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Incisional Negative Pressure Wound Therapy devices applied after Total Ankle Arthroplasty: A Hospital-Based Health
Jamal Atfeh1,2, Pascale Guerre1,3, Emmanuelle Carre4
1Hospices Civils de Lyon, Pôle de Santé Publique, Service d'Evaluation Economique en Santé, Lyon, France.
Plos One
|April 29, 2025
Summary
Incisional Negative Pressure Wound Therapy (iNPWT) showed no significant clinical benefit over standard dressings for ankle replacement surgery. However, iNPWT offers potential organizational advantages and comparable costs, suggesting adoption based on surgeon expertise and patient risk factors.
Area of Science:
- Orthopedic Surgery
- Wound Management
- Health Technology Assessment
Background:
- A portable, single-use incisional Negative Pressure Wound Therapy (iNPWT) device is a potential option for wound management after Total Ankle Arthroplasty (TAA).
- A Hospital Based-Health Technology Assessment (HB-HTA) was conducted to evaluate the clinical, economic, and organizational aspects of adopting iNPWT in a French university hospital.
Purpose of the Study:
- To assess the clinical effectiveness, economic impact, and organizational benefits of using iNPWT compared to standard dressings for TAA incisions.
- To provide data for informed decision-making regarding the adoption of iNPWT in orthopedic departments.
Main Methods:
- A three-dimensional HB-HTA was performed, incorporating a literature review, the PICO-PTC randomized controlled trial (NCT03886818), and semi-structured interviews with healthcare professionals.
- Comparative retrospective cohort studies were reviewed to assess wound healing complications.
Main Results:
- Literature review suggested potential benefits of iNPWT, but the PICO-PTC trial found no significant difference in wound healing complications or hospital costs between iNPWT and standard dressings.
- No significant difference in Medicine-Surgery-Obstetrics (MSO) hospital costs was observed: €10,639.65 for iNPWT versus €9,672.59 for standard dressings.
- iNPWT adoption could lead to a 1.5% MSO hospitalization cost supplement and may improve professional workflow and nursing wound monitoring.
Conclusions:
- The clinical effectiveness of prophylactic iNPWT for TAA, in terms of reducing wound healing complications, was not demonstrated in the PICO-PTC study.
- Despite a lack of proven clinical superiority, iNPWT presents potential organizational benefits without significant economic drawbacks.
- Adoption of iNPWT in orthopedic departments could be guided by surgeon expertise, considering patient-specific risk factors for complications.
