Published: 12 February 2020
A new method of treating wounds after major trauma costing nearly £150 per dressing may be no more effective in reducing infections than a standard wound dressing priced under £2, NIHR researchers have found.
Major trauma is where a patient suffers injuries to several different parts of their body at the same time or very serious injuries to just one part. Worldwide, it is the leading cause of death in people under 45 years and a significant cause of short and long-term disability. Major trauma is commonly associated with serious limb injuries such as fractured bones, but treatment is complicated due to damage to soft-tissues around the bone, causing serious wound healing complications such as deep infection.
The type of dressing applied over the wound at the end of the operation may reduce the risk of infection. Negative pressure wound therapy (NPWT), which involves applying gentle suction to the surface of the wound as it heals, is a relatively new treatment that has provided promising early results in patients with surgical wounds associated with major trauma.
However, a new study published in the Journal of the American Medical Association (JAMA) finds that incisional NPWT, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection (SSI).
The trial was led by the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences at the University of Oxford. It was funded by the NIHR’s Health Technology Assessment (HTA) Programme and supported by the NIHR Oxford Biomedical Research Centre and the NIHR Clinical Research Network.
Each year the NHS spends between £4.5 - £5.1bn on wound management. NPWT costs an average of £149.52, compared to £1.87 for standard dressings due to the extra cost of suction pumps. Exact figures on the number of NPWT dressings currently being used in the NHS is difficult to estimate, according to researchers. Millions of standard dressings are used in the NHS each year, with NPWT also being increasingly used. The researchers are due to publish a further economic analysis of the treatments later this year.
Lead author Professor Matthew Costa said: “We found no evidence that negative pressure dressings reduced the risk of deep infection in the surgical wound. The negative pressure dressings were very unlikely to be cost effective. This is important because the NHS spends millions of pounds on wound dressings each year. Using less costly standard treatment will mean savings for the NHS without compromising patient outcomes.”
The randomised clinical trial included 1,548 participants each given either NPWT, or standard wound dressing, and the primary outcome measure was deep surgical site infection at 30 days. The research found no significant difference in the infection rate in the NPWT group at 5.84% and in the standard dressing group at 6.68%.
Professor Hywel Williams, Director of the HTA Programme, said: “This large study shows that the new technique of negative pressure wound therapy offers no advantage for reducing deep infections from lower limb fractures compared with standard wound dressings. Stopping their use in this situation could free up resources for the NHS to use elsewhere.
"When most people think of research they usually think of developing new cures and tech innovations, but this valuable study shows that research into existing innovations that are being increasingly used in the NHS can be just as important."
Results of the study are also being considered by the National Wound Care Strategy Programme as part of their evidence-based recommendations in developing guidelines for the use of NPWT for the NHS.
More information on the study is available on the NIHR Funding Awards website.
• Professor Costa also led the WOLLF study which has marked a step change in the way in which major trauma research is delivered in the UK.