Clostridial collagenase ointment and medicinal honey utilization for pressure ulcers in US hospitals

Abstract

Aims: To describe the utilization of clostridial collagenase ointment (CCO) and medicinal honey debridement methods in real-world inpatient and outpatient hospital settings among pressure ulcer (PU) patients and compare the frequency of healthcare re-encounters between CCO- and medicinal honey-treated patients.

Materials and methods: De-identified hospital discharge records for patients receiving CCO or medicinal honey methods of debridement and having an ICD-9 code for PU were extracted from the US Premier Healthcare Database. Multivariable analysis was used to compare the frequency of inpatient and outpatient revisits up to 6 months after an index encounter for CCO- vs medicinal honey-treated PUs.

Results: The study identified 48,267 inpatients and 2,599 outpatients with PUs treated with CCO or medicinal honeys. Among study inpatients, n = 44,725 (93%) were treated with CCO, and n = 3,542 (7%) with medicinal honeys. CCO and medicinal honeys accounted for 1,826 (70%) and 773 (30%), respectively, of study outpatients. In adjusted models, those treated with CCO had lower odds for inpatient readmissions (OR = 0.86, 95% CI = 0.80–0.94) after inpatient index visits, and outpatient re-encounters both after inpatient (OR = 0.73, 95% CI = 0.67–0.79) and outpatient (OR = 0.78, 95% CI = 0.64–0.95) index visits in 6 months of follow-up.

Limitations: The study was observational in nature, and did not adjust for reasons why patients were hospitalized initially, or why they returned to the facility. Although the study adjusted for differences in a variety of demographic, clinical, and hospital characteristics between the treatments, we are not able to rule out selection bias.

Conclusion: Patients with CCO-treated PUs returned to inpatient and outpatient hospital settings less often compared with medicinal honey-treated PUs. These results from real-world administrative data help to gain a better understanding of the clinical characteristics of patients with PUs treated with these two debridement methods and the economic implications of debridement choice in the acute care setting.

Keywords:

• Clostridial collagenase ointment
• debridement
• healthcare utilization
• medicinal honey
• pressure ulcer
• re-admission
• Santyl
• wound

Transparency

Declaration of funding

This study was funded by Smith & Nephew.

Declaration of financial/other relationships

CW and GD are employees of Smith & Nephew. JD, JG, and RJ are employed by and have equity ownership in Premier, Inc. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Previous presentations

These results were presented in abstract form at the Symposium on Advanced Wound Care (SAWC) Fall meeting, October 20–22, 2017, and at the Academy of Managed Care Pharmacy (AMCP) Nexus 2017, Dallas, TX, October 16–19, 2017.

Acknowledgments

No assistance in the preparation of this article is to be declared.