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Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study.

OBJECTIVE
To examine the effect of pressure ulcers in older patients on the length of stay in hospital.


BACKGROUND
Previous research on this topic did not focus solely on older people. A growing number of older people require hospital admission.


DESIGN
A retrospective observational study.


METHODS
Data of 3198 patients age 75 years and older were included. The setting was a 1350-bed German University Hospital. Data were drawn from quality indicator data recorded by nurses. The independent effect of pressure ulcers was analysed using a multivariate Poisson-Regression model.


RESULTS
Of the participants, 7·1% had an ulcer during their hospitalisation. 87·3% were classified as categories I and II. Mean age was 81·6 years for all patients and 83·2 years for pressure ulcer patients. Pressure ulcer patients had a longer overall hospital stay (19·0 vs. 9·9 days) and a higher excess length of stay (2·6 vs. 0·3 days). Pressure ulcers had a statistically significant effect (p = 0·0011) on the increase in length of stay. The impact of hospital acquired pressure ulcers on length of stay was more pronounced compared to those ulcers being present on admission. The pressure ulcer category was not significant.


CONCLUSIONS
Pressure ulcers during hospitalisation are an independent and significant predictor of a prolonged inpatient stay for elderly patients. This study indicates that besides complications and co-morbidities social factors, as well as the hospital's internal processes of patient care, also can play a significant role.


RELEVANCE TO CLINICAL PRACTICE
To evaluate the distinct role of hospital acquired pressure ulcers further research is needed. The elderly patients in this study were a heterogeneous group. The implementation of clinical and nursing processes for both the 'fit' and the 'sick' geriatric patients is an important challenge.