Prevalence of Pressure Ulcer and Nutritional Factors Affecting Wound Closure Success in Thailand

Abstract

Introduction:The authors aimed to estimate the prevalence of pressure ulcers and to explore the nutritional effects of the prognostic factors on successful pressure ulcer closure in a public tertiary care hospital in Thailand.Patients and Methods:The study was a retrospective cohort analysis of seven-year census (2008 - 2014) at Surin hospital in Thailand. There were 424 of total 240,826 patients aged over than 15 years admitted to surgery, orthopedics and medicine wards during the study period with documented pressure ulcers (ICD 10TM). We analyzed four hundred and ten patients after excluding 14 patients with non-pressure ulcers (due to burning/ diabetic/ ischemic neuropathic ulcers, and less than 24 hours of admission) and loss medical record. We selected independent factors from demographic data, nutritional factors, pressure ulcer characteristics, and management data. The outcome of interest was successful pressure ulcer closure. The analysis method was the semi-parametric Cox regression model and reported as Hazard Ratios (HR) with 95% confidence interval (95% CI).Results:The total hospital admission was 240,826 patients between 2008 - 2014. 410 patients were developing pressure ulcers, of these, 7% (28/410) success in ulcer closure, and 77% (314/410) failure in closure requiring for additional procedures (excisional debridement). The rest of patients (16%, 68/410) was non-operative care. The prevalence of pressure ulcers was 1.7 per 1,000 person-year. The multivariable model found that only the Nottingham Hospital Screening Tool (NS) score was a statistically significant nutritional variable, and additional subgroup analysis of two models of sepsis and spinal cord co-morbidities was also significant. Adjusted hazard ratios (HR) for NS score = 0.355 (95% CI: 0.187, 0.674), p=0.002), for sepsis = 0.312 (95% CI: 0.140, 0.695), p=0.004), and for spinal cord co-morbidity = 0.420 (95% CI: 0.184, 0.958), p=0.039).Conclusions:The annual prevalence was 1.7 per 1,000 persons. NS score was strongly associated with ulcer closure success.

Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study

“…Magny et al 29 found that low albumin level was associated with PU development. Auiwattanakul et al 4 also suggested that the nutrition factor is an establishing predictor for pressure wound closure, and every 1‐gm/dL increase in serum albumin increases wound closure by 21%. In our study, albumin was only monitored regularly in ICU patients, and low albumin levels were associated with PU development in these patients.…”

“…They can be associated with pain, increased risk of infection, and need for additional surgical procedures. They also increase the risk of prolonged length of hospital stay, morbidity, and mortality 3,4 . Additionally, it is estimated that 11 billion USD per year is spent for the total cost of hospital‐acquired PU (HAPU) in the USA, and this is not reimbursable 5 …”

Effectiveness of Flaps Controlling Inflammation for Severe Pressure Sores in Older Patients with Multiple Comorbidities

“…In 2010, Keys et al [8] found that albumin levels below 3.5 g/dL were associated with ulcer recurrence within 1 year, suggesting that malnutrition should be corrected with high-protein diets and peripheral amino acid infusions, and nutritional markers, including albumin and prealbumin, should be moni-tored as a means of directing treatment [2]. In another study, the caloric deficit per day was higher in patients with successful pressure ulcer closure, although this finding did not achieve statistical significance [9].…”

Hospital malnutrition in northeast and southeast Asia: A systematic literature review

“…A total of 57 studies reported data on clinical outcomes in patients with hospital malnutrition (Table 3) [19,20,22,24e27,29,30, 33,34,36,37,40e46,48,50e54,56e61,63,65e70,72e74,78,80e83, 96,103e110]. Overall, the studies demonstrated a significant association between poor nutrition status and an increased risk of clinical complications, including infection [50,51,53,56,60,63,103], pressure ulcers [87,106], and fractures [104], as well as pulmonary [67,73], renal [67], and hepatic complications [67]. Studies in surgical patients showed an increased risk of postoperative complications [48,52,54,56,58,60,66,67,72e74,83], including surgical site infection [56,60], bleeding [67], pneumonia [73], delayed wound healing [54,67], and delayed ambulation [72].…”