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Orthopaedic surgery

Introduction

In a study on Surgical Site Infections (SSI) at Plymouth Hospitals NHS Trust in the UK, of 980 hip replacement and 970 knee replacement procedures between April 2010 and March 2012, SSI significantly impacted on length of stay and subsequently the cost of surgery - up to 17 additional days in hospital and up to double the cost of surgery.1

Prevention of complications is cheaper than the cure.

The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which the application of innovative technologies can minimise complications.2

References

  1. Jenks et al. (2014), Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital.  Journal of Hospital Infection; 86. 24-33.
  2. Karlakki S et al, Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery, Bone Joint Res 2013; 2:276-84.

PICO can help

Improving outcomes with incisional NPWT

Negative Pressure Wound Therapy (NPWT) has a mechanism of action that improves the speed, strength and quality of incisional wound healing, thus minimising the failures of healing that lead to infection and/or dehiscence.

PICO Incision MOA

Considerable evidence shows NPWT delivers clinical benefits as part of effective incision management.1

Introducing PICO

PICO is a novel, canister- free, single-use system offering the ultimate in portable, accessible and affordable NPWT.

PICO Delivers Active Therapy

A recent paper published in Bone & Joint Research has reviewed the literature surrounding a more recent and emerging indication with the use of NPWT on closed incisions:1

  • From a "counterintuitive indication" position at the beginning of the paper, Karlakki et al. came to the conclusion that "there are now reasonable grounds for confidence that this approach is widely applicable in a range of indications" for the use of NPWT on closed incision
  • From the studies and case series reviewed:
              - 26 of the 33 papers were from the last 3 years
              - A very high proportion presented positive review
              - RCT evidence was presented for Ortho Trauma and Sternal Incisions
  • Although a gap in understanding MOA was identified, it was identified that oedema, haematoma and seroma formation may be reduced through the therapy itself as well as improved lymphatic drainage.2

References

  1. Karlakki S et al, Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery, Bone Joint Res 2013; 2:276-84.
  2. Kilpadi DY, Cunningham MR, Evaluation of closed incision management with negative pressure wound therapy (CIM): hematoma/seroma and involvement of the lymphatic system.  Wound Repair Regen 2011; 19:588-596.

Recommended Pathway and Clinical Cases

PICO pathway

*AAOS Patient Safety Committee. Modifiable risk factors in orthopaedic infections. 20111

Poster no. 1 - Emma Sharp Poster2

Poster no. 2 - Hudson Poster3

Poster no. 3 - Gianini poster4

Poster no. 4 - Leak poster5

References

  1. AAOS Patient Safety Committee.  Modifiable Risk Factors in Orthopaedic Infections, 2011.
  2. Sharp E, An evaluation of PICO negative pressure dressings for complex orthopaedic surgical wounds.  Poster presented at Wounds UK, Harrogate, November 2013.
  3. Hudson DA, Hartwell S, Clinical assessment of a simplified single use NPWT device.  Poster presented at SAWC Conference, USA, Fall 2011.
  4. Luciani D, Capara P, Gianini S, Usage of a disposable negative pressure device for tissue reparation in Orthopedy.  Poster presented at X Congresso Nazionale AIUC, Ancona, September 2011.
  5. Leak K, Bielby A, The value of intervention: post-operative application of single-use negative pressure wound therapy.  Poster at Wounds UK, Harrogate, November 2012.

Economic Benefits

Prevention of complications is cheaper than the cure

17 beds

Hip replacement
SSI = Additional 17 days in hospital1

In Hip replacement an SSI can doublethe cost of surgery

In Hip replacement an SSI can double the cost of surgery1

7 Bed Days

Knee procedures
SSI = Additional 7 days in hospital1

In knee replacement an SSI can adds 50% to the cost of surgery

In knee replacement an SSI can adds 50% to the cost of surgery1

References

  1. Jenks PJ et al., Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital, Journal of Hospital Infection 86 (2014) 24-33.

PICO Videos

This video shows how PICO aids wound healing on incisions, and how its mode of action compares to a standard dressing.

In this video, Marilyn and her daughter share their experiences of PICO when it was used as part of the procedure to replace one of Marilyn's knees.