Wound care, dressings and bandages could not be described as the glamorous side of medicine – but they matter, and they cost. Against this backdrop of a growing need for greater efficiency, an innovative approach is delivering better outcomes than standard care for preventing surgical site complications in high-risk patients with closed surgical incisions. Nigel Clancy, Market Access Lead UKI & Nordics, Wound Care (Ireland), Smith & Nephew, explains.

The number of wounds in the community is set to rise by 10 per cent in the next five years (1), providing a growing challenge to making the most of nurses’ time.

In times of increasing pressures on the NHS to improve clinical outcomes and patient experience, alongside maximising efficiency and throughput, while reducing associated costs, it’s essential that industry, clinicians and business managers work effectively together to achieve these objectives.

Current post-operative dressings are designed only to manage any symptoms resulting from an incision site or infection. They do not prevent post-surgical complications. The majority of superficial infections are managed with antibiotics. However, in some instances infection can result in more severe consequences requiring surgical intervention.

Wound-related complications, such as SSIs, use additional healthcare resource and incur avoidable costs. (2)  In many cases, they are associated with extended length of hospital stay or readmissions to manage these complications. (3) They also have additional costs which have to be contended by the community. Surgical site infections, for example, are reported to cost approximately £4,656. (4) NICE reports that the cost to the NHS of surgical site infections is around £700 million a year.

Identifying the patient and procedural risk factors will allow for the development of specific interventions to decrease the risk of wound-related complications, with the goal of improving outcomes, decreasing morbidity, hospital length of stay, and hospital costs.

What’s interesting is that this is an area that is being addressed by the NHS. In the last few weeks Smith & Nephew has received The National Institute for Health and Care Excellence (NICE) guidance for their PICO single use negative pressure wound therapy (sNPWT) system. NICE recommends that PICO should be considered as an option for closed surgical incisions in patients who are at high risk of surgical site infections (SSIs). (5) Key patient risk factors include a high BMI, diabetes, renal insufficiency and smoking. (6)

NICE concluded that PICO sNPWT is associated with fewer SSIs and seromas compared with standard wound dressings across several types of surgery. Cost modelling suggests that compared with standard wound dressings, PICO provides extra clinical benefits at similar overall cost to the NHS. (5) For some types of surgery, PICO sNPWT is cost saving.(5)

PICO is a product already used effectively across many UK acute and primary care settings. One area that it has shown particular effectiveness from a clinical, financial, and more importantly, emotional impact, is maternity. The effective use of PICO for high-risk caesarean sections has led to a reduction in infection rates and lower cost of care by reducing remittance and longer bed stays. But, most critically, it has reduced the potential impact to mothers and their new-born children; removing the potential disruption a wound complication would cause.

Following a recent in-service evaluation using PICO on high-risk incisions over the course of a year, University Maternity Hospital Limerick has seen a dramatic reduction in wound complications and remittances. The impact has been so great that the hospital has been nominated for a HSJ award in the Maternity and Midwifery Services Initiative of the Year category.

New Real-World Evidence in The Clinical area of Breast Surgery (NI Hospital) (7)

Process

• PICO group (n=22)

• Non PICO group(Standard of care) n= 22)

Outcomes

PICO group = no SSIs

Non PICO group(Standard of Care)

• 6 SSIs (27.3%) – Four x superficial SSIs and Two x Deep SSI’s

• Six patients required additional oral antibiotics

• One patient required IV antibiotics

• One readmission (six nights)

• One patient required additional out-patient visits (number of visits not completed)

A Promising Pathway

The combined data shows an estimated total cost reduction from £11,338-to-£7,133; a reduction in costs of £4,205 (37 per cent). On a per patient basis this equates to an incision spend reduction of £191.

And that’s the key point; by collecting and using evidence like this, patients have benefitted in terms of their health, the health systems are saving money and time and, of course, Smith & Nephew has benefited commercially. Sometimes, if you are armed with the right data, the system works like everyone thinks it should.

To access the NICE guidance for PICO, visit https://www.nice.org.uk/guidance/mtg43.

For more information on PICO, visit http://www.smith-nephew.com/key-products/advanced-wound-management/pico/pico-nice-guidance/

References

1. UK Demand Model v1 Smith and Nephew 2014 53417

2. Sprowson A et al. The effect of Triclosan coated sutures on rate of surgical site infection after hip and knee replacement: a protocol for a double-blind randomized controlled trial. BMC Musculoskeletal Disorders, 2014, 15 (237)

3. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005 Jul;87(7):1487-97

4. Jenks et al, Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital, Journal of Hospital Infection 86 (2014) 24e33

5. NICE Medical Technology Guidance MTG43. PICO Negative Pressure Wound Dressings for closed surgical incisions. May 9th 2019

6. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds International, 2016

7. Data on File:  Asset number 16328.  Impact of Single Use Negative Pressure Wound Therapy on Surgical Incisions Following Breast Surgery – a Multi-Centre Evaluation.  Presented at ABS Conference 2019