Background

Chronic wounds are those that do not proceed through an orderly and timely sequence of repair generally, they remain static for more than 4 weeks [1]. In contrast to acute wounds, which progress in a regulated series of hemostasis, inflammation, proliferation and matrix remodeling, many chronic wounds are arrested in an inflammatory phase with delayed tissue regeneration. Chronic wounds are frequently categorized as diabetic foot ulcers, pressure (or decubitus) ulcers, venous leg ulcers and arterial ulcers [2]. Each category has a specific etiology but is all linked through common pathophysiological aspects such as ischemia, infection, neuropathy and impaired cellular response.

The worldwide burden of chronic wounds is extensive and increasing with ageing populations, rise in diabetes mellitus, obesity and vascular diseases [3]. The diabetic foot ulcers alone are suffered by millions of individuals in the world and are one of determinant factors for the amputations (non-traumatic) in inferior member. Pressure ulcers are very common in hospitals and immobilized patients characterised by an extended period of hospitalisation and substantial health care costs [4]. Venous leg ulcers are the most frequent long-term wound of the lower limb in adults and cause considerable morbidity, impaired quality of life and high expenditure on health care. Chronic wounds represent a substantial cost burden on health systems due to prolonged treatment, multiple hospital visits, and high-level wound care [5].

The pathophysiology of abnormal wound healing in chronic wounds includes prolonged inflammation, increased protease activity, bacterial colonization, reduced growth factor levels and impaired angiogenesis [6]. Microvascular failure with tissue hypoxia also impairs tissue regeneration while other systemic factors (hyperglycaemia, malnutrition, and immunosuppression) perpetuate the local destruction [7]. These multivariate factors highlight the requirement for complex treatment strategies, which serve to modulate the wound environment and encourage resolution.

NPWT is a mode of advanced wound care which utilizes controlled sub-atmospheric pressure on the wound site via granulation tissue formation [8]. NPWT also enhances angiogenesis, improves local blood flow, reduces edema, and decreases bacterial load, thereby creating an optimal wound-healing environment [9]. The mode of action is both by macrodeformation, which promotes wound contraction and removal of exudate, and microdeformation that creates sub-strain at the wound surface, stimulating proliferation and formation of granulation tissue [10]. NPWT also stimulates angiogenesis, increases local circulation, reduces edema and decreases bacterial contamination, and induces an optimal wound-healing environment.

NPWT originally became popular in the late 1990s when new technology allowed for a controlled, portable vacuum system [11]. It has since become more widely used in the treatment of challenging and chronic wounds. In contrast to traditional wound dressings, which mainly provide a  passive coverage and moisture transfer control, NPWT provides not only a means of active wound modulation as constant elimination of exudate by-product but also promotes tissue generation [12]. The initial device cost is greater,  but overall treatment time and hospital stay may be significantly decreased with NPWT.

Rationale for Study

Despite the broad acceptance through clinical practice, literature of NPWT cost-effectiveness is discrepant. Some findings indicate lower long-term costs from faster healing and lower complications, as others reveal higher overall costs with the use of a technology. Moreover, regional historical data observing  at real-life results are scarce. The majority of studies are randomised control trial (RCTs) with very strict inclusions or developed from high-resource settings, hence a lack of generalizability. Hence, current real-world evidence from December 2023 to December 2025 is required in order to evaluate healing rates and complication rates as well as the economic effect under routine clinical conditions.

Study Objectives

The main aim of this study is to assess the rates of healing in chronic wounds when treated with NPWT. Secondary aims are to evaluate therapy-associated complications and cost-effectiveness of NPWT with those of conventional wound therapies in a retrospective study group of 130 patients.

Study Design

This was a retrospective observational cohort study designed to assess clinical and economic outcomes of NPWT in patients with chronic wounds. A retrospective design was chosen to ensure real-world clinical data analysis for a specific period and to avoid affecting decisions regarding treatment. Records were evaluated systematically for healing rate, complications and associated costs to the health care service.

Study Setting

This was a study in the tertiary level teaching hospital with a dedicated wound care and surgical unit. All types of patients are referred to the hospital from urban as well as semi-urban locations and it provides advanced wound care center service, including NPWT. Consistent clinical data recording was assured by the standardized protocols of wound assessment and electronic documentation systems established during the study period.

Study Duration

Patients treated from December 2023 to December 2025 were included. These 2 years were chosen to enable a sufficiently large sample size and allow for an adequate follow-up time in order to be able to evaluate wound healing as well as complications.

Sample Size

A total of 130 patients were eligible and enrolled in the study. Consecutive sampling was used, which means that all suitable patients who were both treated with NPWT and who underwent care for chronic wounds during the study period were recruited. This strategy reduced selection bias and increased the representativeness of the study population.

Inclusion Criteria

Included patients were 18 years or older and had a chronic wound of more than four weeks duration, managed with NPWT. Chronic wounds were diabetic foot ulcers, pressure injuries, venous leg ulcers and other non-healing wounds of a similar duration.

Exclusion Criteria

Patients with malignant wounds, osteomyelitis without cure, or inadequate medical records were excluded from the study. These exclusions were made to minimize potential confounders that may affect the progress of wound healing in and of itself, or potentially confoundable when performing retrospective data analyses.

Data Collection

Data collected were extracted from electronic medical records using a uniform case report form. Variables analysed included the  patient characteristic, co-morbidity, wound patterns and treatment modalities. Wound area (cm²) was recorded at baseline and follow-up. The number of days/weeks NPWT was used, time to closure of the wound and any associated therapy complications were noted. For economic evaluation, financial information such as device and dressing costs, hospital stay expense, and readmission charge was collected from the hospital billing records.

Outcome Measures

The primary outcomes of the study were the rate of complete wound healing, as defined by full epithelialization without drainage, and time to wound closure in days after NPWT initiation. Secondary outcomes were complications (infection, bleeding, device-related problems), rehospitalization for wound complications and overall costs per patient.

Cost-Effectiveness Analysis

Cost-effectiveness analysis was performed through the calculation of direct costs like NPWT device, dressings and hospital stay cost, as well as indirect costs related to readmissions. The cost per healed wound was calculated by dividing total spending by the number of patients whose wounds healed successfully. These results were contrasted by historical institutional data in traditional wound care when appropriate.

Statistical Analysis

The data were analyzed statistically using SPSS. Descriptive statistics summarized baseline characteristics and outcomes. Data for continuous variables were given as mean ± standard deviation, and frequencies with corresponding percentages for categorical data. Relationships between categorical variables were tested using the Chi-square test, while continuous variables were compared using the independent t-test. Time-to-healing responses were analyzed with Kaplan–Meier survival analysis as appropriate. All tests were two-sided and P value < 0.05 was considered statistically significant.

Ethical Approval

This study protocol has been approved by the Institutional Review Board of the participating hospital. Since it is a retrospective study with anonymize patient information, informed consent was waived under institutionally ethical committee.

Baseline Demographics

The final analysis comprised 130 patients. The average age of the study population was 58.4 ±12.6 years (range: 22–84). Most patients were 51-70 years old (46.9%), 31-50 years old (26.9%), >70 (16.9%) and 18–30-year-old groups (9.3%). There was a male majority with (82) 63.1% males and (48) 36.9% females.

As for comorbidity, diabetes mellitus was the most frequent (78 patients, 60.0%). Peripheral arterial disease (PAD) was present in 32 patients (24.6%) and obesity (BMI ≥30 kg/m²) in 41 patients (31.5%). Most patients were diagnosed with more than one comorbidity. In the case of wounds categorized by type, 55 cases (42.3%) were diabetic foot ulcers, 30 cases (23.1%) pressure ulcers, 28 cases (21.5%) venous leg ulcers, and 17 cases (13.1%) other chronic wounds.

Table 1 Baseline Characteristics

Healing Outcomes

The total complete wound healing rate in patients submitted to NPWT was 82.3% (107 patients out of a total of 130). The average duration till wound closure was 41.7 ± 14.3 days.

The subgroup analysis showed that the healing rate in non-diabetic patients was significantly higher (90.4%) than that of diabetic patients (76.9%). The average treatment time was also longer among diabetic (45.6 ± 15.1 days) than non-diabetic patients (36.2 ± 11.8 days).

Table 2 Healing Outcomes

Complications

There were complications occurred in 29 patients (22.3%). The most frequent complication was wound infection, which developed in 15 patients (11.5%). 6 (4.6%) patients experienced post-procedure bleeding, 5 (3.8%) had persistent pain requiring intervention, and 3 (2.3%) experienced device failure. The majority of adverse events were treated conservatively without discontinuation of therapy.

Table 3 Complications

Cost Analysis

The mean entire cost of the therapy provided for patients treated with NPWT was about ₹2,03,350 ± ₹43,160. When compared with historical institutional conventional wound dressing costs (average ₹2,40,700 ± ₹50,630), NPWT resulted in less cost expenditure mainly due to decreased length of hospitalization and a lesser number of the number or processing of dressing changes.

The cost per healed wound for NPWT was ₹2,47,174 and for conventional treatment it was ₹3,00,875with improved cost-effectiveness despite higher initial estimates of device costs.

Table 4 Cost Analysis

Statistical Findings

Statistically, diabetes mellitus was significantly related to delayed wound healing (p = 0.021). Peripheral arterial disease and prolonged healing were also significantly correlated (p = 0.034). Age >70 years was a tendency for prolonged healing but did not reach statistical significance (p = 0.067).

Kaplan-Meier survival analysis demonstrated that wound healing was significantly faster in non-diabetic than in diabetic patients (log-rank p = 0.018). Multiple logistic regression analysis showed diabetes and PAD to be independent risk factors in delayed healing.

Overall, NPWT had a high healing rate, acceptable complication rate and cost-effective benefit in treating chronic wounds.

The current retrospective analysis revealed a better rate of successful healing (82.3%) in patients with chronic wounds following NPWT application, on average after 42 treatment days. Better healing results in this group might be explained by the biological effects of NPWT. The use of controlled sub-atmospheric pressure induces macrodeformation to promote wound contraction and efficient evacuation of excess exudate. At the same time, microdeformation at the cellular level is shown to increase fibroblast proliferation, granulation tissue formation, and angiogenesis. The enhancement of local perfusion and reduction in tissue edema were likely the underlying

mechanisms in the preclinical wound healing study, resulting in accelerated wound closure. However, delayed healing in the presence of diabetes or peripheral arterial disease points to a persistent role for systemic vascular compromise despite high-end local treatment.

Comparison with Existing Literature

The results of this study are similar with reported studies indicating better healing for NPWT than conventional dressing. Several randomized controlled trials and meta-analysis studies report healing rates in between 75 and 85% among chronic wound populations, which is consistent with our finding of 82.3% [13]. Certain trials have also highlighted diabetes and vascular insufficiency as strong predictors of slow healing, which is consistent with our subgroup analysis [14]. Although the initial treatment cost of NPWT in some studies is reported to be higher, there is increasing evidence that shorter hospital stay achieved and faster wound closure can compensate for such expenditure [15]. Our cost calculation also underlines the economic feasibility of NPWT in routine clinical treatment.

Strengths of Study

The current study offers useful real-life evidence of the success of NPWT in treating chronic wounds throughout a variety of patient populations. It provides an exhaustive analysis with the combination of clinical results, complication rates and economic point of view. The use of standardized electronic medical records improved the reliability of data, and the statistical analysis methods supported the validity of results. Overall study provides an even handed and clinically useful view of NPWT in routine clinical practice.

Limitations

The retrospective design restricts causal inference and may lead to documentation bias. Due to the single-center study, there might be limited generalizability. Moreover, the lack of a randomized control group precludes comparison to contemporary standard therapy. Future multi-center prospective research is needed to confirm these results.

The retrospective study collects evidence showing that NPWT effectively increases healing rates with patients with chronic wounds in clinical practice, and the final overall closure rate is higher than 80% within a reasonable time. The treatment was characterised by a reasonable complication profile with predominantly minor, manageable adverse events. However, despite the higher device cost at baseline, more items and less time for dressing changes and a lower cost per healed wound were reported with NPWT over time. Based on these results, NPWT should be considered as an efficacious and feasible technique for the treatment of chronic wounds in daily clinical practice.

Future Recommendations

Further research should concentrate on large prospective RCTs to provide more convincing causal correlation between NPWT and traditional wound care. Multicentered studies that include more patients of varied populations and races would improve study generalizability. Furthermore, long-term follow-up is needed to assess wound recurrence rates, durability of cost-effectiveness, and long-term functional outcomes. Clinical and therapeutic effectiveness may be improved by learning more about how to choose patients and create treatments.

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