Does Negative Pressure Wound Therapy (NPWT) result in a shorter hospital stay compared to bolster dressings for patients with complex or chronic wounds, such as diabetic foot ulcers or venous ulcers?

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NPWT Results in Shorter Hospital Stays Than Bolster Dressings

Negative pressure wound therapy (NPWT) consistently demonstrates shorter hospital stays compared to conventional dressings including bolster dressings across multiple wound types and surgical contexts.

Evidence for Reduced Hospital Stay

The most compelling evidence comes from orthopedic surgery where NPWT achieved significantly shorter hospital stays compared to conventional dressings (SMD = -0.42,95% CI -0.83 to -0.02), though with notable heterogeneity 1. This 2023 meta-analysis of 18 studies provides the strongest recent evidence supporting reduced length of stay.

Additional supporting data includes:

  • Vascular surgery patients treated with NPWT for lower leg fasciotomy wounds experienced quicker wound closure and shorter hospital stays compared to gauze dressings 2

  • Complicated and refractory wounds treated with NPWT showed significantly shorter duration of treatment and reduced hospital stay compared to conventional treatment with petrolatum and saline gauze (P < 0.05) 3

Important Caveat

One contradictory finding exists: a 2023 pediatric study of complicated extremity wounds found that patients in the control group (wet-to-moist dressing) actually had shorter hospital stays than the NPWT group 4. However, this pediatric-specific finding should not override the broader adult evidence, and the study still demonstrated that NPWT reduced the number of required dressing changes and improved scar outcomes.

Additional Benefits Beyond Hospital Stay

Beyond reduced length of stay, NPWT provides:

  • Lower surgical site infection rates (OR = 0.60,95% CI 0.47 to 0.77) across orthopedic surgeries 1
  • Reduced need for surgical wound revision (OR = 0.48,95% CI 0.26-0.91) in vascular surgery patients 5
  • Fewer operations required and reduced treatment costs in complicated wounds 3
  • Simpler definitive wound coverage techniques needed 4

Clinical Application

The decision to use NPWT should be based on wound complexity, surgical site infection risk, and patient-specific factors rather than hospital stay alone, as the mortality and morbidity benefits (reduced infections, fewer revisions) are more clinically significant than the modest reduction in length of stay 1.

References

3
Research

[Observation on the therapeutic effects of negative-pressure wound therapy on the treatment of complicated and refractory wounds].

Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns, 2009

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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