Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings

Authors

  • Dirk Th Ubbink MD, PhD,

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      For the MOKUM trial group. MOKUM is a nickname for Amsterdam and is also a Dutch acronym, which stands for ‘Modern Or Classic the Ultimate Material’

  • Hester Vermeulen PhD, RN,

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      For the MOKUM trial group. MOKUM is a nickname for Amsterdam and is also a Dutch acronym, which stands for ‘Modern Or Classic the Ultimate Material’

  • Jarne Van Hattem MSc

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      For the MOKUM trial group. MOKUM is a nickname for Amsterdam and is also a Dutch acronym, which stands for ‘Modern Or Classic the Ultimate Material’


Dirk Th Ubbink
Department of Clinical Epidemiology Biostatistics and Bioinformatics
J1B-215, Academic Medical Center PO Box 22700 1100 DE Amsterdam The Netherlands
Telephone: +31–20–5669111
E-mail: d.ubbink@amc.nl

Abstract

Aims and objectives.  To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze-based) in surgical patients after hospital dismissal.

Background.  The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze-based dressings, which appears especially useful for homecare patients and could save costs.

Methods.  We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non-parametric bootstrapping.

Results.  Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0·6/day) was significantly (p = 0·008) lower than in the gauze group (1·1/day). Mean daily material costs of modern dressings were €5·31 vs. €0·71 in the gauze group. Mean difference; €4·60 (95% CI, €2·68–€6·83) while daily total (material plus nursing) costs showed no difference between the groups; mean €2·86 (95% CI, €−6·50–€10·25). Wound healing in the gauze-treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log-rank p = 0·060).

Conclusions.  The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home.

Relevance to clinical practice.  District nurses should reconsider using gauze-based dressings, particularly in surgical patients with exudating wounds.

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