• Karan Chopra, Arvind U Gowda, Chris Morrow, Luther Holton, and Devinder P Singh.
• Baltimore and Annapolis, Md. From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
• Plast. Reconstr. Surg. 2016 Apr 1; 137 (4): 1284-9.

BackgroundComplex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients.MethodsCost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results.ResultsThe aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent.ConclusionThe use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.

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