New research published in the BMJ Open highlights an apparent lack of treatment planning, reassessment and re-evaluation of care for most community-based patients with unhealed surgical wounds.
The retrospective cohort study analysed the records of 707 patients in The Health Improvement Network database whose wound failed to heal within 4 weeks of surgery.
The data showed that 83% of all wounds healed within 12 months from onset of community management, ranging from 86% for wounds arising from planned procedures to 74% of wounds arising from emergency procedures. Mean time to healing was 4 months.
Only around half of patients who still had a wound at 3 months were recorded as having had a follow-up visit with their surgeon.
Up to 68% of all wounds may have been clinically infected at the time of presentation, and 23% of patients subsequently developed a putative wound infection at a mean of 4 months after initial presentation.
The mean NHS cost of wound care over 12 months was £7300 per wound, ranging from £6000 to £13,700 per healed and unhealed wound, respectively. The mean NHS cost of managing an uninfected was approximately £2000 while the conflated cost of managing a wound with a putative infection ranged from £5000 to £11,200.
The authors suggest that an improvement in 5 key areas of clinical and service management would enhance healing and other patient outcomes while reducing overall management costs:
- Working to common definitions and reporting standards across primary and secondary care.
- Integrating care across providers.
- Escalating care appropriately with greater senior involvement.
- Rational use of products with access to advanced wound treatments when necessary.
- Recognising high-risk patients and responding with nutritional support and comorbidity management as appropriate.
