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Costs and outcomes in evaluating management of unhealed surgical wounds in the community in clinical practice in the UK: a cohort study
  1. Julian F Guest1,2,
  2. Graham W Fuller1,
  3. Peter Vowden3
  1. 1 Catalyst Health Economics Consultants, Rickmansworth, UK
  2. 2 Faculty of Life Sciences and Medicine, King’s College London, London, UK
  3. 3 Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  1. Correspondence to Dr Julian F Guest; julian.guest{at}catalyst-health.com

Abstract

Objective To evaluate the patient pathways and associated health outcomes, resource use and corresponding costs attributable to managing unhealed surgical wounds in clinical practice, from initial presentation in the community in the UK.

Methods This was a retrospective cohort analysis of the records of 707 patients in The Health Improvement Network (THIN) database whose wound failed to heal within 4 weeks of their surgery. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified, and the total National Health Service (NHS) cost of patient management was estimated at 2015/2016 prices.

Results Inconsistent terminology was used in describing the wounds. 83% of all wounds healed within 12 months from onset of community management, ranging from 86% to 74% of wounds arising from planned and emergency procedures, respectively. Mean time to healing was 4 months per patient. Patients were predominantly managed in the community by nurses and only around a half of all patients who still had a wound at 3 months were recorded as having had a follow-up visit with their surgeon. Up to 68% of all wounds may have been clinically infected at the time of presentation, and 23% of patients subsequently developed a putative wound infection a mean 4 months after initial presentation. Mean NHS cost of wound care over 12 months was £7300 per wound, ranging from £6000 to £13 700 per healed and unhealed wound, respectively. Additionally, the mean NHS cost of managing a wound without any evidence of infection was ~£2000 and the conflated cost of managing a wound with a putative infection ranged from £5000 to £11 200.

Conclusion Surgeons are unlikely to be fully aware of the problems surrounding unhealed surgical wounds once patients are discharged into the community, due to inconsistent recording in patients’ records coupled with the low rate of follow-up appointments. These findings offer the best evidence available with which to inform policy and budgetary decisions pertaining to managing unhealed surgical wounds in the community.

  • burden
  • cost
  • surgical wounds
  • wound management
  • surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors JFG designed the study, managed the analyses, performed some analyses, checked all the other analyses and wrote the manuscript. GWF conducted much of the analyses. PV scrutinised the analyses, suggested further analyses and helped interpret some of the findings. All the authors were involved in revising the manuscript and gave final approval. JFG is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This analysis was originally commissioned and part funded by the National Institute for Health Research (NIHR) Wound Prevention and Treatment Healthcare Technology Co-operative (NIHR WoundTec HTC), Bradford Institute for Health Research, Bradford, West Yorkshire, UK, and part funded by Smith & Nephew Medical, Hull, East Riding of Yorkshire, UK.

  • Disclaimer The study’s sponsors had no influence on (1) the study design; (2) the collection, analysis and interpretation of data; (3) the writing of the manuscript; or (4) the decision to submit the manuscript for publication. The views expressed in this article are those of the authors, and not necessarily those of the NIHR and Smith & Nephew.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval to use anonymised patients’ records from the THIN database for this study was obtained from the Research Ethics Committee that appraises studies using the THIN database (reference number 13-061).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The THIN data set cannot be shared as this restriction was a condition of the ethics approval obtained from the Research Ethics Committee (reference number 13-061).This statement is correct

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