Guest Julian F, Fuller Graham W, Vowden Peter
Catalyst Health Economics Consultants, Rickmansworth, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
BMJ Open. 2018 Dec 14;8(12):e022591. doi: 10.1136/bmjopen-2018-022591.
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.
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.
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.
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.
评估在英国，从社区初次就诊开始，临床实践中处理未愈合手术伤口的患者诊疗路径、相关健康结局、资源使用及相应成本。
这是一项对健康改善网络（THIN）数据库中707例患者记录的回顾性队列分析，这些患者的伤口在手术后4周内未愈合。对患者特征、伤口相关健康结局及医疗资源使用进行量化，并按2015/2016年价格估算患者管理的国民医疗服务体系（NHS）总成本。
描述伤口时使用的术语不一致。从社区管理开始，83%的伤口在12个月内愈合，其中计划性手术和急诊手术产生的伤口愈合率分别为86%和74%。每位患者的平均愈合时间为4个月。患者主要由社区护士进行管理，在3个月时仍有伤口的患者中，只有约一半被记录为接受了外科医生的随访。高达68%的伤口在就诊时可能已发生临床感染，23%的患者在初次就诊后平均4个月出现疑似伤口感染。12个月内伤口护理的平均NHS成本为每个伤口7300英镑，愈合和未愈合伤口的成本分别为6000英镑至13700英镑。此外，无感染迹象伤口管理的平均NHS成本约为2000英镑，疑似感染伤口管理的合并成本为5000英镑至11200英镑。
由于患者记录不一致以及随访预约率低，患者出院进入社区后，外科医生不太可能完全了解未愈合手术伤口周围的问题。这些发现为有关社区中未愈合手术伤口管理的政策和预算决策提供了最佳可用证据。
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