Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013 Hint: a 71% increase! @DiabetesRC

There were at least 3.8 million wounds managed in the UK’s NHS in 2017-2018– an amazing 7% of the adult population. This constitutes a massive 71% increase from the last review in 2014. Here is the abstract from Guest, Fuller and Vowden. Here is the full-text.

Objective To evaluate the prevalence of wounds managed by the UK’s National Health Service (NHS) in 2017/2018 and associated health outcomes, resource use and costs. Design Retrospective cohort analysis of the electronic records of patients from The Health Improvement Network (THIN) database.

Setting Primary and secondary care sectors in the UK. Participants Randomly selected cohort of 3000 patients from the THIN database who had a wound in 2017/2018. Primary and secondary outcome measures Patients’ characteristics, wound-related health outcomes, healthcare resource use and total NHS cost of patient management.

Results There were an estimated 3.8 million patients with a wound managed by the NHS in 2017/2018, of which 70% healed in the study year; 89% and 49% of acute
and chronic wounds healed, respectively. An estimated 59% of chronic wounds healed if there was no evidence
of infection compared with 45% if there was a definite or suspected infection. Healing rate of acute wounds was unaffected by the presence of infection. Smoking status appeared to only affect the healing rate of chronic wounds. Annual levels of resource use attributable to wound management included 54.4 million district/community nurse visits, 53.6 million healthcare assistant visits and 28.1 million practice nurse visits. The annual NHS cost of wound management was £8.3 billion, of which £2.7 billion and £5.6 billion were associated with managing healed and unhealed wounds, respectively. Eighty-one per cent of the total annual NHS cost was incurred in the community. Conclusion The annual prevalence of wounds increased by 71% between 2012/2013 and 2017/2018. There was a substantial increase in resource use over this period and patient management cost increased by 48% in real terms. There needs to be a structural change within the NHS in order to manage the increasing demand for wound care and improve patient outcomes.

This summary published by Julian Guest, lead author of this superb piece:

The recently published 2017/2018 burden of wounds study can be accessed from BMJ Open at https://bmjopen.bmj.com/content/bmjopen/10/12/e045253.full.pdf

The study estimated that the UK’s National Health Service (NHS) managed 3.8 million patients with a wound in 2017/2018, equivalent to 7% of the adult population. This represents a 71% increase in the annual prevalence of wounds since 2012/2013. An estimated 89% and 49% of acute and chronic wounds healed, respectively, indicating only a 13% improvement in the healing rate over the five years (since 2012/2013). However, an estimated 59% of chronic wounds healed if there was no evidence of infection compared with 45% if there was a definite or suspected infection. The healing rate of acute wounds was unaffected by the presence of infection. Smoking status appeared to only affect the healing rate of chronic wounds.

The annual NHS cost of wound management was £8.3 billion, indicating a 48% increase in the cost of wound management in real terms since 2012/2013. This cost is approaching the combined annual NHS cost of managing osteo and rheumatoid arthritis, which was reported to be £10.2 billion in 2017.

An estimated 70% of all the wounds healed in the study period. Resource use associated with managing the 30% of wounds that did not heal in the study year was substantially greater than that of managing the wounds that did heal. Consequently, the cost of managing the healed wounds was an estimated £2.7 billion, compared with £5.6 billion for the wounds that remained unhealed.

In the 2012/2013, it was estimated that 65% of all the patients with a wound were 65 years of age or older. However, in the 2017/2018, only 33% of patients were estimated to be in this age group (p<0.001), suggesting that wounds are no longer predominantly the preserve of the elderly. In parallel with the demographic changes, there was a change in the distribution of patients’ comorbidities. Most striking was that 29% of the 2012/2013 cohort had diabetes compared with 57% in 2017/18 (p<0.05).

The shift towards greater utilisation of community-based resources is reflected in the distribution of patient management between secondary care and the community. In 2012/2013, an estimated 48% of the costs of managing acute wounds and 78% of the costs of managing chronic wounds were incurred in the community and the remainder in secondary care. In 2017/2018, an estimated 68% and 85% of the costs of managing acute and chronic wounds, respectively, were incurred in the community and the remainder in secondary care.

The (real world) evidence in this study indicates there needs to be a structural change within the NHS in order to manage the increasing demand for wound care and improve patient outcomes.

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