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Oral Abstracts (Session 3 of 5)
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(Presentation 34.4) Randomized clinical trial comparing modern versus gauze dressings to treat open wounds in surgical patients DT Ubbink; H Vermeulen; A Goossens; RB Kelner; SM Schreuder; MJ Lubbers Background: The large variety in wounds and dressing materials and the lack of convincing evidence as to local wound care make the choice for the optimum wound dressing cumbersome. Methods: The authors randomized consenting patients admitted to the department of surgery with open wounds due to various etiologies to receive either “modern” occlusive dressings (foams, alginates, hydrocolloids, hydrogels, films) or “classical” gauze-based dressings (dry, moist, or paraffin gauzes). In each group, dressing choices were made on the basis of wound color and exudation. Standard systemic treatment was allowed in both groups. Endpoints were time to complete wound healing, pain during dressing changes (10-point visual analogue scale), and costs of nursing time and dressing materials. Follow-up was until complete wound healing or up to 6 months. An independent investigator judged wound healing. Results: The authors randomized 285 patients. Etiologies of the 419 wounds in these patients were postoperative (62%), trauma (23%), vascular insufficiency (7%), diabetes (5%), and pressure (3%). Time to complete wound healing in the modern group (median 66 days; inter-quartile range [IQR]: 29–132 days) was similar to that in patients receiving gauze dressings (47 days; IQR: 26–106 days; log rank: P = 0.421). Median pain and costs were calculated from 618 measurements during dressing changes. Pain scores were low and comparable: 0.54 (IQR: 0.29–2.14) in the modern versus 0.63 (IQR: 0.30–2.00) in the gauze group (P = 0.914). Daily costs of modern dressing materials were significantly higher (modern, 5.83 versus gauze, 2.55; [P < 0.001]), but nursing time costs per day were significantly higher when gauze was used (modern, 0.89 versus gauze, 2.36 [P < 0.001]). Resulting total costs for local wound care per patient per day of hospital stay were 6.98 in the modern group and 4.65 in the gauze group (P = 0.071). Conclusion: The use of modern materials for local wound care in the clinical setting does not lead to quicker wound healing or less pain for the patient during dressing changes, while the higher costs of modern materials nearly balance the lower costs of nursing time due to a lower dressing change frequency. References Vermeulen H, Ubbink DT, Goossens A, de Vos R, Legemate DA. Systematic review of dressings and topical agents for surgical wounds healing by secondary intention. Br J Surg. 2005 Jun;92(6):665–72. |
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