Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study
Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study
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DOI：
10.1111/j.1749-4486.2011.02354.x
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发表时间：
2011-08-01
影响因子：
2.1
通讯作者：
Allen, M.
中科院分区：
文献类型：
--
作者：
Bonaparte, J. P.;Corsten, M.;Allen, M.
目的：本研究的目的是验证使用非侵入性和廉价的术前组织扩张装置（DynaClose）用于桡侧前臂游离皮瓣供区，与未扩张的桡侧前臂游离皮瓣供区相比，将显著降低院内和院外伤口护理的成本。设计：一项队列研究，由先前在随机对照试验中随机分配的患者组成。意向治疗设计是used.Setting：一个大型的三级保健中心在东部安大略，加拿大。患者：34例患者提出耳鼻咽喉头颈部诊所登记。在这些患者中，29例患者之前入组了随机对照试验，另有5例患者入组并随机分配用于本研究。干预措施：患者被随机分配到治疗组（术前组织扩张，DynaClose扩张系统）或对照组。主要结果measurements：伤口护理费用（美元）计算所有患者的住院护理和需要家庭护理的患者。非参数数据分析被用于statistical assessment.Results：有93%的减少在使用断层皮肤移植在治疗组。与对照组相比，治疗组患者的伤口护理总费用显著降低（P < 0.0001）。治疗组患者需要的伤口护理平均（SD）总额为36.00美元（23.50美元），而对照组需要277.00美元（325.00美元）。在排除家庭护理费用后，治疗组与对照组相比，总费用和住院伤口护理费用继续显著降低（P < 0.001）。结论：使用简单、廉价和非侵入性的术前组织扩张方法，可显著降低住院和院外治疗的伤口护理费用。DynaClose动态皮肤扩张系统是一种经济有效的方法，可减少前臂桡侧游离皮瓣供皮区对分层植皮的需求。
Objectives: The objective of this study is to test the hypothesis that using a non-invasive and inexpensive pre-operative tissue expansion device (DynaClose) for radial forearm free-flap donor sites will result in a significant reduction in the cost of both in-hospital and out-of-hospital wound care compared with that of unexpanded radial forearm free-flap donor sites.Design: A cohort study consisting of patients previously randomised in a randomised controlled trial. An intention to treat design was utilised.Setting: A large tertiary care centre in eastern Ontario, Canada.Patients: Thirty-four patients presenting to Otolaryngology Head and Neck clinic were enroled. Of these patients, 29 were previously enroled in a randomised controlled trial, while an additional five patients were enroled and randomised for the purpose of this study. Interventions: Patients were randomised to either the treatment (pre-operative tissue expansion, DynaClose Expansion System) or control group.Main outcome measures: Wound care costs (in US dollars) were calculated for all patients for both in-hospital care and for patients requiring home care. Nonparametric data analysis was utilised for statistical assessment.Results: There was a 93% reduction in the use of split-thickness skin grafts in the treatment group. There was a significant reduction in total wound care cost for patients in the treatment group versus the control group (P < 0.0001). Patients in the treatment group required a mean (SD) total of $36.00 (23.50) per patient, while the control group required $277.00 (325.00) of wound care. After excluding the cost of home care, the treatment group continued to have a significant reduction in total and in-hospital wound care costs compared with the control group (P < 0.001).Conclusions: Using a simple, inexpensive and non-invasive method of pre-operative tissue expansion results in a significant reduction in the costs of wound care for both in-hospital and out-of-hospital treatment. The DynaClose dynamic skin expansion system results in a cost-effective method to reduce the need of a split-thickness skin graft for coverage of a radial forearm free-flap donor site.