Incidence and Risk Factors of Hospital-Acquired Pressure Ulcers Following Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Abstract

BackgroundThe occurrence of hospital-acquired pressure ulcers (HAPUs) is disturbing and costly, leading to a variety of adverse effects. The objective of this study was to examine the incidence and risk factors of HAPUs following total hip arthroplasty (THA) using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed.ResultsA total of 592,174 THAs were captured from the NIS database. The general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance compared to the nonaffected individuals. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors of HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n≥3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Both elective admission and Private insurance were detected as protective factors. ConclusionsIt is beneficial to study the risk factors of HAPUs after THA to ensure the preventive management and optimize consequences although a really low incidence was identified.