Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial
OBJECTIVE To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTI...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2008-10, Vol.143 (10), p.950-955 |
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| creator | Ubbink, Dirk T Vermeulen, Hester Goossens, Astrid Kelner, Raoul B Schreuder, Sanne M Lubbers, Maarten J |
| description | OBJECTIVE To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTION Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed. MAIN OUTCOME MEASURES Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay. RESULTS Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, €6.34 [US $9.95] vs gauze, €1.85 [US $2.90]; P |
| doi_str_mv | 10.1001/archsurg.143.10.950 |
| format | Article |
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DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTION Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed. MAIN OUTCOME MEASURES Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay. RESULTS Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, €6.34 [US $9.95] vs gauze, €1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, €1.28 [US $2.01] vs gauze, €2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was €7.48 (US $11.74) in the occlusive group and €3.98 (US $6.25) in the gauze-based group (P = .002). CONCLUSIONS The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. TRIAL REGISTRATION trialregister.nl Identifier: 56264738.Arch Surg. 2008;143(10):950-955--></description><identifier>ISSN: 0004-0010</identifier><identifier>EISSN: 1538-3644</identifier><identifier>DOI: 10.1001/archsurg.143.10.950</identifier><identifier>PMID: 18936373</identifier><identifier>CODEN: ARSUAX</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Academic Medical Centers ; Adult ; Bandages - economics ; Bandages - statistics & numerical data ; Bandages, Hydrocolloid - economics ; Bandages, Hydrocolloid - statistics & numerical data ; Biological and medical sciences ; Cost Savings ; Female ; Follow-Up Studies ; General aspects ; Hospital Costs ; Humans ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Netherlands ; Occlusive Dressings - economics ; Occlusive Dressings - statistics & numerical data ; Pain Measurement ; Patient Satisfaction ; Probability ; Reference Values ; Risk Assessment ; Severity of Illness Index ; Statistics, Nonparametric ; Surgical Procedures, Operative - methods ; Surgical Procedures, Operative - mortality ; Surgical Wound Infection - prevention & control ; Surgical Wound Infection - therapy ; Wound Healing - physiology ; Wounds and Injuries - therapy</subject><ispartof>Archives of surgery (Chicago. 1960), 2008-10, Vol.143 (10), p.950-955</ispartof><rights>2008 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.143.10.950$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.143.10.950$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,778,782,3329,27911,27912,76244,76247</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20707056$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18936373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ubbink, Dirk T</creatorcontrib><creatorcontrib>Vermeulen, Hester</creatorcontrib><creatorcontrib>Goossens, Astrid</creatorcontrib><creatorcontrib>Kelner, Raoul B</creatorcontrib><creatorcontrib>Schreuder, Sanne M</creatorcontrib><creatorcontrib>Lubbers, Maarten J</creatorcontrib><title>Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>OBJECTIVE To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTION Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed. MAIN OUTCOME MEASURES Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay. RESULTS Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, €6.34 [US $9.95] vs gauze, €1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, €1.28 [US $2.01] vs gauze, €2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was €7.48 (US $11.74) in the occlusive group and €3.98 (US $6.25) in the gauze-based group (P = .002). CONCLUSIONS The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. TRIAL REGISTRATION trialregister.nl Identifier: 56264738.Arch Surg. 2008;143(10):950-955--></description><subject>Academic Medical Centers</subject><subject>Adult</subject><subject>Bandages - economics</subject><subject>Bandages - statistics & numerical data</subject><subject>Bandages, Hydrocolloid - economics</subject><subject>Bandages, Hydrocolloid - statistics & numerical data</subject><subject>Biological and medical sciences</subject><subject>Cost Savings</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Netherlands</subject><subject>Occlusive Dressings - economics</subject><subject>Occlusive Dressings - statistics & numerical data</subject><subject>Pain Measurement</subject><subject>Patient Satisfaction</subject><subject>Probability</subject><subject>Reference Values</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Surgical Procedures, Operative - methods</subject><subject>Surgical Procedures, Operative - mortality</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Surgical Wound Infection - therapy</subject><subject>Wound Healing - physiology</subject><subject>Wounds and Injuries - therapy</subject><issn>0004-0010</issn><issn>1538-3644</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFtPGzEQha2qCALlB1SVKr-Utw3jtXfj7RtKy0WKlKoF8bgavGPqai_Uk40Evx6HBJAfPDrzzYzOEeKLgqkCUKcY3V8e4_1UGZ2UaVXABzFRhbaZLo35KCYAYLKEwoE4ZP6XqtxW-b44ULbSpZ7piXBL59qRw5rkmuUFjk8kf0RiDv09Sz9EuRgctvJ2GPtGzjGSDL38k86GjfwLV4H6FX-XZ_I39s3QhSdKXBv6l_51DNh-EnseW6bj3X8kbs5_Xs8vs8Xy4mp-tshQg1pldxq9bjySRXTaO8gd5daUhgzkZFNFYMzMEhTJUuOTuUL5mQeXA5Kx-kicbPc-xOH_SLyqu8CO2hZ7Gkauy6q0VaUhgXoLujgwR_L1QwwdxsdaQb3Jtn7Ntk7ZbsSUbZr6uls_3nXUvM_swkzAtx2AnMz7iL0L_MblMEuvKBP3ecthh29dA6qqjH4GthGMQA</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Ubbink, Dirk T</creator><creator>Vermeulen, Hester</creator><creator>Goossens, Astrid</creator><creator>Kelner, Raoul B</creator><creator>Schreuder, Sanne M</creator><creator>Lubbers, Maarten J</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20081001</creationdate><title>Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial</title><author>Ubbink, Dirk T ; Vermeulen, Hester ; Goossens, Astrid ; Kelner, Raoul B ; Schreuder, Sanne M ; Lubbers, Maarten J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a301t-b3af3dfae8aac3fc02ce28464e402e8846e04478e05010df00451f7f0c20ae483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Academic Medical Centers</topic><topic>Adult</topic><topic>Bandages - economics</topic><topic>Bandages - statistics & numerical data</topic><topic>Bandages, Hydrocolloid - economics</topic><topic>Bandages, Hydrocolloid - statistics & numerical data</topic><topic>Biological and medical sciences</topic><topic>Cost Savings</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Netherlands</topic><topic>Occlusive Dressings - economics</topic><topic>Occlusive Dressings - statistics & numerical data</topic><topic>Pain Measurement</topic><topic>Patient Satisfaction</topic><topic>Probability</topic><topic>Reference Values</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Surgical Procedures, Operative - methods</topic><topic>Surgical Procedures, Operative - mortality</topic><topic>Surgical Wound Infection - prevention & control</topic><topic>Surgical Wound Infection - therapy</topic><topic>Wound Healing - physiology</topic><topic>Wounds and Injuries - therapy</topic><toplevel>online_resources</toplevel><creatorcontrib>Ubbink, Dirk T</creatorcontrib><creatorcontrib>Vermeulen, Hester</creatorcontrib><creatorcontrib>Goossens, Astrid</creatorcontrib><creatorcontrib>Kelner, Raoul B</creatorcontrib><creatorcontrib>Schreuder, Sanne M</creatorcontrib><creatorcontrib>Lubbers, Maarten J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ubbink, Dirk T</au><au>Vermeulen, Hester</au><au>Goossens, Astrid</au><au>Kelner, Raoul B</au><au>Schreuder, Sanne M</au><au>Lubbers, Maarten J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>Arch Surg</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>143</volume><issue>10</issue><spage>950</spage><epage>955</epage><pages>950-955</pages><issn>0004-0010</issn><eissn>1538-3644</eissn><coden>ARSUAX</coden><abstract>OBJECTIVE To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTION Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed. MAIN OUTCOME MEASURES Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay. RESULTS Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, €6.34 [US $9.95] vs gauze, €1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, €1.28 [US $2.01] vs gauze, €2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was €7.48 (US $11.74) in the occlusive group and €3.98 (US $6.25) in the gauze-based group (P = .002). CONCLUSIONS The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. TRIAL REGISTRATION trialregister.nl Identifier: 56264738.Arch Surg. 2008;143(10):950-955--></abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>18936373</pmid><doi>10.1001/archsurg.143.10.950</doi><tpages>6</tpages></addata></record> |
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| subjects | Academic Medical Centers Adult Bandages - economics Bandages - statistics & numerical data Bandages, Hydrocolloid - economics Bandages, Hydrocolloid - statistics & numerical data Biological and medical sciences Cost Savings Female Follow-Up Studies General aspects Hospital Costs Humans Kaplan-Meier Estimate Male Medical sciences Netherlands Occlusive Dressings - economics Occlusive Dressings - statistics & numerical data Pain Measurement Patient Satisfaction Probability Reference Values Risk Assessment Severity of Illness Index Statistics, Nonparametric Surgical Procedures, Operative - methods Surgical Procedures, Operative - mortality Surgical Wound Infection - prevention & control Surgical Wound Infection - therapy Wound Healing - physiology Wounds and Injuries - therapy |
| title | Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial |
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