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Silver Dressing Reduces Femoral Wound Complications and Cost in High-Risk Vascular Surgery Patients
Jill N. Zink, MD, Tiffany J. Turner, Mandy R. Maness, MD, Daniel J. Torrent, MD, Charles S. Powell, MD, Frank M. Parker, DO, Dean J. Yamaguchi, MD, William M. Bogey, MD, Michael C. Stoner, MD.
East Carolina University, Greenville, NC, USA.
OBJECTIVES: Femoral wound infection remains a significant problem for both open surgical procedures and minimally-invasive endovascular procedures. The purpose of this study was to evaluate the impact of a silver-impregnated dressing (Ag) versus sterile gauze (control) in high-risk patients undergoing vascular procedures involving open femoral artery exposure.
METHODS: Utilizing a retrospective database, high-risk cases involving open femoral artery exposure were identified over a 44-month time period (10/2009 - 6/2013). High-risk patients were defined as those with a Hemoglobin A1c (HbA1c) > 8 mg/dL, Body Mass Index (BMI) > 30 kg/m2 or the presence of tissue loss. Ag dressing was utilized in high-risk patients during the last 18 months of the study period. Inclusion criteria and 30-day infection-related outcomes were compared with univariate statistical methods. Overall institutional savings was calculated.
RESULTS: The Ag group (n=113) was well-matched to the control (n=198) with respect to high-risk inclusion criteria (Table). Use of Ag dressing was associated with a decreased overall rate of wound complications and a significant reduction in the requirement for operative debridement (Table, *P <0.05). The estimated cost savings for one year of using a silver dressing instead of sterile gauze was $130,000.
CONCLUSIONS: Ag dressing use is associated with decreased femoral infection-related complications and institutional cost in a cohort of high-risk patients. These data demonstrate that selective use of an Ag dressing results in decreased morbidity and resource utilization, which is especially important within the evolving context of value-based care and reimbursement models.
| Ag (n=113) | Control (n=198) | | BMI > 30 kg/m2 (%) | 69.9 | 75.3 | | HbA1c > 8 mg/dL (%) | 22.1 | 18.7 | | Tissue loss (%) | 27.4 | 21.7 | | Extended Antibiotic Therapy (%) | 7.1 | 12.1 | | Bedside Debridement (%) | 0.0 | 1.0 | | Operative Debridement (%) | 0.9 * | 6.6 | | Readmission for Wound (%) | 2.7 | 3.5 | | Any Wound Complication (%) | 7.1 | 12.1 |
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