Van Beest Dominique, Koh Shannon J, Tzen Yi-Ting, Wang Jijia, Moore-Matthews Dindi, Kargel Jennifer S, Cutrell James B, Bedimo Roger J, Bennett Bridget R, Tan Wei-Han
Physical Medicine & Rehabilitation, VA North Texas Health Care System, Dallas, Texas, USA.
Infectious Disease, Texas Health Resources, Dallas, Texas, USA.
J Spinal Cord Med. 2024 May;47(3):345-353. doi: 10.1080/10790268.2022.2052500. Epub 2022 Apr 4.
Pressure injuries (PI) are a significant source of morbidity for individuals with spinal cord injury/disease (SCI/D). They are also associated with significant healthcare resource utilization including prolonged hospitalizations. However, the long-term outcomes in terms of wound recurrence-free survival, hospital readmission rates, and all-cause mortality in this population remain largely unknown.
To examine the clinical characteristics, healthcare utilization and outcomes of SCI Veterans hospitalized at the VA North Texas Health Care System (VANTHCS) SCI inpatient unit with stage 3 and 4 PI, and compare these between those who received a myocutaneous flap surgery (flap patients (FP)) and those treated medically (non-flap patients (NFP)).
A retrospective chart review was conducted of all adult patients admitted to the VANTHCS SCI/D unit with stage 3 or 4 pelvic PI between 1/1/2013 and 12/31/2018. Healthcare utilization and outcome information was extracted for pre-specified time points.
78 patients met criteria (113 hospitalizations; 27 FP; 51 NFP). Average length of stay (LOS) was 122 days; FP had a significantly higher LOS than NFP (P = 0.01). Average number of consults was 24. Estimated cost per hospitalization was $175,198. Readmission rate within 30 days was 12.39%. The mortality rate within 1 year of discharge was 21.57% for NFP, as opposed to 3.70% in the FP group. Only 5.00% of NFP wounds were healed at discharged with sustained healing at 1 year, significantly less than FP wounds (55.26%, P < 0.01).
Despite the high investment in terms of healthcare utilization, outcomes in terms of wound healing are poor. Additionally, nearly 22% of NFP died within one year of discharge. This calls into question the utility of prolonged hospitalizations for PI in the SCI/D population in terms of wound treatment efficacy, healthcare costs, and patient morbidity/mortality.
压疮（PI）是脊髓损伤/疾病（SCI/D）患者发病的重要原因。它们还与大量医疗资源的使用相关，包括延长住院时间。然而，该人群在无伤口复发存活、医院再入院率和全因死亡率方面的长期结果仍 largely 未知。
研究在弗吉尼亚州北德克萨斯医疗系统（VANTHCS）脊髓损伤住院部住院的患有3期和4期压疮的脊髓损伤退伍军人的临床特征、医疗资源利用情况和结果，并比较接受肌皮瓣手术的患者（皮瓣患者（FP））和接受药物治疗的患者（非皮瓣患者（NFP））之间的这些情况。
对2013年1月1日至2018年12月31日期间入住VANTHCS SCI/D科室且患有3期或4期骨盆压疮的所有成年患者进行回顾性病历审查。在预先指定的时间点提取医疗资源利用和结果信息。
78名患者符合标准（113次住院；27名皮瓣患者；51名非皮瓣患者）。平均住院时间（LOS）为122天；皮瓣患者的住院时间显著长于非皮瓣患者（P = 0.01）。平均会诊次数为24次。每次住院的估计费用为175,198美元。30天内的再入院率为12.39%。非皮瓣患者出院后1年内的死亡率为21.57%，而皮瓣患者组为3.70%。出院时只有5.00%的非皮瓣患者伤口愈合，1年后持续愈合，明显少于皮瓣患者伤口（55.26%，P < 0.01）。
尽管在医疗资源利用方面投入巨大，但伤口愈合方面的结果很差。此外，近22%的非皮瓣患者在出院后1年内死亡。这就伤口治疗效果、医疗成本以及患者发病率/死亡率而言，对脊髓损伤/疾病人群中因压疮而延长住院时间的效用提出了质疑。
