Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation

Authors

  • Jaap-Peter Schuurman,

    1. Authors:Jaap-Peter Schuurman, MD, Surgical resident, St Antonius Hospital, Nieuwegein, The Netherlands; Lisette Schoonhoven, PhD, RN, Assistant Professor Nursing Science, Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; B Paul JA Keller, MD, PhD, Surgeon, Department of Surgery, Medical Centre Rijnmond Zuid, location Zuider, Rotterdam, The Netherlands; Bert van Ramshorst, MD, PhD, Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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  • Lisette Schoonhoven,

    1. Authors:Jaap-Peter Schuurman, MD, Surgical resident, St Antonius Hospital, Nieuwegein, The Netherlands; Lisette Schoonhoven, PhD, RN, Assistant Professor Nursing Science, Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; B Paul JA Keller, MD, PhD, Surgeon, Department of Surgery, Medical Centre Rijnmond Zuid, location Zuider, Rotterdam, The Netherlands; Bert van Ramshorst, MD, PhD, Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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  • B Paul JA Keller,

    1. Authors:Jaap-Peter Schuurman, MD, Surgical resident, St Antonius Hospital, Nieuwegein, The Netherlands; Lisette Schoonhoven, PhD, RN, Assistant Professor Nursing Science, Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; B Paul JA Keller, MD, PhD, Surgeon, Department of Surgery, Medical Centre Rijnmond Zuid, location Zuider, Rotterdam, The Netherlands; Bert van Ramshorst, MD, PhD, Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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  • Bert Van Ramshorst

    1. Authors:Jaap-Peter Schuurman, MD, Surgical resident, St Antonius Hospital, Nieuwegein, The Netherlands; Lisette Schoonhoven, PhD, RN, Assistant Professor Nursing Science, Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; B Paul JA Keller, MD, PhD, Surgeon, Department of Surgery, Medical Centre Rijnmond Zuid, location Zuider, Rotterdam, The Netherlands; Bert van Ramshorst, MD, PhD, Surgeon, Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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Jaap-Peter Schuurman, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands. Telephone: +0031 30 6099111.
E-mail:jp.schuurman@umcutrecht.nl

Abstract

Aim and objective.  The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation.

Background.  Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of pressure ulcers on length of hospital stay after cardiothoracic surgery is yet undetermined.

Design.  Prospective follow-up study.

Methods.  Two hundred and four patients admitted for elective cardiothoracic surgery and with an intensive care unit stay of >48 hours were included in a prospective cohort study. The course of the skin condition in relation to pressure ulcers was monitored during their stay in a teaching hospital. Length of hospital stay was compared between the group with and without pressure ulcers.

Results.  Hospital stay for cardiothoracic patients with and without pressure ulcers did not differ significantly (p = 0·23). Patients that developed pressure ulcers had a median hospital stay of 13 days (interquartile range: 9–19) vs. 12 days (interquartile range: 7–15) for patients without pressure ulcers. However, we observed that length of stay in the intensive care unit was significantly (p = 0·005) longer for patients with pressure ulcers. This was not associated with the occurrence of complications. However, the occurrence of pressure ulcers was significantly correlated with length of intensive care support in postoperative care.

Conclusion.  Non-complicated pressure ulcers in postsurgery patients do not significantly increase the length of total hospital stay.

Relevance to clinical practice.  Health professionals need to recognise that patients who have undergone major surgery (such as cardiothoracic surgery) are prone to develop pressure ulcers. Despite the fact that pressure ulcers do not necessarily extend hospital stay, monitoring the skin condition remains of crucial importance for prevention and early detection as well as treatment of pressure ulcers and to minimise patient discomfort. Moreover, as pressure ulcers often originate in the operating room, prevention in the operating room should receive more attention.

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