Timing of rehabilitation and pressure ulcers requiring treatment during acute hospitalization in patients with cervical spinal cord injuries

Abstract

A retrospective cohort study using a nationwide Japanese inpatient database. To investigate the association between the timing of rehabilitation interventions and pressure ulcers requiring treatment in acute hospitalized patients with cervical spinal cord injuries between 2010 and 2022 in a real-world clinical setting. We used the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database. We included patients with cervical spinal cord injury who underwent spinal surgery within 3 days of admission between July 2010 and March 2022. We defined rehabilitation within 2 days of surgery as early rehabilitation and ≥3 days of surgery as non-early rehabilitation. The primary outcome was pressure ulcers requiring treatment ≥4 days after admission, and the secondary outcomes were length of hospital stay, hospitalization costs, and in-hospital mortality. Propensity score inverse probability of treatment weighting was conducted to compare the outcomes between the early and non-early rehabilitation groups. We identified 5162 eligible patients, 3434 (66.1%) of whom underwent early rehabilitation. After weighting, the pressure ulcers requiring treatment showed no significant difference between the early and non-early rehabilitation groups (odds ratio, 1.42; 95% confidence interval [CI], 0.78–2.59; P = 0.249). The early rehabilitation group showed shorter length of hospital stay (difference, −7.4; 95% CI, −13.1–−1.3%; P = 0.018) than did the non-early rehabilitation group. This study found no significant difference in the pressure ulcers requiring treatment between the early and non-early rehabilitation groups.