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Patients with surgically treated pressure ulcers: a multivariate analysis of factors influencing surgical readmission in a tertiary hospital
Isis Scomacao, Eliana F. R. Duraes, Humzah A. Quereshy, Christi Cavaliere
Cleveland Clinic
2018-02-15
Presenter: Isis Scomacao
Affidavit:
I certify the project represents original work of the residents and authors on this project
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: The goal of this study was to evaluate factors influencing wound-related readmissions after surgical debridement of pressure ulcers and intravenous antibiotic treatment of osteomyelitis or soft tissue infection.
Method: From January/2014-December/2016 a retrospective chart review was performed to evaluate patients that underwent surgical debridement in the plastic surgery department. Multivariate analysis was performed to identify independent factors leading to wound-related readmissions.
Results: Eighty-three patients were surgically debrided: 54.21% male, 31.32% had smoking history, 90.36% were ASA class 3-4. Average BMI was 27.49 ±9.36 m2 and average age 58.74 ±16.88 years. Paraplegia/ quadriplegia was observed in 34 (38.55%) patients. Moderate and severe malnutrition was present in 38 (45.78%). Mean albumin level was 2.75 ±0.70 g/dL. Patients underwent an average of 1.49 ±1.04 debridements. Upon initial assessment 62.65% of patients were scheduled for inpatient debridement. For the remaining patients (30.12%), initial evaluation led to a recommendation for non-operative management. These patients were readmitted on average 6.79 ±7.35months later and then underwent surgical debridement. Post-operative bleeding occurred in 2 (2.40%) patients. Readmission was observed in 62 (74.69%) patients with an average of 2.89 ±3.52 admissions/patient. Readmissions related to PU occurred in 23 (27.71%) with an average of 0.89 ±1.28. Average surgical blood loss was 57 ±26.03ml and OR time was 58 ±41min. Independent factors influencing wound-related readmissions were: hypertension (p=0.014), diabetes (p=0.009).
Conclusion: Surgical debridement of pressure ulcers presents low rates of complications with minimal blood loss and relatively short surgical time. Hypertension and diabetes were significantly associated with increased wound-related readmissions.
