title: A retrospective cohort study evaluating efficacy in high-risk patients with chronic lower extremity ulcers treated with negative pressure wound therapy.
abstract: The purpose of this study was to evaluate the efficacy of negative pressure wound therapy (NPWT) compared with standard of care on wound healing in high-risk patients with multiple significant comorbidities and chronic lower extremity ulcers (LEUs) across the continuum of care settings. A retrospective cohort study of 'real-world' high-risk patients was conducted using Boston University Medical Center electronic medical records, along with chart abstraction to capture detailed medical history, comorbidities, healing outcomes and ulcer characteristics. A total of 342 patients, 171 NPWT patients with LEUs were matched with 171 non-NPWT patients with respect to age and gender, were included in this cohort from 2002 to 2010. The hazard ratios (HRs) were estimated by COX proportional hazard models after adjusting for potential confounders. The NPWT patients were 2·63 times (95% CI = 1·87-3·70) more likely to achieve wound closure compared with non-NPWT patients. Moreover, incidence of wound closure in NPWT patients were increased in diabetic ulcers (HR = 3·26, 95% CI = 2·21-4·83), arterial ulcers (HR = 2·27, CI = 1·56-3·78) and venous ulcers (HR = 6·31, 95% CI = 1·49-26·6) compared with non-NPWT patients. In addition, wound healing appeared to be positively affected by the timing of NPWT application. Compared with later NPWT users (1 year or later after ulcer onset), early NPWT users (within 3 months after ulcer onset) and intermediate NPWT users (4-12 months after ulcer onset) were 3·38 and 2·18 times more likely to achieve wound healing, respectively. This study showed that despite the greater significant comorbidities, patients receiving NPWT healed faster. Early use of NPWT demonstrated better healing. The longer the interval before intervention is with NPWT, the higher the correlation is with poor outcome.
authors.affiliation: VA New England Health Care Division, Providence, RI, Department of Surgery, Center for Restorative and Regenerative Medicine, Limb Preservation and Wound Care Research, Providence, RI, USA; Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.forename: Matteo
authors.initials: M
authors.lastname: Fabbi
authors.forename: Hisae
authors.initials: H
authors.lastname: Hayashi
authors.forename: Nanjin
authors.initials: N
authors.lastname: Park
authors.forename: Khaled
authors.initials: K
authors.lastname: Attala
authors.forename: Gousheng
authors.initials: G
authors.lastname: Gu
authors.forename: Michael A
authors.initials: MA
authors.lastname: French
authors.forename: Vickie R
authors.initials: VR
authors.lastname: Driver
mesh_terms: D000367:Age Factors; D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D058729:Peripheral Arterial Disease; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing