Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions.
OBJECTIVE
We wished to determine the reduction in the rate of wound complications that would render the use of prophylactic negative pressure wound vacuum therapy (NPWT) cost saving compared to routine incision care (RC) following laparotomy for gynecologic malignancy.


METHODS
A decision tree was designed from a payer perspective to compare strategies for incision management following laparotomy for gynecologic malignancy: (1) RC; (2) prophylactic NPWT. Rates of wound complication, antibiotic use, re-hospitalization, re-operation, and home health use were obtained from a published cohort of 431 women who underwent laparotomy for endometrial cancer 2002-2007. Costs were estimated using Medicare reimbursements; cost of NPWT ($200) was obtained from hospital financial department. A 50% reduction in wound complications using NPWT was assigned initially and varied for sensitivity analysis.


RESULTS
The mean BMI was 36. The wound complication rate was 31% (37% for BMI>30, 41% for BMI>40). The overall cost of incision care was $104 lower for NPWT than for RC. At the lowest cost of NPWT ($200), the risk of wound complication must be reduced by 33% (relative risk=0.67) for NPWT to achieve cost savings in this cohort. Modeling obese and morbidly obese cohorts, the NPWT resulted in overall cost savings of $163 and $203, respectively, and the risk of wound complication must be reduced by 28% and 25%, respectively, for NPWT to achieve cost savings.


CONCLUSIONS
If the wound complication rate can be reduced by one-third, prophylactic NPWT is potentially cost saving in high-risk women undergoing laparotomy for gynecologic malignancy.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Lauren S
LS
Lewis
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Patricia A
PA
Convery
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Corey S
CS
Bolac
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA.
Fidel A
FA
Valea
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
William J
WJ
Lowery
Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: havri001@mc.duke.edu.
Laura J
LJ
Havrilesky
D015331:Cohort Studies; D017046:Cost Savings; D003663:Decision Trees; D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000191:economics* / Q000379:methods; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007813:Laparotomy / Q000191:economics* / Q000379:methods; D054843:Negative-Pressure Wound Therapy / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control
Gynecologic cancer; Prophylactic negative pressure wound vacuum; Wound complication