Real World Use: Effect of Early Versus Late Initiation of Negative Pressure Wound Therapy on Wound Surface Area Reduction in Patients at Wound Care Clinics

Benefits of early versus late initiation of negative pressure wound therapy (NPWT*) on acute and chronic wounds have been demonstrated in acute care, long-term acute care, and home health care. The purpose of this study was to examine the “real world” effect of early versus late initiation of NPWT on the rate of wound surface area (WSA) reduction in patients at wound care clinics (WCCs). We retrospectively examined US Wound Registry data (de-identified) on a total of 4,739 acute (surgical, traumatic and amputations) and chronic (diabetic foot, pressure, and venous ulcers) wounds (56.7% and 43.3%, respectively) from 3,604 patients treated in 56 outpatient WCCs. Early-NPWT initiation was defined for acute wounds as treatment initiated within seven days from the first visit to the WCC and within 30 days for chronic wounds. Late-NPWT initiation occurred after this time. Time-to–wound-surface-area change was defined as number of days from first visit to first date after NPWT initiation that WSA was reduced by 75%. For acute wounds, median days from first visit to 75% WSA reduction was 40.4 for the early group versus 81.6 days for the late group (p<0.0001). For chronic wounds, median days were 96.4 and 274.6 for early and late groups, respectively (p<0.0001).  The hazard ratio after adjustment for wound size and age at initial visit for acute wounds with early-NPWT initiation was 2.27, indicating it was twice as likely for the early group to reach 75% WSA reduction as the late group. Chronic wounds had a similar hazard ratio of 2.43. These WCC data support previous analyses of benefits of early-NPWT initiation in other wound care settings.