotomy infections. A decision tree was developed from the Germany Statutory Health Insurance payer's perspective over a 3-month time horizon. ...
... Cost data (in euros) were taken from the relevant diagnostic-related groups and published literature. 85) The clinical data showed an increase in wounds that healed without complications in 37/40 (92.5%) patients in the sNPWT group compared to 30/40 (75%) patients in the SC group (p = 0.03). 85) The estimated mean cost per patient resulted in a cost-saving of €586 in the sNPWT group. ...
... 85) The clinical data showed an increase in wounds that healed without complications in 37/40 (92.5%) patients in the sNPWT group compared to 30/40 (75%) patients in the SC group (p = 0.03). 85) The estimated mean cost per patient resulted in a cost-saving of €586 in the sNPWT group. 85) Sensitivity analyses showed that the findings were robust for a realistic range of values of the key variables. ...
Bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG) has traditionally been limited. This review looks at the recent outcome data on BIMA in CABG focusing on the management of risk factors for mediastinitis, one of the potential barriers for more extensive BIMA utilization. A combination of pre-, intra- and postoperative strategies are essential to reduce mediastinitis. Limited data indicate that the incidence of mediastinitis can be reduced using closed incision negative-pressure wound therapy as a part of these strategies with the possibility of offering patients best treatment options by extending BIMA to those with a higher risk of mediastinitis. Recent economic data imply that the technology may challenge the current low uptake of BIMA by reducing the short-term cost differentials between single internal mammary artery and BIMA. Given that most published randomized controlled trials and meta-analyses of observational long-term outcome data favor BIMA, if short-term complications of BIMA including mediastinitis can be controlled adequately, there may be opportunities for more extensive use of BIMA leading to improved long-term outcomes. An ongoing study looking at BIMA in high-risk patients may provide evidence to support the hypothesis that mediastinitis should not be a factor in limiting the use of BIMA in CABG.
... This raises the question whether NPWT, by reducing SSIs, are a better use of scarce healthcare resources than standard dressings, i.e. whether it is cost-effective, despite a higher price per dressing. The costeffectiveness of NPWT has been evaluated after caesarean section in obese women [13] and after coronary artery bypass grafting surgery [14], with inconclusive results. To date, only in one study [15] the healthcare costs associated with NPWT after inguinal vascular surgery has been evaluated, demonstrating non-significantly lower costs compared to standard dressings. ...
Aim
While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on sutured incisions in the prevention of surgical site infections (SSIs) has increased, the cost-effectiveness after vascular surgery has not been evaluated. The aim of this study was to evaluate the cost-effectiveness of NPWT compared to standard dressings for the prevention of SSIs after open inguinal vascular surgery.
Materials and methods
Patient data were retrieved from the randomised INVIPS-trial's open arm, which included patients randomised to either NPWT or standard dressings. The patients were surveyed for SSIs for 90 days postoperatively. The patients' individual cost data were included and analysed from a healthcare perspective. The patients' quality of life was measured using the Vascuqol-6 questionnaire pre- and 30 days postoperatively. Cost-effectiveness of NPWT was determined by decreased or equal total costs and a significant reduction in SSI incidence. Results: The mean vascular procedure-related costs at 90 days were €16,621 for patients treated with NPWT (n = 59) and €16,285 for patients treated with standard dressings (n = 60), p = 0.85. The SSI incidence in patients treated with NPWT was 11.9% (n = 7/59) compared to 30.0% (n = 18/60) with standard dressings, p = 0.015. This corresponds to an increased mean cost of €1,853 per SSI avoided. The cost-effectiveness plane of incremental vascular procedure-related costs and difference in Vascuqol-6 score showed that 42% of estimates were in the quadrant where NPWT was dominant. Conclusion: NPWT is considered cost-effective over standard dressings in patients undergoing open inguinal vascular surgery due to reduced SSI incidence at no higher costs.
... Recent cost-effectiveness analyses have demonstrated that single-use NPWT can be a cost-saving intervention to reduce surgical site complications following hip and knee replacement 25 and coronary artery bypass grafting surgery. 26 The costs of complications and their consequences can be substantial, as shown in our analysis, where the consequential cost for 1 implant loss was estimated to be £14,902. Given the reduction in reconstruction failure rate from 4% to zero, our analysis shows that the use of singleuse NPWT in patients undergoing prepectoral reconstruction is cost-effective, compared with standard care. ...
Background:
Single-use negative pressure wound therapy (NPWT) has been shown to encourage wound healing. It is often used when patient factors impair wound healing, or in more complex wounds, such as in implant-based breast reconstruction. We report the findings of a prospective cohort study comparing the use of NPWT with standard dressings in prepectoral breast reconstruction.
Methods:
A prospective database of implant-based reconstruction from a single institution was mined to identify patients who underwent prepectoral reconstruction. Patient demographics, operative data, surgical complications, and 90-day outcomes were compared between patients who had NPWT and those who had standard dressings.
Results:
Prepectoral implant-based breast reconstruction was performed on 307 breasts. NPWT dressings were used in 126 cases, with standard dressings used in 181 cases. Wound breakdown occurred in 10 cases after standard dressings versus 1 where NPWT was utilized. Of the standard dressing cases, only 3 implants were salvaged, while 7 cases led to implant loss. The 1 case of wound breakdown in the NPWT cohort settled with conservative measures. The cost of a reconstructive failure was £14,902, and the use of NPWT resulted in a cost savings of £426 per patient.
Conclusions:
The utilization of single-use NPWT reduces the rate of wound breakdown and implant loss in prepectoral implant-based reconstruction. In addition to the significant clinical benefits, this approach is cost-saving compared with standard dressings. These data suggest that prepectoral implant reconstruction should be considered as an indication for the use of NPWT.
