Allman R M, Goode P S, Burst N, Bartolucci A A, Thomas D R
Division of Gerontology and Geriatric Medicine, University of Alabama at Birmingham.
Adv Wound Care. 1999 Jan-Feb;12(1):22-30.
To determine whether or not the development of a Stage II or greater pressure ulcer in-hospital is associated with increased hospital costs and length of stay after adjusting for admission severity of illness, comorbidities, nosocomial infections, and other hospital complications.
Prospective, inception cohort study.
Tertiary care, urban, university teaching hospital.
286 patients identified within 3 days of admission to a tertiary care, urban teaching hospital were enrolled in a prospective, inception cohort study. Patients were age 55 or greater; expected to be confined to bed or chair or with a hip fracture; and expected to remain in hospital at least 5 days.
Baseline data were collected within 3 days of admission. Weekly skin assessments were performed by study nurses to document the development of pressure ulcers. Medical record reviews, patient exams, and physician and nurse interviews were used to obtain baseline demographic, medical, functional, nutritional, and global measures of disease severity. The incidence of nosocomial infections and the number of other hospital complications were monitored by medical record reviews. Hospital costs were estimated using category-specific cost-to-charge ratios. Diagnostic-related group (DRG) adjusted length of stay was calculated by subtracting the mean length of stay for assigned DRGs from actual stays.
Incident pressure ulcers were associated with significantly higher mean unadjusted hospital costs ($37,288 vs $13,924, P = 0.0001) and length of stay (30.4 vs 12.8 days, P = 0.0001). In addition to pressure ulcers, other independent predictors of hospital costs and length of stay after multivariable analyses included: admission to an intensive care unit or surgical service, younger age, nosocomial infection, the physician assessment of disease severity, and the number of other hospital complications. Compared with those who did not develop pressure ulcers, patients who developed pressure ulcers also were more likely to develop nosocomial infections (45.9% [17/37] vs 20.1% [50/249], P = 0.001) and other hospital complications (86.5% [32/37] vs 43.0% [107/249], P < 0.001). After adjusting for only the admission predictors of costs and length of stay by multivariable analyses, hospital costs, and length of stay for those who developed pressure ulcers remained significantly greater than for those who did not develop pressure ulcers ($14,260 vs $12,382, P = 0.03, and 16.9 vs 12.9 days, P = 0.02, respectively). The differences in costs and length of stay for those with and without incident pressure ulcers were even greater when adjusted for admission predictors and also the occurrence of nosocomial infections and other complications ($29,048 vs $13,819, P = 0.002, and 20.9 vs 12.7 days, P = 0.0001, respectively).
Incident pressure ulcers are associated with substantial and significant increases in hospital costs and length of stay. Nosocomial infections and other hospital complications are additional significant independent predictors of health care utilization among patients at risk for pressure ulcers.
在对入院时疾病严重程度、合并症、医院感染及其他医院并发症进行校正后，确定住院期间Ⅱ期或更严重压疮的发生是否与住院费用增加及住院时间延长相关。
前瞻性起始队列研究。
城市三级医疗大学教学医院。
在一所城市三级医疗教学医院入院3天内确定的286例患者纳入一项前瞻性起始队列研究。患者年龄在55岁及以上；预计需卧床或坐轮椅或有髋部骨折；预计住院至少5天。
入院3天内收集基线数据。研究护士每周进行皮肤评估以记录压疮的发生情况。通过病历审查、患者检查以及医生和护士访谈获取基线人口统计学、医学、功能、营养及疾病严重程度的综合指标。通过病历审查监测医院感染发生率及其他医院并发症数量。利用特定类别成本收费比估算住院费用。通过从实际住院时间中减去所分配诊断相关组（DRG）的平均住院时间来计算DRG校正住院时间。
发生压疮与未校正的平均住院费用显著更高（37288美元对13924美元，P = 0.0001）及住院时间显著更长（30.4天对12.8天，P = 0.0001）相关。多变量分析后，除压疮外，住院费用和住院时间的其他独立预测因素包括：入住重症监护病房或外科科室、年龄较小、医院感染、医生对疾病严重程度的评估以及其他医院并发症数量。与未发生压疮的患者相比，发生压疮的患者发生医院感染（45.9%[17/并症数量。与未发生压疮的患者相比，发生压疮的患者发生医院感染（45.9%[17/37]对20.1%[50/249]，P = 0.001）及其他医院并发症（86.5%[32/37]对43.0%[107/249]，P < 0.001）的可能性也更高。多变量分析仅对住院费用和住院时间的入院预测因素进行校正后，发生压疮患者的住院费用和住院时间仍显著高于未发生压疮的患者（分别为14260美元对12382美元，P = 0.03，以及16.9天对12.9天，P = 0.02）。在校正入院预测因素以及医院感染和其他并发症的发生情况后，有和无新发压疮患者的费用和住院时间差异更大（分别为29048美元对13819美元，P = 0.002，以及20.9天对12.7天，P = 0.0001）。
新发压疮与住院费用大幅显著增加及住院时间延长相关。医院感染及其他医院并发症是压疮高危患者医疗资源利用的额外显著独立预测因素。
