Paul Trueman

Cost‐effectiveness analysis of single‐use negative pressure wound therapy dressings (sNPWT) to reduce surgical site complications (SSC) in routine primary hip and knee replacements

We sought to evaluate the cost‐effectiveness of single‐use negative pressure wound therapy in patients undergoing primary hip and knee replacements using effectiveness data from a recently completed non‐blinded randomized controlled trial. A decision analytic model was developed from UK National Health Service perspective using data from a single‐centre trial. 220 patients were randomized to treatment with either single‐use negative pressure wound therapy or standard care i.e., film dressings of clinician choice and followed for 6 weeks. Outcomes included dressing changes, length of stay, surgical site complications, cost and quality adjusted life years. The randomized controlled trial reported a reduction in dressing changes (p = 0.002), SSC (p = 0.06) and LOS (p = 0.07) in favor of single‐use negative pressure wound therapy compared with standard care. The model estimated 0.116 and 0.115 QALY gained, 0.98 and 0.92 complications avoided for single‐use negative pressure wound therapy and standard care, respectively. The cost/patient was £5,602 (

A systematic review and meta-analysis of clinical outcomes associated with nanocrystalline silver use compared to alternative silver delivery systems in the management of superficial and deep partial thickness burns

7,954) and £6,713 (

Assessment of Risk Factors Associated With Hospital-Acquired Pressure Injuries and Impact on Health Care Utilization and Cost Outcomes in US Hospitals:

9,559) for single‐use negative pressure wound therapy and standard care respectively resulting in cost‐saving of £1,132 (

Silver delivery approaches in the management of partial thickness burns: A systematic review and indirect treatment comparison

1,607) in favor of single‐use negative pressure wound therapy. Greater savings were observed in subgroups of higher risk patients with BMI ≥ 35 and ASA ≥ 3 i.e., £7,955 (

Comparing the costs and outcomes of an integrated twin compression screw (ITCS) nail with standard of care using a single lag screw or a single helical blade cephalomedullary nail in patients with intertrochanteric hip fractures

11,296) and £7,248 (

Cost-effectiveness analysis of single use negative pressure wound therapy dressings (sNPWT) compared to standard of care in reducing surgical site complications (SSC) in patients undergoing coronary artery bypass grafting surgery

10,293), respectively. The findings were robust to a range of sensitivity analyses. In conclusion, single‐use negative pressure wound therapy can be considered a cost saving intervention to reduce surgical site complications following primary hip and knee replacements compared with standard care. Providers should consider targeting therapy to those patients at elevated risk of surgical site complications to maximize efficiency.

Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures

OBJECTIVE The purpose of this systematic review and meta-analysis was to assess the clinical effectiveness of nanocrystalline silver compared to alternative silver delivery systems (silver sulphadiazine [SSD] and silver nitrate) in adults and children with superficial and deep partial thickness burns. METHODS PubMed, EMBASE, Cochrane and other databases were searched to identify relevant randomised controlled trials and observational studies. RESULTS Eight studies that assessed both nanocrystalline silver and SSD and one study that compared nanocrystalline silver vs. silver nitrate were identified. Nanocrystalline silver compared to SSD/silver nitrate was associated with a statistically significant reduction in infections (odds ratio [OR] 0.21, 95% CI 0.07-0.62, p=0.005), length of stay in hospital (mean difference -4.74 (95% CI -5.79 to -3.69, p=0.00001) and surgical procedures (OR 0.40, 95% CI 0.28-0.56, p=0.00001). Three studies that reported on pain had lower pain scores with nanocrystalline silver use than with SSD/silver nitrate; a high level of heterogeneity precluded pooling estimates. CONCLUSION This comprehensive systematic review and meta-analysis of the available evidence suggest that the use of nanocrystalline silver dressings results in shorter length of stay in hospital, less pain, fewer surgical procedures and reduced infection rates compared to silver sulphadiazine/silver nitrate.

Cost-Effectiveness of a Twin Interlocking Derotation and Compression Screw Cephalomedullary Nail (2-Screw Nail)* with a Single Screw Derotation Cephalomedullary Nail (Single-Screw Nail)** in Patients with Intertrochanteric HIP Fractures

Hospital-acquired pressure injuries (HAPI) are a societal burden and considered potentially preventable. Data on risk factors and HAPI burden are important for effective prevention initiatives. This study of the 2009-2014 US Premier Healthcare Database identified HAPI risk factors and compared outcomes after matching HAPI to non-HAPI patients. The cumulative incidence of HAPI was 0.28% (47 365 HAPI among 16 967 687 total adult inpatients). Among the matched sample of 110 808 patients (27 702 HAPI), the strongest risk factors for HAPI were prior PI (odds ratio [OR] = 12.52, 95% confidence interval [CI] = 11.93-13.15), prior diabetic foot ulcer (OR = 3.43, 95% CI = 3.20-3.68), and malnutrition (OR = 3.11, 95% CI = 3.02-3.20). HAPI patients had longer adjusted length of stay (3.7 days, P < .0001), higher total hospitalization cost (

Comparing the Costs and Outcomes of a Twin Interlocking Derotation and Compression Screw Cephalomedullary Nail (2-Screw Nail)* with a Single Screw Cephalomedullary Nail (Single-Screw Nail) in Patients with Intertrochanteric HIP Fractures

8014, P < .0001), and greater odds of readmissions through 180 days (OR = 1.60, 95% CI = 1.55-1.65). This study demonstrates how big data may help quantify HAPI burden and improve internal hospital processes by identifying high-risk patients and informing best practices for prevention.

Cost-Effectiveness Analysis of the use of Coblation Technology Versus Mechanical Debridement in Knee Chondroplasty - A UK National Health Service Perspective

Silver‐containing products play an important role in the management of burn wound infections. We sought to compare the efficacy of commonly used silver delivery approaches including nanocrystalline silver, silver‐impregnated hydrofiber dressing, and silver‐impregnated foam dressing as the main products in the management of partial thickness burns. A systematic review was performed by searching PubMed, EMBASE, Cochrane, and other databases to identify relevant randomized controlled trials and observational studies. Due to the paucity of direct head‐to‐head trials, an indirect treatment comparison was performed. The use of nanocrystalline silver was associated with a statistically significant reduction in length of stay when compared to silver‐impregnated hydrofiber dressing (p = 0.027) and a shorter time to healing when compared to silver‐impregnated foam dressing (p = 0.0328). There were no statistically significant differences in infection rates and surgical procedures between nanocrystalline silver, silver‐impregnated hydrofiber dressing, and silver‐impregnated foam dressing; however, nanocrystalline silver was found to be the most beneficial for all the outcomes, including infection rates and surgical procedures, according to the Monte Carlo simulation method. In conclusion, current evidence from the published literature suggests that where the clinical and microbiological priority is to get in control of infection quickly it would seem prudent to use the most potent silver delivery system, which is nanocrystalline silver. Nanocrystalline silver may offer both clinical and economic benefits compared to alternative treatments in the management of patients with mixed burns that are at high risk of infection.