{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:20:06Z","timestamp":1789474806661,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T00:00:00Z","timestamp":1583712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001348","name":"Agency for Science, Technology and Research","doi-asserted-by":"publisher","award":["H18\/01\/a0\/ZZ9"],"award-info":[{"award-number":["H18\/01\/a0\/ZZ9"]}],"id":[{"id":"10.13039\/501100001348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>The aim of this study is to evaluate the clinical and economic burden of wound care in the Tropics via a 5\u2010year institutional population health review. Within our data analysis, wounds are broadly classified into neuro\u2010ischaemic ulcers (NIUs), venous leg ulcers (VLUs), pressure injuries (PIs), and surgical site infections (SSIs). Between 2013 and 2017, there were a total of 56\u2009583 wound\u2010related inpatient admissions for 41\u2009461 patients, with a 95.1% increase in wound episodes per 1000 inpatient admissions over this period (142 and 277 wound episodes per 1000 inpatient admissions in 2013 and 2017, respectively). In 2017, the average length of stay for each wound episode was 17.7\u2009days, which was 2.4 times that of an average acute admission at our institution. The average gross charge per wound episode was USD $12\u2009967. Among the 12\u2009218 patients with 16\u2009674 wound episodes in 2017, 71.5% were more than 65\u2009years of age with an average Charlson Comorbidity Index (CCI) of 7.2. Half (51.9%) were moderately or severely frail, while 41.3% had two or more wound\u2010related admission episodes. In 2017, within our healthcare cluster, the gross healthcare costs for all inpatient wound episodes stand at USD $216 million within hospital care and USD $596\u2009000 within primary care. Most NIU patients (97.2%) had diabetes and they had the most comorbidities (average CCI 8.4) and were the frailest group of patients (44.9% severely frail). The majority of the VLU disease burden was at the specialist outpatient setting, with the average 1\u2010year VLU recurrence rate at 52.5% and median time between healing and recurrence at 9.5 months. PI patients were the oldest (86.5% more than 65\u2009years\u2010old), constituted the largest cohort of patients with 3874 patients at an incidence of 64.6 per 1000 admissions in 2017, and have a 1\u2010year all\u2010cause mortality rate of 14.3%. For SSI patients, there was a 125% increase of 14.2 SSI wound episodes per 1000 inpatient admissions in 2013 to 32.0 in 2017, and a 413% increase in wound\u2010related 30\u2010day re\u2010admissions, from 40 in 2013 (4.1% of all surgeries) to 205 (8.3% of all surgeries) in 2017. The estimated gross healthcare cost per patient ranges from USD $15789\u201317\u2009761 across the wound categories. Similar to global data, there is a significant and rising trend in the clinical and economic burden of wound care in Tropics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iwj.13333","type":"journal-article","created":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T09:11:38Z","timestamp":1583745098000},"page":"790-803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Clinical and economic burden of wound care in the tropics: a 5\u2010year institutional population health review"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2289-5266","authenticated-orcid":false,"given":"Zhiwen J.","family":"Lo","sequence":"first","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuxin","family":"Lim","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Eng","sequence":"additional","affiliation":[{"name":"Nursing Service Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josip","family":"Car","sequence":"additional","affiliation":[{"name":"Centre for Population Health Sciences Nanyang Technological University Lee Kong Chian School of Medicine  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiantai","family":"Hong","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enming","family":"Yong","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadhana","family":"Chandrasekar","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn W. L.","family":"Tan","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yam M.","family":"Chan","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seow C.","family":"Sim","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service Department of General Surgery, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien W.","family":"Oei","sequence":"additional","affiliation":[{"name":"Office of Clinical Epidemiology Analytics and Knowledge, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Office of Clinical Epidemiology Analytics and Knowledge, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayliana","family":"Dharmawan","sequence":"additional","affiliation":[{"name":"Office of Clinical Epidemiology Analytics and Knowledge, Tan Tock Seng Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Z.","family":"Ng","sequence":"additional","affiliation":[{"name":"Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Harding","sequence":"additional","affiliation":[{"name":"Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zee","family":"Upton","sequence":"additional","affiliation":[{"name":"Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun W.","family":"Yap","sequence":"additional","affiliation":[{"name":"Health Services and Outcomes Research National Health Group  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bee H.","family":"Heng","sequence":"additional","affiliation":[{"name":"Health Services and Outcomes Research National Health Group  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-2786"},{"key":"e_1_2_9_3_1","volume-title":"Wound Healing (Neligan Plastic Surgery: Volume One)","author":"Sen CK","year":"2017"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2017.07.007"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12443"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12603"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12683"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.10.005"},{"key":"e_1_2_9_9_1","unstructured":"National Healthcare Group Corporate Yearbook FY2018.https:\/\/corp.nhg.com.sg\/Lists\/Corporate%20Year%20Book\/Attachments\/67\/NHG%20Yearbook%202019%20Lowres%20Single1.pdfAccessed December 2019."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-8-24"},{"issue":"1","key":"e_1_2_9_12_1","first-page":"20","article-title":"Modelling the direct health care costs of chronic wounds in Australia","volume":"22","author":"Graves N","year":"2014","journal-title":"Wound Prac Res: J Aust Wound Manage Assoc"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2009.00543.x"},{"issue":"3","key":"e_1_2_9_14_1","first-page":"130","article-title":"An economic evaluation of chronic wound management in a tertiary hospital","volume":"24","author":"Tan BK","year":"2016","journal-title":"Wound Prac Res"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2006.15.6.26922"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12580"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2010.00666.x"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13332"},{"key":"e_1_2_9_19_1","unstructured":"World Health Organization Fact Sheet on Diabetes.https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes. 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