Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization

J. Hunter Mehaffey, Amani Politano, Castigliano Bhamidipati, Margaret C. Tracci, Kenneth J. Cherry, John A. Kern, Irving L. Kron, Gilbert R. Upchurch

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. Methods Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non–decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. Results A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non–decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non–decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non–decubitus ulcer cohort (non–decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). Conclusion Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.

Original languageEnglish (US)
Pages (from-to)1720-1727
Number of pages8
JournalSurgery (United States)
Volume161
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Pressure Ulcer
Blood Vessels
Mortality
Ulcer
Intermediate Care Facilities
Risk Adjustment
Diagnosis-Related Groups
Medicare
Hospital Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization. / Mehaffey, J. Hunter; Politano, Amani; Bhamidipati, Castigliano; Tracci, Margaret C.; Cherry, Kenneth J.; Kern, John A.; Kron, Irving L.; Upchurch, Gilbert R.

In: Surgery (United States), Vol. 161, No. 6, 01.06.2017, p. 1720-1727.

Research output: Contribution to journalArticle

Mehaffey, J. Hunter ; Politano, Amani ; Bhamidipati, Castigliano ; Tracci, Margaret C. ; Cherry, Kenneth J. ; Kern, John A. ; Kron, Irving L. ; Upchurch, Gilbert R. / Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization. In: Surgery (United States). 2017 ; Vol. 161, No. 6. pp. 1720-1727.
@article{511ad5a550be421aa5080346b3329a72,
title = "Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization",
abstract = "Background While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. Methods Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non–decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. Results A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non–decubitus ulcers: 1.5{\%}, decubitus ulcers: 3.2{\%}, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non–decubitus ulcers: 3{\%}, decubitus ulcers: 6{\%}, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non–decubitus ulcer cohort (non–decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). Conclusion Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.",
author = "Mehaffey, {J. Hunter} and Amani Politano and Castigliano Bhamidipati and Tracci, {Margaret C.} and Cherry, {Kenneth J.} and Kern, {John A.} and Kron, {Irving L.} and Upchurch, {Gilbert R.}",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.surg.2017.02.002",
language = "English (US)",
volume = "161",
pages = "1720--1727",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization

AU - Mehaffey, J. Hunter

AU - Politano, Amani

AU - Bhamidipati, Castigliano

AU - Tracci, Margaret C.

AU - Cherry, Kenneth J.

AU - Kern, John A.

AU - Kron, Irving L.

AU - Upchurch, Gilbert R.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. Methods Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non–decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. Results A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non–decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non–decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non–decubitus ulcer cohort (non–decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). Conclusion Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.

AB - Background While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. Methods Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non–decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. Results A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non–decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non–decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non–decubitus ulcer cohort (non–decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). Conclusion Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.

UR - http://www.scopus.com/inward/record.url?scp=85015373030&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015373030&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2017.02.002

DO - 10.1016/j.surg.2017.02.002

M3 - Article

C2 - 28318554

AN - SCOPUS:85015373030

VL - 161

SP - 1720

EP - 1727

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 6

ER -