Healthcare utilization and outcomes of spinal cord injured veterans with stage 3–4 pressure injuries

The Journal of Spinal Cord Medicine, 2024 · DOI: 10.1080/10790268.2022.2052500 · Published: January 1, 2024

Spinal Cord Injury Healthcare Dermatology

Simple Explanation

Pressure injuries are a significant problem for people with spinal cord injuries, leading to health issues and high healthcare costs. This study looks at how these injuries affect Veterans and how they are treated. The study compares Veterans who had surgery to treat their pressure injuries with those who were treated with medicine and wound care. It looks at things like how long they stayed in the hospital, whether they got readmitted, and if they survived. The findings show that despite the high cost of treatment, many Veterans still have problems with their wounds healing, and some die within a year. This raises questions about the best way to treat these injuries in people with spinal cord injuries.

Study Duration

5 Years

Participants

78 Veterans with SCI/D and stage 3-4 pelvic pressure injuries

Evidence Level

Not specified

Key Findings

1
Patients who received flap surgery (FP) had significantly longer hospital stays than those treated medically (NFP), with an average length of stay of 148 days compared to 111 days (P = 0.01).
2
The one-year mortality rate was significantly higher for NFP (21.57%) compared to FP (3.70%).
3
Only 5.00% of NFP wounds were healed at discharge with sustained healing at 1 year, significantly less than FP wounds (55.26%, P < 0.01).

Research Summary

This study examined the healthcare utilization and outcomes of spinal cord injured (SCI) Veterans with stage 3 and 4 pressure injuries (PI), comparing those who received myocutaneous flap surgery (FP) with those treated medically (NFP). The study found that FP had significantly longer hospital stays but lower mortality rates compared to NFP. Despite high healthcare investment, wound healing outcomes were poor, especially in the NFP group. The authors question the utility of prolonged hospitalizations for PI in the SCI/D population, highlighting the need for more cost-effective treatments and better identification of patients who would benefit from surgical interventions.

Practical Implications

Treatment Strategies

The study suggests a need to redefine who is a surgical candidate and to improve the management of non-surgical patients with pressure injuries.

Cost-Effectiveness

There is a need for high-quality, prospective, multi-center studies to develop and implement more cost-effective treatments for pressure injuries in SCI patients.

Post-Hospital Care

Prospective studies are warranted to evaluate post-hospitalization wound care paradigms of care and outcomes to improve patient outcomes after discharge.

Study Limitations

1
Single VA SCI center with a predominantly white male population.
2
Retrospective design limited by data available in the clinical record.
3
Hospital readmission rate may not capture true readmission rate if patients were admitted outside the VA.

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