Presentation (CTI)

Problem Statement: We evaluated the clinical and financial value of using negative pressure wound therapy (NPWT) in patients with a BMI greater 30 kg/m² who undergo cesarean section at our quaternary care hospital.
Description: Questions remain about the clinical effectiveness of NPWT versus standard care in women with high BMI post-cesarean section. We conducted a meta-analysis of 10 randomized controlled trials to evaluate (i) the impact of NPWT vs standard care on clinical outcomes in patients with a BMI greater than 30 kg/m² who undergo cesarean section (ii) whether the level of negative pressure (-80 mmHg vs -125 mmHg) impacts outcomes. We also conducted a budget impact analysis. We found moderate quality evidence indicating that NPWT reduces surgical site infections (SSI) in patients with BMI greater than 30 kg/m² undergoing cesarean section; however, there was no evidence of benefit for other outcomes such as hospital readmissions and reoperation. Low quality evidence indicated no difference in level of pressure on SSI. In terms of budget impact, the use of the NPWT device at $200/patient would result in an additional $40,000 per year to treat 200 patients. The ICER indicates that it would cost $11,173 to prevent one additional case of an SSI by using this device in this population. Given the very low rate of surgical site infection (1.47% to 2.8%) post-caesarean section at the MUHC, and that there is no evidence of effectiveness of the device on more serious complications and readmissions, we issued a recommendation that the opportunity for impact on clinical benefit and cost savings is minimal.
Lessons Learned: Although moderate-quality evidence indicates that NPWT could reduce surgical site infections in this population, it is important to look at local burden of illness, which demonstrated that the low rate at our hospital did not justify investing in this technology.
Stakeholder Perspective: Government-affiliated hospital