Clostridial Collagenase Ointment and Medicinal Honey Utilization for Pressure Ulcers in U.S. Hospitals

Background: Pressure ulcers (PUs) represent a considerable societal burden, affecting 2.5 million patients annually in the United States and accounting for up to $11 billion in healthcare costs. An important aspect of the treatment for PUs is debridement. Among debriding methods, enzymatic debridement with clostridial collagenase ointment (CCO) has clinical advantages over other debriding methods by selectively removing necrotic tissue.

Aims: Describe the utilization of CCO and medicinal honey debridement methods in real-world inpatient and outpatient hospital settings among pressure ulcer (PU) patients and compare the frequency of healthcare re-encounters between CCO- and medicinal honey-treated patients.

Materials and Methods:  De-identified hospital discharge records for patients receiving debridement and having an ICD-9 code for PUs were extracted from the U.S. Premier Healthcare Database. Multivariate analysis was used to compare the frequency of inpatient and outpatient revisits up to six months after an index encounter for CCO- vs. medicinal honey-treated PUs.

Results: The study identified 74,524 inpatients and 25,955 outpatients with PUs.  Overall, 54% of inpatients and 43% of outpatients had stages III or IV ulcers during their index visit. Among inpatients, N=44,725 (60% of discharges) were treated with CCO, and N=3,542 (5%) with medicinal honeys.  CCO and medicinal honeys accounted for 1,826 (7%) and N=773 (3%), respectively, of outpatients with PUs. In adjusted models, those treated with medicinal honeys had greater odds for inpatient readmissions (OR=1.16, 95% CI 1.07-1.25) after inpatient index visits, and outpatient re-encounters both after inpatient (OR=1.37, 95% CI 1.26-1.48) and outpatient (OR=1.28, 95% CI 1.05-1.57) index visits in six months of follow-up.

 Conclusion: Patients with CCO-treated PUs returned to the inpatient and outpatient hospital settings less often compared with medicinal honey-treated PUs. These real-world data indicating less healthcare utilization support results from retrospective clinical outcomes studies demonstrating faster healing time for CCO- vs. medicinal honey-treated wounds.