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Natural History of Pressure Ulcers in the Hospital: Who Benefits From Surgical Intervention?
Shawn Loder MD, Michael Gimbel MD
University of Pittsburgh
2019-02-14
Presenter: Shawn J Loder
Affidavit:
This work in its entirety represents the original work of the resident under guidance of the named faculty mentor.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Given public and political focus on healthcare costs, greater scrutiny has been applied to the distribution of care with the goal of increasing quality, decreasing cost, and avoiding futile treatment. In this study we examined characteristics associated with early post-operative mortality after pressure ulcer debridement.
Methods: This is a retrospective analysis of 147 patients with ulcer debridement between 2000-2016 for a total of 208 operative encounters. Average time to death was 2.2+/-2.5 years. We evaluated post-operative survival versus social, surgical, medical and wound histories. Sub-population analysis was performed for plegic patients vs. those immobilized secondary to medical debility.
Results: Paraplegia/quadriplegia and diverting ileostomy/colostomy were significantly associated with survival. History of cardiopulmonary disease and type 2 diabetes were associated with 1-year mortality while end-stage renal disease, end-stage liver disease (ESLD), chronic respiratory failure and pulmonary hypertension were significantly associated with death in the first post-operative month. On sub-population analysis, post-operative survival to 1-year was greater for the plegic group. Within the debilitated group ESLD was significantly associated with first month mortality, cardiopulmonary disease remained associated with death by 1 year, and tracheostomy was associated with death at all time-points.
Conclusion: Patients with mechanical cause for immobility tended to be more likely to survive operative intervention, however, they had had a lower burden of medical comorbidities. Even in debilitated populations ESLD and tracheostomy independently suggested poor post-operative outcome. These data are suggestive of a sub-population of medically debilitated patients for whom judicious restraint is necessary prior to pursuing operative intervention.
