Risk factors of major complications after ﬂap surgery in the treatment of stage III and IV pressure injury in people with spinal cord injury/disorder: a retrospective cohort study

Spinal Cord, 2024 · DOI: https://doi.org/10.1038/s41393-023-00944-9 · Published: December 20, 2023

Simple Explanation

This study aims to identify risk factors associated with major complications after flap surgery for pressure injuries (PIs) in people with spinal cord injury or disorder (SCI/D). It focuses on stage III and IV PIs. The study was conducted in a Swiss hospital specializing in the treatment of people with SCI/D using the Basel Decubitus Approach, a multidisciplinary treatment method. The research examined various factors, including patient characteristics, comorbidities, and lab values, to determine which ones were linked to major postoperative complications requiring reoperation.

Study Duration

01/2016 and 12/2021

Participants

220 PI treatment procedure from 149 individuals

Evidence Level

Retrospective cohort study

Key Findings

1
Major complications occurred more often in individuals with stage IV PI.
2
Major complications occurred more often in individuals without osteomyelitis.
3
Pathological blood concentrations of cystatin c, calcium, and vitamin B12 as well as normal blood concentrations of HbA1c were associated with major complications.

Research Summary

This retrospective cohort study examined risk factors for major postoperative complications after flap surgery for stage III and IV pressure injuries (PIs) in individuals with spinal cord injury or disorder (SCI/D). The study, conducted at a Swiss hospital using the Basel Decubitus Approach, included 220 PI treatment procedures from 149 individuals and analyzed 60 potential risk factors. The findings suggest that stage IV PIs, absence of osteomyelitis, and specific blood concentrations (cystatin c, calcium, vitamin B12, and HbA1c) are associated with increased major complications.

Practical Implications

Prevention Strategies

Encourage early hospital admission for individuals with SCI/D and stage III PIs to prevent progression to stage IV.

Antibiotic Treatment

Consider individualized antibiotic treatment based on tissue samples for both individuals with and without osteomyelitis.

Blood Value Monitoring

Closely monitor and manage blood values, particularly cystatin c, calcium, vitamin B12, and HbA1c, to optimize patient outcomes.

Study Limitations

1
Retrospective observational cohort design limited data standardization.
2
Potential unassessed risk factors (e.g., PLMS, vascular status, autonomic nervous system function).
3
Results may not be generalizable to settings without a similar treatment approach.

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