title: A randomised study of NPWT closure versus alginate dressings in peri-vascular groin infections: quality of life, pain and cost.
abstract: OBJECTIVE
  The aim of this study was to compare the vacuum assisted wound closure (VAC) system (negative pressure wound therapy; NPWT) and alginate wound dressings in terms of quality of life (QoL), pain resource use and cost in patients with deep peri-vascular groin infection after vascular surgery.
  
  
  METHODS
  Patients with deep peri-vascular groin infection (Szilagyi grade III) were included and randomised to NPWT or alginate therapy. EuroQol 5D (EQ-5D) and brief pain inventory (BPI) were used to evaluate QoL and pain, respectively.
  
  
  RESULTS
  Wound healing time until complete skin epithelialisation was shorter in the NPWT (n=9) compared to the alginate group (n=7), median 57 and 104 days, respectively (p=0.026). No difference was recorded in QoL and pain between the groups at study start and the second assessment. QoL analysis within groups between time points, showed that patients in NPWT groups improved in EQ-5D domains, 'self-care' (p= 0.034), 'usual activities' (p=0.046); EQ-5D index value (p=0.046) and EQ-VAS (p=0.028). Patients in the NPWT group reported significantly less pain 'affecting their relations with other people' and 'sleep' between time points. The NPWT group had significantly fewer dressing changes compared to the alginate group (p<0.001). The median frequency of wound dressing changes outside hospital was 20 (IQR 6-29) in the NPWT group (n=9), compared to 48 (IQR 42-77) in the alginate group (n=8; p=0.004). The saved personnel time for wound care in the first week for the NPWT group, compared with the alginate group, was 4.5 hours per week per nurse. The total hospitalised care cost was 83-87% of the total cost in both groups.
  
  
  CONCLUSIONS
  NPWT therapy in patients with deep peri-vascular groin infection can be regarded as the dominant strategy due to improved clinical outcome with equal cost and quality of life measures.
authors.affiliation: Vascular Center, Malmö-Lund, Skåne University Hospital.
authors.forename: C
authors.initials: C
authors.lastname: Monsen
authors.affiliation: Vascular Center, Malmö-Lund, Skåne University Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Acosta
authors.affiliation: Institution for Surgical Sciences, Uppsala University Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Mani
authors.affiliation: Department of Care Science, Malmö University, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Wann-Hansson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000464:Alginates / Q000627:therapeutic use*; D047070:Bandages, Hydrocolloid / Q000191:economics*; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D005260:Female; D020723:Glucuronic Acid / Q000627:therapeutic use; D006119:Groin / Q000601:surgery; D006603:Hexuronic Acids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000191:economics*; D059408:Pain Management / Q000191:economics*; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing / Q000502:physiology
chemical_list: D000464:Alginates; D001672:Biocompatible Materials; D006603:Hexuronic Acids; D020723:Glucuronic Acid
keywords: cost; groin infection; negative wound pressure therapy; pain; quality of life