Care‐Related Risk Factors for Hospital‐Acquired Pressure Ulcers in Elderly Adults with Hip Fracture

Abstract

OBJECTIVES To identify care-related factors associated with increased incidence of hospital-acquired pressure ulcers (HAPU) DESIGN Prospective cohort study SETTING Nine hospitals in Baltimore Hip Studies network PARTICIPANTS 658 patients age ≥65 years who underwent surgery for hip fracture MEASUREMENTS Skin examinations at baseline and alternating days until hospital discharge. Patients were deemed to have a HAPU if they developed ≥1 new pressure ulcers stage 2 or higher during the hospital stay. RESULTS Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio [aIRR] 0.68, 95% confidence interval [CI] 0.48-0.96; >6 hours: aIRR 0.68, 95% CI 0.46-0.99, both compared to ≤4 hours). Patients with ≥24 hours between admission and surgery had a higher post-surgery HAPU rate than those with <24 hours (aIRR 1.62, 95% CI 1.24-2.11). Surgery with general anesthesia had a lower post-surgery HAPU rate than surgery with other types of anesthesia (aIRR 0.66, 95% CI 0.49-0.88). There was no significant association of HAPU incidence with timing or type of transport to hospital, or surgery duration. CONCLUSION Most of the factors hypothesized to be associated with higher pressure ulcer incidence were either associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice.

Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study

“…It should be noted that the time in the ER, and therefore on the gurney, was only 1 hour and 35 minutes, much less than that indicated in other studies [25]. Other results which contrasted with those reported in the literature regarded the length of time to surgery; this did not have any correlation with the development of pressure ulcers as has instead been indicated by the majority of studies [6,10,25]. However, the average wait (40 hours) was less than that stated in the above-mentioned studies which confirmed the value of early surgery.…”

“…Instead, the thickness of the mattress on the gurney in the ER was confirmed not to influence the development of lesions [9]. It should be noted that the time in the ER, and therefore on the gurney, was only 1 hour and 35 minutes, much less than that indicated in other studies [25]. Other results which contrasted with those reported in the literature regarded the length of time to surgery; this did not have any correlation with the development of pressure ulcers as has instead been indicated by the majority of studies [6,10,25].…”

Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014)

“…14,15,16 Patients with hip fracture are at high risk of pressure ulcers 17 and can have significant negative effects in terms of pain, quality of life, length of hospital stay, cost of care, medical complications, and mortality. 18 The optimal treatment for these injuries is surgery, since nonoperative treatment was associated with longer hospitalization, more malunions, pressure ulcers, and less likely to return to an independent level of functioning. 19 Current guidelines suggest that Surgery for hip fracture should be performed within 24 hours of injury.…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…27 Early surgery has been shown to reduce the risk of pressure ulcer. 173,174 Frequent repositioning of bedbound patients with hip fracture was not shown in a recent study to reduce the risk of development of pressure ulcer. 175 Early mobilization following surgery seems to be a useful approach to avoidance of pressure ulcer.…”