Kerivan Lauren T, Vilain Katherine A, Hill Terra M, Guidry Christopher A
Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
Saint Luke's Hospital Cardiovascular and Cardiothoracic Research, Kansas City, MO, USA.
Surg Infect (Larchmt). 2025 Aug;26(6):413-419. doi: 10.1089/sur.2024.286. Epub 2025 Mar 19.
Surgical site infections (SSIs) have a significant health economic burden, accounting for more than US $3.3 billion in costs, and lead to increased microbial resistance, prolonged hospital stays, elevated 30-day mortality rates, greater incidences of reoperation, and decreased quality of life. Recently, evidence has emerged suggesting that prophylactic closed incision negative pressure wound therapy (ciNPWT) may substantially reduce the risk of post-operative wound complications, specifically SSIs. This study aimed to evaluate whether ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. We hypothesized that ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. A cost-effectiveness decision analytic model was created comparing the use and non-use of ciNPWT. Superficial SSI probabilities, cost of care for patients with and without post-operative infection, and quality of life Short Form (SF)-36 survey data were obtained from a literature review. Cost of ciNPWT was obtained from health administrative data. A decision tree was constructed using TreeAge Software Pro Version 2020 (TreeAge Software, Inc., Williamstown, MA). Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness and reliability of the model. One-way sensitivity analysis with a willingness-to-pay threshold of $5,000 demonstrated that above a baseline infection rate of approximately 6.4%, ciNPWT is cost-effective at reducing superficial SSI. Probabilistic sensitivity analysis indicated that even with uncertainty present in the parameters analyzed, the majority of simulations (95.4%) favored ciNPWT as the more effective tactic. Despite the added device cost, ciNPWT is cost-effective for superficial SSI prevention across a variety of surgical infection risk profiles.
手术部位感染（SSIs）造成了巨大的健康经济负担，成本超过33亿美元，并导致微生物耐药性增加、住院时间延长、30天死亡率升高、再次手术发生率更高以及生活质量下降。最近，有证据表明预防性闭合切口负压伤口治疗（ciNPWT）可能会大幅降低术后伤口并发症的风险，尤其是手术部位感染。本研究旨在评估与常规切口护理相比，ciNPWT预防浅表手术部位感染是否具有成本效益。我们假设与常规切口护理相比，ciNPWT在预防浅表手术部位感染方面具有成本效益。创建了一个成本效益决策分析模型，比较ciNPWT的使用和不使用情况。浅表手术部位感染概率、有无术后感染患者的护理成本以及生活质量简表（SF）-36调查数据均来自文献综述。ciNPWT的成本来自卫生行政数据。使用TreeAge Software Pro Version 2020（TreeAge Software公司，马萨诸塞州威廉斯敦）构建决策树。进行了确定性和概率敏感性分析，以评估模型的稳健性和可靠性。支付意愿阈值为5000美元的单向敏感性分析表明，在基线感染率约为6.4%以上时，ciNPWT在降低浅表手术部位感染方面具有成本效益。概率敏感性分析表明,即使在所分析的参数中存在不确定性，大多数模拟（95.4%）也支持ciNPWT作为更有效的策略。尽管增加了设备成本，但ciNPWT在预防各种手术感染风险情况下的浅表手术部位感染方面具有成本效益。
