Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds

Tuffaha, Haitham; Gillespie, Brigid M.; Chaboyer, Wendy; Gordon, Louisa G.; Scuffham, Paul Anthony

doi:10.1016/j.jss.2015.02.008

Cited by 98 publications

(69 citation statements)

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“…The five included studies focused on selection of postoperative wound dressings, and compared either negative pressure (vacuum), gauze or film dressings, or wound management protocols using selected dressings. Of the five economic studies, two were conducted in Australia, and one each in Japan, Spain and England ( Table ). These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years.…”

Section: Resultsmentioning

confidence: 99%

“…Of the five economic studies, two were conducted in Australia, and one each in Japan, Spain and England ( Table ). These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years. Two studies were cost‐effectiveness analyses, two were cost–utility analyses and one was a cost–benefit analysis.…”

Section: Resultsmentioning

confidence: 99%

“…These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years. Two studies were cost‐effectiveness analyses, two were cost–utility analyses and one was a cost–benefit analysis. Detailed descriptions of the included studies are provided in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Of the five included studies, two were from the perspective of the healthcare provider whereas other three did not explicitly state the study perspective. The costs of interventions were reported in different ways, such as mean cost per patient or patient episode, cost of managing a hypothetical cohort of 1000 surgical patients and cost of each arm of care.…”

Section: Resultsmentioning

confidence: 99%

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Economic case for intraoperative interventions to prevent surgical-site infection

Gillespie

Chaboyer

Erichsen-Andersson

et al. 2017

British Journal of Surgery

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Background: Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting. Methods:The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists.Results: Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality. Conclusion:With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Economic case for intraoperative interventions to prevent surgical-site infection

Gillespie

Chaboyer

Erichsen-Andersson

et al. 2017

British Journal of Surgery

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“…On the other hand, pNPWT also incurs additional costs. We identified three studies [25–27] on cost-effectiveness of pNPWT and these were all performed in a gynaecological population. Lewis et al [26] found that the risk of wound complications must be reduced by 33% for pNPWT to achieve cost savings.…”

Section: Discussionmentioning

confidence: 99%

Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair

Vries

Atema

Lapid

et al. 2017

Hernia

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PurposeTo evaluate if incisional prophylactic negative pressure wound therapy (pNPWT) reduces wound infections and other wound complications in high-risk patients undergoing major complex ventral abdominal wall repair.MethodsRetrospective before–after comparison nested in a consecutive series of patients undergoing elective major complex abdominal wall repair. Starting January 2014, pNPWT was applied on the closed incisional wound for a minimum of 5 days. To minimize selection bias, we compared two periods of 14 months before and after January 2014. Wound infections according to the Centre for Disease Control Surgical Site Infection classification as well as other wound complications were recorded.ResultsThirty-two patients were included in the pNPWT group and 34 in the control group. The study group involved clean-contaminated and contaminated operations due to enterocutaneous fistula, enterostomies or infected mesh. Median duration of pNPWT was 5 days (IQR 5–7). Overall wound infection rate was 35%. pNPWT was associated with a significant decrease in postoperative wound infection rate (24 versus 51%; p = 0.029, OR 0.30 (95% CI 0.10–0.90)). Incisional wound infection rates dropped from 48 to 7% (p < 0.01, OR 0.08 (95% CI 0.16–0.39), whereas the number of subcutaneous abscesses was comparable in both groups. Moreover, less interventions were needed in the pNPWT group (p < 0.001).ConclusionsClosed incision pNPWT seems a promising solution to reduce the incidence of wound infections in complex abdominal wall surgery. Randomized controlled trials are needed to estimate more precisely the value and cost-effectiveness of pNPWT in this high-risk setting.

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Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery

Tuuli

Liu

Tita

et al. 2020

JAMA

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IMPORTANCE Obesity increases the risk of both cesarean delivery and surgical-site infection. Despite widespread use, it is unclear whether prophylactic negative pressure wound therapy reduces surgical-site infection after cesarean delivery in obese women.OBJECTIVE To evaluate whether prophylactic negative pressure wound therapy, initiated immediately after cesarean delivery, lowers the risk of surgical-site infections compared with standard wound dressing in obese women. DESIGN, SETTING, AND PARTICIPANTSMulticenter randomized trial conducted from February 8, 2017, through November 13, 2019, at 4 academic and 2 community hospitals across the United States. Obese women undergoing planned or unplanned cesarean delivery were eligible. The study was terminated after 1624 of 2850 participants were recruited when a planned interim analysis showed increased adverse events in the negative pressure group and futility for the primary outcome. Final follow-up was December 18, 2019.INTERVENTIONS Participants were randomly assigned to either undergo prophylactic negative pressure wound therapy, with application of the negative pressure device immediately after repair of the surgical incision (n = 816), or receive standard wound dressing (n = 808). MAIN OUTCOMES AND MEASURESThe primary outcome was superficial or deep surgical-site infection according to the Centers for Disease Control and Prevention definitions. Secondary outcomes included other wound complications, composite of surgical-site infections and other wound complications, and adverse skin reactions. RESULTSOf the 1624 women randomized (mean age, 30.4 years, mean body mass index, 39.5), 1608 (99%) completed the study: 806 in the negative pressure group (median duration of negative pressure, 4 days) and 802 in the standard dressing group. Superficial or deep surgical-site infection was diagnosed in 29 participants (3.6%) in the negative pressure group and 27 (3.4%) in the standard dressing group (difference, 0.36%; 95% CI, −1.46% to 2.19%, P = .70). Of 30 prespecified secondary end points, 25 showed no significant differences, including other wound complications (2.6% vs 3.1%; difference, −0.53%; 95% CI, −1.93% to 0.88%; P = .46) and composite of surgical-site infections and other wound complications (6.5% vs 6.7%; difference, −0.27%; 95% CI, −2.71% to 2.25%; P = .83). Adverse skin reactions were significantly more frequent in the negative pressure group (7.0% vs 0.6%; difference, 6.95%; 95% CI, 1.86% to 12.03%; P < .001).CONCLUSIONS AND RELEVANCE Among obese women undergoing cesarean delivery, prophylactic negative pressure wound therapy, compared with standard wound dressing, did not significantly reduce the risk of surgical-site infection. These findings do not support routine use of prophylactic negative pressure wound therapy in obese women after cesarean delivery.

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Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds

Cited by 98 publications

References 50 publications

Economic case for intraoperative interventions to prevent surgical-site infection

Economic case for intraoperative interventions to prevent surgical-site infection

Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair

Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery

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