Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Am Surg. 2024 Jun;90(6):1140-1147. doi: 10.1177/00031348241227214. Epub 2024 Jan 9.
Inability to achieve primary fascial closure after damage control laparotomy is a frequently encountered problem by acute care and trauma surgeons. This study aims to compare the cost-effectiveness of Wittmann patch-assisted closure to the planned ventral hernia closure.
A literature review was performed to determine the probabilities and outcomes for Wittmann patch-assisted primary closure and planned ventral hernia closure techniques. Average utility scores were obtained by a patient-administered survey for the following: rate of successful surgeries (uncomplicated abdominal wall closure), surgical site infection, wound dehiscence, abdominal hernia and enterocutaneous fistula. A visual analogue scale (VAS) was utilized to assess the survey responses and then converted to quality-adjusted life years (QALYs). Total cost for each strategy was calculated using Medicare billing codes. A decision tree was generated with rollback and incremental cost-utility ratio (ICUR) analyses. Sensitivity analyses were performed to account for uncertainty.
Wittmann patch-assisted closure was associated with higher clinical effectiveness of 19.43 QALYs compared to planned ventral hernia repair (19.38), with a relative cost reduction of US$7777. Rollback analysis supported Wittmann patch-assisted closure as the more cost-effective strategy. The resulting negative ICUR of -156,679.77 favored Wittmann patch-assisted closure. Monte Carlo analysis demonstrated a confidence of 96.8% that Wittmann patch-assisted closure was cost-effective.
This study demonstrates using the Wittmann patch-assisted closure strategy as a more cost-efficient management of the open abdomen compared to the planned ventral hernia approach.
损伤控制剖腹术后无法实现初次筋膜闭合是急性护理和创伤外科医生经常遇到的问题。本研究旨在比较 Wittmann 补片辅助闭合与计划的腹侧疝闭合的成本效益。
进行文献回顾，以确定 Wittmann 补片辅助初次闭合和计划的腹侧疝闭合技术的概率和结果。通过患者管理调查获得以下方面的平均效用评分：手术成功率（无并发症的腹壁闭合）、手术部位感染、伤口裂开、腹部疝和肠皮瘘。使用视觉模拟量表（VAS）评估调查结果，然后转换为质量调整生命年（QALY）。使用 Medicare 计费代码计算每种策略的总成本。生成决策树，并进行回溯和增量成本效益比（ICUR）分析。进行敏感性分析以考虑不确定性。
Wittmann 补片辅助闭合与计划的腹侧疝修复相比，具有更高的临床效果，为 19.43 QALY，相对成本降低了 7777 美元。回溯分析支持 Wittmann 补片辅助闭合作为更具成本效益的策略。产生的负 ICUR 值为-156679.77，有利于 Wittmann 补片辅助闭合。蒙特卡罗分析表明，96.8%的置信度认为 Wittmann 补片辅助闭合具有成本效益。
本研究表明，与计划的腹侧疝方法相比，使用 Wittmann 补片辅助闭合策略作为开放性腹部的更具成本效益的管理方法。
