US Medicare data show incidence of hospital-acquired pressure ulcers is 4.5%, and they are associated with longer hospital stay and higher risk of death

Abstract

Commentary on: Lyder CH, Wang Y, Metersky M, et al. Hospital-acquired pressure ulcers: results from the national Medicare patient safety monitoring system study. J Am Geriatr Soc 2012;60:268-8. Implications for practice and research▪ Pressure ulcers (PUs) are common and often occur in older persons and those with multiple comorbidities.▪ Patients with hospital-acquired PUs (HAPUs) have longer hospital stays and higher rates of morbidity and mortality; therefore, prevention and early detection are important priorities for nursing care.▪ Interpretation of epidemiological studies of PUs is difficult due to variances in data collection methods and PU classification employed, making cross comparisons between clinical sites challenging. ContextDevelopment of HAPUs is considered an adverse event. 1 Thus, the incidence of HAPU is commonly used as a quality marker for healthcare facilities. One of the challenges in interpreting data lies in the lack of homogeneity in how figures are collated, for example, variability in sample sizes, data collection and PU grading systems employed. For institutions, the ability to benchmark against others is therefore limited, compounding the challenges in determining success in prevention strategies. It is with this background that the current study was undertaken, the aim of which was to determine PU incidence across the USA. MethodsData were collected, retrospectively, for hospital discharges for a 2-year period ( January 2006 to December 2007. The records of 51 842 Medicare fee-for-services in patient discharges, across the 50 states, were analysed for documented presence of PU on admission ( prevalence) and the development of new PUs during hospital stay (incidence). Demographic data and the presence of comorbidities associated with PU risk were also recorded. Diagnosis of a PU was based on the nurse and physician documentation within the medical record. Inter-rater reliability of data collection was established at 90%, between the data abstractors and the principal investigator, before commencement of the study. Data were analysed using descriptive and bivariate analysis, with the focus to compare the differences in characteristics and outcomes for those who did and did not develop a HAPU. FindingsThe nationwide HAPU incidence was 4.5% (n=2313/ 51 842); however, there was a variance between states (3.2%, SE=1.2%). PU prevalence on admission was 5.8% (n=2999/51 842) and of these 16.7% (n=502/2999) developed a new PU during hospital stay. The majority of PUs occurred in individuals aged 75-85 years, who were non-white and had higher rates of comorbidities (p≤0.05). There was a statistically significant association between the development of a HAPU and inpatient mortality, and mortality within 30 days postdischarge (p≤0.001; OR 2.81, 95% CI 2.44 to 3.23; p≤0.001; OR 1.69, 95% CI 1.67 to 1.77, respectively). Furthermore, those with a HAPU had a statistically significant longer length of stay compared to those without a HAPU (11.6±10.1 days vs 4.9±5.2 days, p<0.001).

The relationship between pressure injury complication and mortality risk of older patients in follow‐up: A systematic review and meta‐analysis

“…Our results showed that elderly patients with concurrent PIs can accelerate mortality of the elderly patients (HR: 1.78; 95% CI: 1.46‐2.16). Our finding confirmed the previous researches on the relationship between PIs and mortality . There are few reports that have reported the mortality of PIs.…”

Length of surgery and pressure ulcers risk in cardiovascular surgical patients: a dose–response meta‐analysis

“…Pressure ulcers not only make a significant independent contribution to the excess length of hospitalisation but also increase significant additional costs for pressure ulcer treatment . Most importantly, pressure ulcers are associated with a higher risk of mortality . Many studies have examined factors associated with SRPU development in cardiovascular surgery patients.…”

Costs of topical treatment of pressure ulcer patients

“…In the international setting, the prevalence varies between 5.0 and 15%, and the incidence between 1.9 and 7% (3,(6)(7)(8)(9) . International studies show a prevalence of 11.1 to 23.2%, and an incidence of 22.5 to 66.6% (10)(11)(12)(13)(14) . Costs of PU management represent a constant challenge for health institutions, since the economic aspect is essential for making decisions related to the use of technologies (15) .…”