A retrospective analysis of hypochlorous acid solution versus saline 0.9% as instillation for negative pressure wound therapy in seriously infected lesions.

Introduction: Negative pressure wound therapy (NPWT) with instillation and dwell time is an accepted adjunct therapy for infected lesions. A study was conducted to assess whether the use of hypochlorous acid solution* (HOCl) as the irrigant would reduce cost of care in comparison to saline 0.9% (NaCl).

Method: A comparative, observational, retrospective analysis assessed 27 serious and infected skin lesions in 24 patients. The lesions were of different and complex etiologies, including necrotizing fasciitis and stage IV diabetic foot ulcers. NPWT was used as part of the overall treatment. The only variance in the treatment protocol was the use of saline (N=8) or HOCl (N=19) as the irrigant.

Results: When compared to NaCl, lesions treated with HOCl trended towards fewer OR visits (i.e., for debridement)  vs. NaCl (3.3 vs. 4.1) and a shorter length of stay (LOS, 24.3 vs. 37.9). The Orlando Health Transparency guide shows the cost of debridement as $ 25251. Thus, debridement for HOCl-treated lesions ($ 8332) costs $2020 (24%) less than for NaCl-treated lesions ($10,352).   Using 2016 Kaiser Health data2 (average daily hospital cost, excluding all interventions: $2052) the cost of HOCl and NaCl instill translates to $ 49,864 and $77,771 respectively, a difference of $ 27,906 (56%) more for NaCl treatment. AHRQ 2012 data3 indicate an average daily cost of hospital stay, including all interventions, of $10,400. Thus, HOCl treatment cost translates to $252,720 vs. NaCl related costs of $394,160: in these calculations, using NaCl costs $141.440 (+56%) more per patient than HOCl.

Conclusion: The use of NPWT with HOCl vs. NaCl as instillation in NPWT reduces the number of visits to the operating room as well as LOS: this has a significant impact on lowering cost of care when HOCl is used.