A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database

• Published in: The American journal of surgery 2019-04, Vol.217 (4), p.658-663
• Main Authors: Veith, Jacob P., Collier, Willem, Kim, Jaewhan, Agarwal, Jayant, Kwok, Alvin
• Format: Article
• Language: English
• Subjects: Back; Buttocks; Codes; Complications; Data bases; Databases, Factual; Diabetes; Family income; Female; Health care policy; Hip; Humans; Hypertension; Infections; Male; Medicaid; Middle Aged; Mortality; National readmissions database; Obesity; Paralysis; Patient admissions; Patient Protection & Affordable Care Act 2010-US; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Patients; Pressure; Pressure Ulcer - economics; Pressure Ulcer - surgery; Pressure ulcers; Reoperation - economics; Risk analysis; Risk factors; Surgery; Surgical Flaps; Surgical outcomes; Surgical readmissions; Tobacco; Ulcers; Wound Closure Techniques; Wound healing
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.12.013

Traditionally, a 30-day postoperative period is used to assess outcomes in surgery. However, it is not clear if this is sufficient. Our study assessed readmissions and their risk factors following the surgical repair of pressure ulcers in a 90-day postoperative period. Patients with a pressure ulcer to the lower back, hip, and/or buttocks who underwent a pedicled or flap based wound operation were identified in the National Readmissions Database. We then analyzed risk factors for overall 0–90-day readmissions, early readmissions (0–30 days), and late-readmissions (31–90 days). 3329 patients were identified, of which 154 (4.66%) had surgical wound-related readmissions. A majority of these occurred after 30 days (53.89%). 90% of patients with a surgical-wound related readmission were readmitted within 63 days of index procedure. The traditional 30-day outcome period is not enough to properly assess outcomes in pressure ulcer surgery such as readmission. We demonstrate that a period of at least 10 weeks and perhaps the entire global 90-day postoperative period would be more appropriate to evaluate readmissions after ulcer repair. •3329 patients underwent surgical repair of pressure ulcer and 154 (4.66%) of these had surgical wound-related readmissions.•A majority of these readmissions occurred after 30 days (53.89%).•90% of readmitted patients were readmitted within 63 days of index procedure.•Mean cost for a surgical-wound related readmission was $58,701.41 and $72,399.08 in those requiring reoperation.