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• Smith & Nephew: Summit participants suggest pathway to greater adoption of NPWT
• 15/05/2014
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           Smith & Nephew (LSE:SN, NYSE:SNN), the global medical technology business, reports a survey of participants at its first North American Negative Pressure Wound Therapy Summit outlining a pathway to greater adoption of Negative Pressure Wound Therapy (NPWT).
           The Summit, titled “Unlocking the Potential of NPWT,” provided a forum for discussion of new clinical research and issues relevant to helping patients suffering with traumatic, chronic and post-surgical wounds. The survey revealed consensus that NPWT has a key role to play in reducing the cost of wound care and improving patient outcomes, and identified areas where progress and innovation could drive adoption of NPWT across a broader range of wounds.
           The Summit’s 115 participants came from across the clinical spectrum that treats the full range of wound types. The largest numbers of participants were from wound care, plastic, general and orthopaedic surgery, OB/GYN and podiatry. Participants came from twenty-five states in the US as well as Canada. The survey included responses from 92 participants, and revealed the following:
           - 91% are actively seeking to implement innovative wound treatments that will lower costs and improve patient outcomes.
           - 89% believe that up to 75% of all wounds they treat could be treated more effectively with NPWT.
           - 82% agree that improved healing is NPWT’s greatest benefit to patient care; 11% said that the greatest benefit was shortened length of stay. (The survey technology allowed for only one response per question.)
           - 81% said that NPWT has the potential to reduce the overall cost of wound care.
           - And 76% agree that it is important for NPWT to expand beyond its current use. Of the broad areas in which NPWT is most commonly used, 22% believe that general surgery includes the most promising, potential new uses for NPWT; 19% said plastics, 19% podiatry and 16% orthopaedics.
           Along with this interest in expanding NPWT within general surgery, participants are keen to see NPWT’s application to closed surgical incisions, especially for the potential of improvement in the control of surgical site infection (SSI). Survey responses indicate that this is a compelling opportunity for growth:
           - 66% of participants agree that more widespread use of NPWT may have a significant impact on the rate of SSI.
           - 95% are using NPWT on less than half of closed incisions at this time.
           When asked which single factor could expand access to NPWT in their facilities, 39% of participants indicated that reduced cost would help the most, followed by ease of implementation of treatment (26%) and easier access to the technology (22%). The top three factors that would increase the individual clinician’s use of NPWT were improved patient access to NPWT (39%), reduced cost (32%) and increased clinical indications (11%).
           “It was wonderful to have experts from so many specialities across the spectrum together at the Summit,” said Michael Sugrue, MD, Chair of the Summit and Surgeon at Letterkenny Hospital and Galway University, Ireland. “Medicine is best delivered by a team. The patient requires it. Opportunities like the NPWT Summit bring us together as a team, sharing best practices and new research.
           “There is little if any doubt that NPWT is a critically important tool for the treatment of chronic and traumatic wounds, and the emerging focus on surgical incisions is beginning to fill a pressing need to reduce post-surgical infection,” Dr. Sugrue added. “Very clearly, clinicians are looking for more to be done to make the therapy more accessible, easier for the clinician to manage and easier to deliver at home or in the community. These are exciting opportunities for innovation to extend the benefits of NPWT over a broader range of patients with all manner of wounds.”
           Presentations from Summit faculty aligned recent evidence on the efficacy of NPWT for the treatment of open wounds with the current emphasis on cost efficiency and improved outcomes driven by the Affordable Care Act, and for the treatment of post-surgical incisions with the American College of Surgeons’ National Surgical Quality Improvement Program. For example, the program included:
           - Dr. John C. Lantis, Chief of the Vascular/Endovascular Surgery Division at St Luke’s-Roosevelt Hospital in New York and Associate Professor of Clinical Surgery at Columbia University, who discussed the role of adjunctive therapies alongside NPWT to maximize wound bed preparation in open wounds. Although some of the evidence is still emerging, Dr. Lantis shared his experiences using NPWT adjunctive therapies in order to close wounds as quickly as possible, including debridement, irrigation and topical therapies depending on the desired treatment objectives for each particular patient.
           - Dr. Sudheer Karlakki, Consultant Orthopaedic and Arthroplasty Surgeon at Robert Jones & Agnes Hunt Hospital, Oswestry in the UK, reviewed the accumulating evidence for the use of NPWT in closed incisions before presenting top-line results from two studies soon to be published from his own group. In the first study, on 120 hip and knee revisions, standard dressings or NPWT were applied in the operating room to two groups after surgery. They noted a large reduction in length of stay for patients with wound related complications. In the second study (a 220 patient RCT) treating hip and knee primary arthroplasties with PICO◊ Negative Pressure Wound Therapy or standard dressings, they were able to discharge patients with leaky wounds one day earlier with the PICO system. He concluded that NPWT helps to achieve predictable wound healing, minimize wound complications and reduce length of stay.
           - Dr. Craig Olson, Assistant Professor – Section of Colon and Rectal Surgery, Division of GI Surgery, University of Texas Southwestern Medical Center in Dallas presented his recently published work demonstrating that incisional NPWT can significantly reduce SSI following colorectal surgery. Colorectal operations are commonly associated with higher rates of SSI (5-45%) leading to increased patient morbidity, cost of care and length of stay. Dr. Olson described findings from a retrospective review of 254 patients in their center, which revealed that while the presence of diabetes was associated with a greater risk of SSI in colorectal surgery, the use of incisional NPWT actually decreased the likelihood of SSI by more than half.
           Additional presentations focused on the NPWT mode of action in different wound types, reviewing the evidence for incisional NPWT, the impact of biofilms on wound healing and the emerging consensus guidelines for NPWT. Breakout sessions discussed surgical site complication management strategies, and experiences with the use of NPWT in plastic and abdominal surgery.
           The North American NPWT Summit convened in Dallas, Texas, on May 2 and 3. The Summit and associated educational activities were supported by Smith & Nephew.
           The survey was conducted with an audience response system that utilized a wireless keypad technology allowing for immediate response polling, participants were asked to select the single best response to each question.
           1. Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R. Negative pressure wound therapy for managementof the surgical incision in orthopaedic surgery: A review of evidence and mechanisms for an emerging indication. Bone Joint Res. 2013;2(12):276–84. doi:10.1302/2046-3758.212.2000190.
           2. Bonds AM, Novick TK, Dietert JB, Araghizadeh FY, Olson CH. Incisional negative pressure wound therapy significantly reduces surgical site infection in open colorectal surgery. Dis Colon Rectum. 2013;56(12):1403–1408. doi:10.1097/DCR.0b013e3182a39959.