Surgical complications can significantly impact both patient health and healthcare systems, particularly in pediatric cases of non-idiopathic scoliosis. This study explores a revolutionary approach to mitigating these complications using incisional negative pressure wound therapy (iNPWT). By comparing its effectiveness and cost-efficiency to traditional hydrofibre and hydrocolloid dressings with silver, the findings aim to provide valuable insights for healthcare providers and policymakers.
Study Design and Participants
The randomized clinical trial involved pediatric patients under 18 years old who underwent surgery for non-idiopathic scoliosis. These patients were divided into two groups: one received standard postoperative hydrofibre and hydrocolloid dressings with silver (control group), while the other was treated with a single-use iNPWT system (intervention group). The primary objective was to determine the cost-effectiveness of iNPWT in preventing surgical wound complications.
Complication Rates and Economic Impact
The intervention group exhibited a significantly lower incidence of surgical wound complications—7.7% compared to 38.5% in the control group (p = 0.009). Common complications included surgical wound dehiscence, infections, seroma, and fibrin formation. Factors such as type of surgery, duration, and patient age were linked to higher complication risks. Despite higher initial costs for iNPWT dressings, the overall postoperative costs were lower compared to the control group.
The study’s economic analysis revealed that for every additional US$1.00 spent on iNPWT, there was a US$12.93 benefit in terms of complications prevented. This significant cost-benefit ratio underscores the financial viability of adopting iNPWT in pediatric non-idiopathic scoliosis surgeries.
Market access implications are profound, suggesting that broader implementation of iNPWT could reduce healthcare costs and improve patient outcomes. The longer healing times associated with traditional dressings further highlight the advantages of iNPWT, making it a compelling choice for healthcare providers.
Key Inferences on Cost-Effectiveness
- iNPWT significantly reduces the incidence of surgical wound complications in pediatric scoliosis surgeries.
- Higher initial dressing costs are offset by substantial savings in overall postoperative care.
- The cost-benefit ratio of US$1.00 to US$12.93 strongly supports the economic viability of iNPWT.
- Market access for iNPWT could lead to improved healthcare outcomes and reduced financial burdens on healthcare systems.
In conclusion, this study demonstrates that iNPWT is not only effective but also cost-efficient in managing surgical wound complications in pediatric patients undergoing non-idiopathic scoliosis surgery. The findings advocate for broader adoption of iNPWT, promising enhanced patient care and economic benefits.
Original Article:
Int Wound J. 2024 Sep;21(9):e70034. doi: 10.1111/iwj.70034.
ABSTRACT
Surgical wound complications are adverse events with important repercussions for the health of patients and health system. Surgical site infections and wound dehiscences are among the most important surgical wound complications, with a high incidence in paediatric patients undergoing surgery for non-idiopathic scoliosis. Incisional negative pressure wound therapy for surgical incisions is used as a preventive measure against surgical wound complications in adults; however, there has been scant evidence for using it in children. The purpose of this study is to evaluate the cost-effectiveness of incisional negative pressure wound therapy in preventing surgical wound complications in paediatric patients undergoing surgery to treat non-idiopathic scoliosis. Randomized clinical trial. Children younger than 18 years of age undergoing surgery for non-idiopathic scoliosis were randomly assigned into two groups to receive one of two different types of dressings for the first 7 days after surgery. One group were treated with a postoperative hydrofibre and hydrocolloid dressing with silver for wounds (control group), and the other group received a single-use incisional negative pressure wound therapy system (intervention group). The wounds were assessed after removal of the dressings at 7 days after surgery and again at 30, 90, and 180 days after surgery. Surgical wound complications, sociodemographic variables, variables related to the procedure and postoperative period, economic costs of treatment of surgical wound complications, and time to healing of the surgical wound were recorded. Per protocol and per intention to treat analysis was made. The per protocol incidence of surgical wound complications was 7.7% in the intervention group versus 38.5% in the control group (p = 0.009; Fisher exact test. RR = 0.20 IC95%: 0.05-0.83). Surgical wound dehiscence, surgical site infections, seroma, and fibrin were the most common surgical wound complications. The type of surgery, duration of surgery, and patients’ age were associated with a higher risk for surgical wound complications. Postoperative hydrofibre and hydrocolloid dressing with silver for wounds were found to be associated with a longer time to healing. Initial costs for dressings in the group receiving incisional negative pressure wound therapy were higher, but the total postoperative costs were higher for those receiving postoperative hydrofibre and hydrocolloid dressing with silver for wounds. It was found that for each US$1.00 of extra costs for using incisional negative pressure wound therapy, there was a benefit of US$12.93 in relation to the cost of complications prevented. Incisional negative pressure wound therapy is cost-effective in the prevention of surgical wound complications in children undergoing surgery for non-idiopathic scoliosis.
PMID:39224961 | DOI:10.1111/iwj.70034
This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.
