The Association between Pre-existing Diabetes Mellitus and Pressure Ulcers in Patients Following Surgery: A Meta-analysis

Kang, Zhou-Qing; Zhai, Xiaojie

doi:10.1038/srep13007

Cited by 22 publications

(19 citation statements)

References 19 publications

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“…The first one performed by Liu et al [25], reported a 115% (OR, 2.15; 95% CI 1.62 to 2.84) higher risk of surgery-related bedsore in diabetic patients compared with that of in non-diabetic patients. The other one conducted by Kang et al found similar result (surgery related bedsore risk: diabates vs. non-diabetes OR, 1.74; 95% CI 1.40 to 2.15) [24]. Our findings are consistent with the results of previous systematic reviews.…”

Section: Discussionsupporting

confidence: 92%

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies

et al. 2016

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Diabetes is a major cause of morbidity for patients undergoing surgery and can increase the incidence of some postoperative complications such as bedsores. We conducted a meta-analysis of observational studies to examine whether patients with diabetes undergoing surgery had high risk of bedsore. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library Central Register of Controlled Trials database from inception to November 2016. Studies were selected if they reported estimates of the relative risk (RR) for bedsore risk in postoperative diabetic patients compared with that of in non-diabetic patients. Random-effects meta-analysis was conducted to pool the estimates. A total of 16 studies with 24,112 individuals were included in our meta-analysis. The pooled RR of bedsore development for patients with diatetes was 1.77 (95% CI 1.45 to 2.16). The results of subgroup analyses were consistent when stratified by surgery type, study design, research region, sample size, inclusion period, analysis method and study quality. There was evidence of publication bias among studies and a sensitivity analysis using the Duval and Tweedie “trim-and-fill” method did not significantly alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This meta-analysis provides indications that diabetic patients undergoing surgery could have a higher risk of developing bedsores. Further large-scale prospective trials should be implemented to comfirm the association.

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Section: Discussionsupporting

confidence: 92%

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies

et al. 2016

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“…A systematic review on cardiac surgical patients has agreed that diabetes is a significant predictor of the development of HAPU. However, a meta‐analysis on all types of surgical patients did not find any increase in the incidence of pressure ulcers in diabetic patients undergoing hip surgery compared with non‐diabetic controls …”

Section: Introductionmentioning

confidence: 85%

“…However, a meta-analysis on all types of surgical patients did not find any increase in the incidence of pressure ulcers in diabetic patients undergoing hip surgery compared with non-diabetic controls. 35 A majority of the studies had focused on pre-or intraoperative risk factors associated with HAPU among surgical patients. However, the associated risk factors are still somewhat unclear.…”

Section: Demographic Risk Factorsmentioning

confidence: 99%

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

Aloweni

Ang

Fook‐Chong

et al. 2018

International Wound Journal

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Surgical patients are prone to developing hospital‐acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case‐control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015‐December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap‐corrected c‐statistic 0.78 indicating good discrimination. A cut‐off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%‐84.2%) and a negative predictive value of 80.7% (CI: 74.3%‐86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.

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“… 3–5 Diabetes has been shown to be an important risk factor and in a recent meta-analysis the pooled OR of the incidence of pressure ulcers in patients with diabetes was 1.74 (95% CI 1.40 to 2.15) compared with patients without diabetes. 6 Another recent meta-analysis found a slightly lower but significantly adjusted relative risk ratio of 1.17 (95% CI 1.02 to 1.36) after sensitivity analysis accounting for publication bias. 7 Of note nearly all reports to date, as well as those included in these meta-analyses, relate to pressure ulcers in surgical patients and at all anatomical sites combined, not specifically the foot.…”

Section: Introductionmentioning

confidence: 98%

Increased risk of hospital-acquired foot ulcers in people with diabetes: large prospective study and implications for practice

Wensley

Kerry

Rayman

2018

BMJ Open Diab Res Care

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AimsDiabetes increases the risk of costly and potentially preventable hospital-acquired pressure ulceration. Given that peripheral arterial disease and neuropathy, important risk factors for foot ulceration, are more common in people with diabetes, their risk of hospital-acquired foot ulceration (HAFU) in particular may be even greater. This study aims to determine this risk.MethodsUsing data collected over 2 years from all admissions to the Ipswich Hospital NHS Trust, we conducted a prospective multilevel regression analysis of the risk of HAFU in 5043 admissions of people with diabetes versus 23 599 without diabetes. Patients over 50 years who developed HAFU at least 48 hours after admission were included in analyses. Progressive adjustment for important risk factors and subgroup analyses were conducted to compare patients with and without diabetes.ResultsThere were significant differences between patients with and without diabetes among a range of covariates including sex, Comorbidity Score, and length of stay (p value <0.001). After progressive adjustment for age, sex, and other risk factors, there persisted a significant increase risk of HAFU in people with diabetes (OR 2.24; 95% CI 1.80 to 2.69). There were no substantial differences between clinically relevant subgroups.ConclusionsThese analyses demonstrate at least a twofold increase in the risk of HAFU in patients with diabetes and suggest further work should focus on specific processes to detect those inpatients with diabetes at increased risk, in whom preventative measures may reduce the prevalence of this costly complication.

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The Association between Pre-existing Diabetes Mellitus and Pressure Ulcers in Patients Following Surgery: A Meta-analysis

Cited by 22 publications

References 19 publications

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

Increased risk of hospital-acquired foot ulcers in people with diabetes: large prospective study and implications for practice

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