Obstetric surgery

Economic overview

There is increasing pressure on the health system as a result of more complex, high risk pregnancies presenting to maternity units.  Complex pregnancies and medical issues, such as obese patients, multiple births, older mothers and chronic diseases like diabetes, increases the risk of complications, contributing to the growing need for caesarean section. 

• 1 in 10 women undergoing a C-section experience a Surgical Site Infection (SSI)¹ 
• 1 in 7 women with diabetes undergoing a C-section experiences an SSI¹
• 1 in 5 with a BMI >35 experience an SSI¹ 

Managing SSIs is becoming more costly at a time when healthcare budgets are tighter and quality of care is closely scrutinised.  The cost to the patient can be even higher - the impact of SSIs on the wellbeing of new mothers at this important time in their lives can be devastating.

Clinical overview

PICO^◊ Negative Pressure Wound Therapy (NPWT) is a revolutionary single use, canister free, incision management system. The use of PICO Single Use NPWT to reduce surgical site complications following C-section surgery, has been shown to lead to improved outcomes whilst lowering the costs associated with post-operative management.⁴ 

On a closed incision such as a C-section, the PICO system helps hold the edges of the incision together⁵, and has been proven to reduce the risk of infection^4-6 and other complications, including seromas.⁶ In a recent study, PICO was used on patients who were identified to be high risk (BMI >35) and OPSITE^◊ Post-Op Visible was used in uncomplicated, low risk cases (BMI <35). Following this protocol, the hospital experienced no readmissions for these high risk patients. Data was collated through post-discharge surveillance with patients monitored for 30 days post operatively.⁴

References

1. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012.
2. Health Protection Agency (2012) Risk of infection from caesareans at nearly 10 percent, http://www.hpa.org.uk/NewsCentreNationalPressReleases/2012PressReleases/120801Infectionriskfromcsection/ accessed March 2014.
3. Jenks PJ 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.
4. Bullough L, Wilkinson D, Burns S, Wan L (2014) Changing wound care protocols to reduce postoperative caesarean section infection and readmission. Wounds UK; 10(1) 84-89.
5. Hudson D, Adams K, Huyssteen A, Martin M and Huddleston E. (2013). Simplified Negative Pressure Wound Therapy: clinical evaluation of an ultraportable, no-canister system.
6. Selvaggi F et al., (2014) New Advances in Negative Pressure Wound Therapy (NPWT) for Surgical Wounds of Patients Affected with Crohn’s Disease. Surgical Technology International XXIV.

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.

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.

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.

Reproduced with permission from Lindsey Bullough, Tissue Viability Nurse, Wrightington, Wigan and Leigh NHS Foundation Trust.

Click here or on the image above to view a larger version of the pathway.

Poster no. 1 - Bullough et al.¹

Poster no. 2 - Bullough et al. EBCOG Version²

Poster no. 3 - Harris et al.³

References

1. Bullough L., Wilkinson D., Changing wound care protocols to reduce post-operative caesarean section complications. Poster presented at Wounds UK, Harrogate, November 2012.
2. Bullough L. et al., Reducing infection rates in Caesarean section patients with BMI of 35 or more: a 138 patients evaluation. Poster presented at EBCOG, Glasgow 2014.
3. Harris J., Hickson E., Using a multi-faceted active change process and infection prevention to reduce post-op C-section infections. Poster presented at SAWC Spring 2013.

The innovative PICO Negative Pressure Wound Therapy (NPWT) System helped make this possible in a UK trust which had highlighted a high incidence of wound infection and readmissions in patients undergoing Caesarean section.¹

Implementation of a protocol including PICO used post operatively on 50 patients resulted in a 50% reduction in infections and no readmissions.

Prevention of complications is cheaper than the cure

References

1. Bullough L, Wilkinson D, Burns S, Wan L (2014) Changing wound care protocols to reduce postoperative caesarean section infection and readmission. Wounds UK; 10(1) 84-89.
2. Jenks PJ 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.

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

In this video, new mum Claire talks about the impact developing an SSI following a Caesarean section had on her and her baby.