The safety of vacuum assisted closure therapy in the home care setting

Presenter Dr. Caroline Fife (US)
Event WUWHS congress 2008, Toronto
Podcast nr 010
Length 9:26

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Description

The objective of this study was to compare the frequency of complications and adverse events (AE) in wounds treated with negative pressure wound therapy using the vacuum assisted wound closure compared to moist wound care among patients treated in an outpatient care setting.

Methods: Eighteen outpatient wound centers in 11 U.S. States using the Intellicure electronic medical record (EMR) contributed to the Intellicure Research Consortium (IRC) database. Analyses were based on data collected between 8/31/2001 and 11/24/2006 from 9,119 patients with 20,371 wounds involving 161,913 outpatient visits. From these data, 931 patients (~10 %) received vacuum assisted closure therapy.
AE surrogates such as infection, peri-wound complications, change or increase in exudate, wound cultures, pain and antibiotic medication prescriptions were used to determine whether the incidence of AEs differed between the treatment groups. Data were stratified by ICD-9 diagnosis code, wound size, and wound duration.

Results: Compared to moist wound care patients treated with vacuum assisted wound closure therapy with acute traumatic wounds (ATW) and pressure ulcers (PU) experienced fewer presumed infections (p=0.006 and 0.005 respectively). Amount and type of drainage were decreased for ATW (p<0.001), PU (p=0.004), and subacute flaps and grafts (p=0.034). Periwound complications were significantly less for ATW (p<0.001) and PU (p=0.014). Antibiotic prescription rates were reduced among chronic diabetic foot ulcers (p=0.036) and ATW (p=0.016), and no difference in the number of pain medication prescriptions were observed. There were no cases of hospitalization or deaths related to vacuum assisted wound closure therapy. A surprising 9.6 % of patients on vacuum assisted wound closure therapy were on heparin or warfarin and none experienced bleeding.

Conclusions:Among 931 patients on vacuum assisted wound closure therapy, depending on wound type, there was either no statistical difference in the frequency of AE surrogates compared to patients on moist wound are, or patients on vacuum assisted wound closure experienced significantly fewer AE surrogates. This study suggests that vacuum assisted wound closure is safe for outpatient use in all wound
types evaluated.

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