Surgical reconstruction of severe pressure ulcers in England from 01/04/2011 to 30/09/2018: Retrospective cohort study using routinely collected data.

Abstract

Introduction: We identified patients in England admitted to hospital with severe pressure ulcers (SPUs), quantified how many had surgical reconstruction (SR) to close SPUs and described their outcomes.

Methods: Using Hospital Episode Statistics (2010ꟷ2019), we identified adults with SPU who had undergone SR. Outcomes were: length of stay; time-to-next-admission with SPU diagnosis; repeat SR; death from any cause (Office for National Statistics). Maximum and minimum numbers of SRs to close SPUs (the latter comprising a subset about whom we had greatest confidence) were estimated by applying increasingly specific filters.

Results: A minimum of 404 and maximum of 1018 patients with SPUs had SR over 7.5 years. Patients in the minimum subset were younger than the entire SR group (median 52 versus 58 years), had fewer comorbidities and were more likely to have a cause of impaired mobility. In the subset and entire group, median hospital stays after SR were 26 (IQR 13ꟷ48) and 42 (IQR 17ꟷ90) days. By one year, more patients in the subset had a further admission with SPU (24.4%, 95% CI 20.5%ꟷ29.0% versus 21.7%, 95%CI 19.2%ꟷ24.5% vs) and fewer had died (4.0%, 95%CI 2.5%ꟷ6.4% versus 14.6%, 95%CI 12.6%ꟷ16.7%); by two years, more had a second SR (10.7%, 95%CI 7.8%ꟷ14.5% versus 7.4%, 95%CI 5.7%ꟷ9.5%). Half the entire number of SRs (505/1018) were performed by 10 of 124 English hospitals.

Conclusion: Patients in the subset most likely had SR to close their SPUs. Their outcomes provide evidence that SR to close an SPU is effective for such patients.