| アブストラクト | 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 pound7300 per wound, ranging from pound6000 to pound13 700 per healed and unhealed wound, respectively. Additionally, the mean NHS cost of managing a wound without any evidence of infection was ~ pound2000 and the conflated cost of managing a wound with a putative infection ranged from pound5000 to pound11 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. |
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| ジャーナル名 | BMJ open |
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| Pubmed追加日 | 2018/12/16 |
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| 投稿者 | Guest, Julian F; Fuller, Graham W; Vowden, Peter |
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| 組織名 | Catalyst Health Economics Consultants, Rickmansworth, UK.;Faculty of Life Sciences and Medicine, King's College London, London, UK.;Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30552253/ |
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