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Post-Operative PICO

Post-operative use of PICO Single use Negative Pressure Wound Therapy improves predictability in wound healing and reduces complications following orthopaedic surgery.  

A Randomised Controlled Trial (RCT) of 220 patients undergoing primary hip or knee replacement compared the use of PICO, the novel Single use Negative Pressure Wound Therapy (NPWT) system, with standard dressings on closed surgical incisions. The research took place over a 12 month period at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH), Shropshire, UK. Results show significant reduction in; wound exudate distribution within the dressing, the number of dressing changes and extreme length of stay in hospital amongst those patients where PICO was applied.1 

Whilst Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are commonplace procedures, reported figures of complications vary. Surgical site infection rate is suggested to be between 1-3% in the general orthopaedic population2, however UK Patient Reported Outcome Measures note that post-operative wound problems are recorded by approximately 10-13% of patients.3   

Mr Sudheer Karlakki, lead RCT author and Consultant Orthopaedic Surgeon at RJAH, explains, “By introducing PICO as a prophylactic measure we have been able to demonstrate predictable wound healing following total hip and knee replacement procedures. Better wound management offers significant value to our hospital both in terms of reducing associated healthcare costs and by improving each patient’s outcome and experience.” 

The impact of post-operative complications and prolonged wound exudate is serious and can lead to delayed discharge, increasing the care and cost burden to the hospital.4   The cost of any additional stay in a UK hospital is estimated at £275.00 per day, per hospital bed.1 Findings indicate that the use of PICO resulted in patients having a significantly smaller probability of experiencing excessive Length of Stay (LOS). The study showed a smaller range and spread of LOS in those patients with PICO compared to the standard dressing (1-10 days compared to 2-61 days).1     

The use of PICO resulted in a four-fold reduction in the number of patients experiencing Grade 4 distribution of wound exudate within the dressing when compared with standard wound dressing in those undergoing joint replacement.1 Prolonged wound drainage and high exudate levels increase the risk of wound complications by delaying healing, and have been associated with surgical site and deep prosthetic infections.1,4 

There was also a four-fold decrease (from 8% to 2%) in superficial surgical site complications.1 A further benefit was shown in the significant reduction in the number of total dressing changes required per patient using PICO. Fewer dressing changes may lead to greater patient comfort and less burden on nursing resource. Taking into account reduced LOS for the study group, lower wound complications, lower dressing changes and potential cost savings for wound care in the community due to reduced wound complications in the study group, the authors believes the cost of the PICO is justifiable.1  

“Wound complications do not only impact the hospital, but they can have a devastating effect on a patient’s recovery,” explains Helen Griffiths, Outpatient Nurse at RJAH. “There is often a financial impact for the family as more time off work is required, not just for the patient but also their carer. High levels of wound exudate or infections can also cause embarrassment and discomfort, often resulting in significant anxiety. PICO can help prevent these issues through improved wound healing and increased patient confidence.” 

While significant benefits have been demonstrated for patients across all demographics, statistical analysis suggests that the use of PICO as a prophylactic for closed surgical incision management in patients that are categorised as high risk (BMI >35, ASA >3 or, diabetics is particularly beneficial.1  

The full study is published in Bone and Joint Research in August 2016 and is available here: [link to study]

Read more about PICO 

References

Karlakki, S. et al. (2016). Incisional negative pressure wound dressings (NPWTd) in routine primary hip and knee replacements – A randomised controlled trial. Bone and Joint Research. Hester, T., Mahmood, S., & Moftah, F. (2015). Is Single Use Portable Incisional Negative Pressure Wound Therapy System Suitable for Revision Arthroplasty?. Advances in Orthopedic Surgery, 2015.Chicago HES Online (Hospital Episode Statistics). (2011). Provisional monthly Patient Reported Outcome Measures (PROMs) in England – A guide to PROMs methodology. NHS: The Information Centre.Patel VP. et al. (2007). Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am; 89:33-8.

This information is intended for health care professionals only.

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