![]() ![]() The overall effect of NPWT on pain is uncertain (very low‐certainty evidence from seven trials (2218 participants) which reported disparate measures of pain) but moderate‐certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low‐certainty evidence) for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59 I 2 = 0% nine trials 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68 I 2 = 69% seven trials 796 participants). For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41 I 2 = 13% 12 trials 3523 participants) for seroma, the RR was 0.72 (95% CI 0.50 to 1.05 I 2 = 0% seven trials 729 participants). There is low‐certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. There is low‐certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13 I 2 = 0%). Eighteen studies reported dehiscence 14 of these (3809 participants) were included in meta‐analysis. There is moderate‐certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment with standard dressings (13.0% of participants) after surgery RR 0.66 (95% CI 0.55 to 0.80 I 2 = 23%). Thirty‐nine studies reported SSI 31 of these (6204 participants), were included in meta‐analysis. There is low‐certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86 95% confidence interval (CI) 0.50 to 1.47 I 2 = 0%). Most studies had unclear or high risk of bias for at least one key domain.įour studies (2107 participants) reported mortality. ![]() All studies compared NPWT with standard dressings. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. HCPCS code A7000 applies to the canister that goes with the pump.In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. The Healthcare Common Procedures Coding System (HCPCS) code E2402 applies to the pump (NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE) and HCPCS code A6550 applies to the dressing sets (WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND ACCESSORIES). Currently, all NPWT devices are classified into the same HCPCS codes. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Use an existing process for the consideration of coding changes and consider all relevant studies and information furnished pursuant to such processes. Specifically the evaluation of existing HCPCS codes for NPWT should:Įnsure accurate reporting and billing for items and services under such codes and Section 154 (c) (3) of the Medicare Improvements for Patient and Providers Act (MIPPA) of 2008 calls for the Secretary of Health and Human Services to perform an evaluation of the Healthcare Common Procedure Coding System (HCPCS) coding decisions for Negative Pressure Wound Therapy (NPWT) devices. AHRQ assigned this report to the following Evidence-based Practice Center: ECRI Institute EPC (Contract Number: 290-2007-10063). The Center for Medicare Management at the Centers for Medicare and Medicaid Services (CMS) requested this report from The Technology Assessment Program (TAP) at the Agency for Healthcare Research and Quality (AHRQ). ![]()
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