Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial

Abstract

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, euro6.34 [US $9.95] vs gauze, euro1.85 [US $2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, euro1.28 [US $2.01] vs gauze, euro2.41 [US $3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was euro7.48 (US $11.74) in the occlusive group and euro3.98 (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.