National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

Abstract

BackgroundComplication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers.MethodsData from the NSQIP database (2005–2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications.ResultsThere were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications.ConclusionsDespite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

Development and Implementation of a Computerized Decision Support Systems in the Interdisciplinary Treatment of Stage IV Pressure Injury in Patients with Spinal Cord Injury: A Real Life Two-Group Parallel Design

“…This quality improvement initiative demonstrated that use cases development was feasible in an interdisciplinary and interprofessional treatment processes [3]. The description of a PI treatment concept in patients with SCI should therefore include detailed information about the inter-professional and interdisciplinary interventions, milestones and treatment elements [17,19]. The relevant milestones and treatment elements for example in the Basel Decubitus Concept are the debridement, surgical procedures, diagnosis and therapy of osteomyelitis, time of immobilisation, risk analyses and additional interventions based on the bio-psycho-social model.…”

“…Due to the complexity this treatment could bene t from process-based management and CDSS supported care to achieve clearly structured procedure. PIs are among the most frequent and cost-intensive complications in people with SCI [14,15], often aggravated by early and late post-surgical complications [16][17][18][19][20], leading to long hospital stays and reduced quality of life [21,22]. Internationally, it is accepted that PI grade III and IV require ap reconstruction [17,19,22,23], post-surgical immobilisation [23] and antibiotic therapy [24].…”

“…PIs are among the most frequent and cost-intensive complications in people with SCI [14,15], often aggravated by early and late post-surgical complications [16][17][18][19][20], leading to long hospital stays and reduced quality of life [21,22]. Internationally, it is accepted that PI grade III and IV require ap reconstruction [17,19,22,23], post-surgical immobilisation [23] and antibiotic therapy [24]. Because complications during the early post-surgical treatment occur more often in patients with a high-risk pro le individual risk analyses are recommended [19].…”

Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

“…Often aggravated by early and late postsurgical complications [ 16 – 20 ], PIs can lead to long hospital stays and reduced quality of life [ 21 , 22 ]. Internationally, it is accepted that stage III/IV PIs require flap reconstruction [ 17 , 19 , 22 ], postsurgical immobilization, and antibiotic therapy [ 23 ]. Because complications during early postsurgical treatment occur more often in patients with a high-risk profile, individual risk analyses are recommended, such as malnutrition screening, as well as the diagnosis and treatment of comorbidities [ 19 , 24 – 26 ].…”

Case Report: Surgical Closure of Chronic Soft Tissue Defects Using Extracellular Matrix Graft Augmented Tissue Flaps

“…The long-term success of flap closure is further complicated by patient co-morbidities such as obesity, diabetes and venous insufficiency. Retrospective analysis of 755 pressure injuries managed via flap closure demonstrated an overall complication rate of 25% at 30-day follow up ( 1 ). A prospective study of 276 pressure injuries closed by flap advancement demonstrated a complication rate of 58%, where wound dehiscence (31.2%) and re-occurrence (28.6%) were the most frequent complications ( 2 ).…”