Risk prediction for major postoperative complications in people with chronic spinal cord injury/disorder and stage III and IV pressure injury.

Background: Approximately 20% of flap surgeries in people with spinal cord injury/disorder and stage III and IV pressure injury result in a major complication requiring re-surgery. Although several factors are associated with postoperative complications according to the literature, there is no risk prediction model for major postoperative complications in the treatment of stage III and IV pressure injuries in people with spinal cord injury/disorder.

Study aim: The study aims to predict the risk of major postoperative complications in people with spinal cord injury/disorder and stage III and IV pressure injury at hospital admission.

Setting: The study was conducted in a Swiss acute and rehabilitation hospital for people with spinal cord injury/disorder that specialises in the treatment of people with spinal cord injury/disorder using the Basel Decubitus Approach.

Methods: We performed a retrospective cohort study based on routinely collected clinical data in a Swiss hospital. Risk predictors for major postoperative complications during hospitalisation in pressure injuries over the sacrum/coccyx, ischium or trochanter between 01/2016 and 12/2022 were identified using a mixed effects logistic Bayesian LASSO analysis.

Results: We included 252 treatment procedures in 167 individuals. Major complications occurred in 48 (19%) treatment procedures. Estimated glomerular filtration rate (eGFR) according to the cystatin formula (odds ratio [OR] 0.91, confidence interval [CI] 0.62-1.02), vitamin D (25-hydroxy vitamin D; OR 1.05, CI 0.98-1.23), vitamin B12 (OR 0.91, CI 0.74-1.05), sodium (OR 0.75, CI 0.16-1.05) and C-reactive protein (CRP; OR 0.98, CI 0.79-1.07) were found to be predictive of major complications at hospital admission.

Conclusion: For the Basel Decubitus Approach, high levels of eGFR, vitamin B12 and sodium negatively affected major postoperative complications and should, therefore, be assessed during hospital stay. Further investigation is needed to determine the positive effect of high vitamin D and low CRP levels on major postoperative complications.