Institut für Forschung in der Operativen Medizin (IFOM), Witten/Herdecke University, Cologne, Germany.
Ann Surg. 2022 Feb 1;275(2):e290-e298. doi: 10.1097/SLA.0000000000004960.
To compare resource utilization of NPWT and CWT for SAWHI after surgery.
NPWT is widely used in the management of complex wounds but high-level evidence of its resource use remains sparse.
The multicenter, multinational, randomized clinical SAWHI study enrolled a total of 539 consecutive, compliant adult patients with SAWHI after surgery without fascial dehiscence between August 2, 2011, and January 31, 2018. Patients were randomly assigned to NPWT and CWT stratified by study site and wound size using a centralized web-based tool. Evaluation of direct resource use comprised inpatient and outpatient time, personnel and material for wound treatment, and associated wound-related procedures. The resource use analysis was primarily based on the per protocol population (NPWT 157; CWT 174).
Although treatment length within 42 days was significantly shorter in the NPWT arm {Mean [Standard deviation (SD)] NPWT 22.8 (13.4); CWT 30.6 (13.3); P < 0.001 U-test}, hospitalization time was shorter with CWT [Mean (SD) NPWT 13.9 (11.1); CWT 11.8 (10.8); P = 0.047 U-test]. Significantly more study participants were outpatient with CWT [N=167 (96.0%)] than with NPWT [N = 140 (89.2%) (P = 0.017)]. Time for dressing changes per study participant [Mean (SD) (min) NPWT N = 133, 196 (221.1); CWT N = 152, 278 (208.2); P < .001 U-test] and for wound-related procedures [Mean (SD) (min) NPWT 167 (195); CWT 266 (313); P < 0.001 U-test] was significantly lower with NPWT.
NPWT reduces resource use and maybe an efficient treatment alternative to CWT for SAWHI after surgery.
比较 NPWT 和 CWT 用于手术后 SAWHI 的资源利用情况。
NPWT 广泛应用于复杂伤口的管理，但关于其资源利用的高等级证据仍然很少。
这项多中心、多国、随机临床试验纳入了 2011 年 8 月 2 日至 2018 年 1 月 31 日期间手术后无筋膜裂开的连续、符合条件的 539 例成年 SAWHI 患者。患者按研究地点和伤口大小分层，使用集中式网络工具随机分配到 NPWT 和 CWT 组。直接资源使用的评估包括住院和门诊时间、伤口治疗的人员和材料以及相关的伤口处理程序。资源使用分析主要基于方案人群（NPWT 组 157 例；CWT 组 174 例）。
尽管 NPWT 组在 42 天内的治疗时间明显短于 CWT 组{NPWT 组的平均（标准偏差 [SD]）为 22.8（13.4）；CWT 组为 30.6（13.3）；P <0.001 U 检验}，但 CWT 组的住院时间更短[NPWT 组的平均（SD）为 13.9（11.1）；CWT 组为 11.8（10.8）；P = 0.047 U 检验]。与 NPWT 组相比，CWT 组有更多的研究参与者为门诊患者[CWT 组为 167 例（96.0%）]，NPWT 组为 140 例（89.2%）（P = 0.017）。每位研究参与者的换药时间[NPWT 组 N = 133，平均（SD）（分钟）196（221.1）；CWT 组 N = 152，平均（SD）（分钟）278（208.2）；P <0.001 U 检验]和伤口相关处理程序的时间[NPWT 组 N = 167，平均（SD）（分钟）167（195）；CWT 组 N = 266，平均（SD）（分钟）266（313）；P <0.001 U 检验]均显著低于 NPWT 组。
NPWT 可减少资源使用，可能是手术后 SAWHI 的一种有效替代 CWT 的治疗方法。
