Workstreams 1–3 have substantially contributed to the evidence base and understanding of SWHSIs, providing data about patient characteristics, wound origins, durations and treatments, alongside patient and clinician views of living with and treating SWHSIs.
Workstream 1 has identified the prevalence of treated SWHSIs and has provided extensive data on populations of clinical relevance for inclusion in further research. The median time to healing we observed in this workstream highlights the extended period of time that patients might expect to cope with open surgical wounds. This workstream has also highlighted the distinctive management challenge posed by SWHSIs.
Workstream 2 has identified that NPWT is not a clinically effective or cost-effective treatment for SWHSIs. However, because this uses observational research, even with adjustment, there is still the potential for unresolved confounding to affect the results and so reduce confidence in them. This lack of confidence may justify calls for definitive evidence from a RCT, which would be more likely to effect a change in clinical practice should the evidence support one.
Workstream 3 has provided the first evidence of clinicians’ and patients’ views about the management and treatment of SWHSIs, and patients’ experiences of living with this condition. The impact of SWHSI on patients was evident in all interviews and the understanding of patient experiences will assist in providing effective management of this condition. The work conducted in workstream 3 has provided the necessary groundwork for further research in this area.
Interviews with clinicians identified increasing use of NPWT and illustrated the strength of support for NPWT among clinical staff, despite the lack of research. Surgeons and nurses perceived NPWT as safe and cost-effective; however, we have been unable to identify existing, or derive new, evidence to support this. Given the increasing use and perceived effectiveness of this treatment, it is crucial that further, robust evidence is obtained to support, or refute, the estimates derived from observational data in workstream 2.
In addition to the need to establish clinical effectiveness and cost-effectiveness of treatments, such as NPWT, the findings from workstreams 1–3 suggested that further research is necessary to understand the epidemiology of SWHSIs, prognostic factors for healing and the clinical effectiveness and cost-effectiveness of other treatment options. The findings of workstreams 1–3 helped formalise key components of the design of workstream 4 for this research programme, which comprised a pilot, feasibility RCT, required to assess feasibility of RCT assessment of NPWT compared with usual care (no NPWT), prior to a larger study being conducted.