title: Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings.
abstract: OBJECTIVE
  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 euro5.31 vs. euro0.71 in the gauze group. Mean difference; euro4.60 (95% CI, euro2.68-euro6.83) while daily total (material plus nursing) costs showed no difference between the groups; mean euro2.86 (95% CI, euro-6.50-euro10.25). 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.
  
  
  CONCLUSIONS
  District nurses should reconsider using gauze-based dressings, particularly in surgical patients with exudating wounds.
authors.affiliation: Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. d.ubbink@amc.nl
authors.forename: Dirk Th
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
authors.forename: Jarne
authors.initials: J
authors.lastname: van Hattem
mesh_terms: D000328:Adult; D001458:Bandages; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D013514:Surgical Procedures, Operative; D014947:Wounds and Injuries / Q000451:nursing*