TY - JOUR
T1 - Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients
AU - Santosa, Katherine B.
AU - Keane, Alexandra M.
AU - Keller, Matt
AU - Olsen, Margaret A.
AU - Sears, Erika D.
AU - Snyder-Warwick, Alison K.
N1 - Funding Information:
Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and by the National Institute of Neurological Disorders and Stroke under award numbers F32NS098561 (to K.B.S.) and K08NS096232 (to A.K.S.W.).
Funding Information:
Authors? contributions: K.B.S. assisted with study design and data interpretation and wrote the first draft of the article. M.K. assisted with study design, performed all data analysis, and assisted with data interpretation. M.A.O. assisted in study design, statistical analyses, and data interpretation. A.M.K. helped with data interpretation and writing of the first draft of the article. E.D.S. assisted with study design, statistical analysis, and data interpretation. A.K.S.-W. assisted with study design and data interpretation. All authors contributed to critical revisions of the article. A.K.S.-W. takes responsibility for the integrity of the data and the accuracy of the data analysis. She had final responsibility for the decision to submit for publication. Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and by the National Institute of Neurological Disorders and Stroke under award numbers F32NS098561 (to K.B.S.) and K08NS096232 (to A.K.S.W.). In addition, the work was supported by the Center for Administrative Data Research, which is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences of the NIH, grant number R24 HS19455 through the Agency for Healthcare Research and Quality, and grant number KM1CA156708 through the National Cancer Institute at the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. All authors have nothing to disclose. The funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in writing of the report; or the decision to submit the article for publication. All authors have approved the final article.
Funding Information:
In addition, the work was supported by the Center for Administrative Data Research, which is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences of the NIH, grant number R24 HS19455 through the Agency for Healthcare Research and Quality, and grant number KM1CA156708 through the National Cancer Institute at the NIH.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients. Materials and methods: We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with ≤50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with >50% of NPWT. Results: We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy. Conclusions: Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.
AB - Background: Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients. Materials and methods: We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with ≤50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with >50% of NPWT. Results: We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy. Conclusions: Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.
KW - Children
KW - Infants
KW - Inpatient
KW - Negative pressure wound therapy
KW - Outpatient
KW - Vacuum-assisted closure
UR - http://www.scopus.com/inward/record.url?scp=85085061199&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2020.04.025
DO - 10.1016/j.jss.2020.04.025
M3 - Article
C2 - 32450421
AN - SCOPUS:85085061199
SN - 0022-4804
VL - 254
SP - 197
EP - 205
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -