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A Randomized Clinical Trial

Dirk T. Ubbink, MD, PhD; Hester Vermeulen, RN, PhD; Astrid Goossens, RN, PhD; Raoul B. Kelner, MSc; Sanne M. Schreuder, MSc; Maarten J. Lubbers, MD

Arch Surg. 2008;143(10):950-955.

Objective  To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles.

Design  Randomized clinical trial.

Setting  Academic Medical Center, Amsterdam, the Netherlands.

Patients  Two hundred eighty-five hospitalized surgical patients with open wounds.

Intervention  Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed.

Main Outcome Measures  Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay.

Results  Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, 6.34 [US $9.95] vs gauze, 1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, 1.28 [US $2.01] vs gauze, 2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was 7.48 (US $11.74) in the occlusive group and 3.98 (US $6.25) in the gauze-based group (P = .002).

Conclusions  The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials.

Trial Registration  trialregister.nl Identifier: 56264738.

Author Affiliations: Departments of Surgery (Drs Ubbink, Vermeulen, and Lubbers, Mr Kelner, and Ms Schreuder) and Clinical Epidemiology, Biostatistics, and Bioinformatics (Drs Ubbink, Vermeulen, and Goossens), Academic Medical Center, Amsterdam, the Netherlands.

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