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 osteoarthritis 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’ history 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.
Notwithstanding the study’s limitations, real-world evidence highlights the substantial burden that wounds
continue to impose on the NHS in an average year. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (1) accurate diagnosis, (2) preventing infection and (3) improving
wound-healing rates. However, these benefits are unlikely to be realised unless there is a structural change within
the NHS in order to manage the increasing demand for wound care.