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405 Cost of Pressure ulcers in Gunshot Wounds Victims with Paraplegia in Metro Detroit

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Teena Chopra, M.D , Detroit Medical Center, Wayne State University, Detroit, MI
Smitha Sathyaprakash, M.D , Detroit Medical Center, Wayne State University, Detroit, MI
Miriam. T Levine, M.D , Detroit Medical Center, Wayne State University, Detroit, MI
Indu Chalana, M.D , Wayne State University / Detroit Medical Center, Detroit, MI
Farah Ahmad, M.D , Detroit Medical Center, Wayne State University, Detroit, MI
Zeinab Tamam, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Sanjeet Panda, M.D , Detroit Medical Center, Wayne State University, Detroit, MI
Sylvia Whittington, RN-BC, BSN, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Kenetra Ruffin, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Karambir Singh, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kyrie Yujing Wang, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Jack D. Sobel, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith .S Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Tom Taylor, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Emily .T Martin, MPH, PhD , Detroit Medical Center, Wayne State University, Detroit, MI

Background: Limited data exists on epidemiology of pressure ulcer infections and hospital costs in gunshot paraplegics.

Objective: To describe the prevalence and characteristics of pressure ulcers and associated hospital costs among gunshot associated paraplegics and to identify the costs attributable to infected pressure ulcers.

Methods: Patients admitted to three acute care hospitals in metro Detroit January 2004 through December 2008 were included if they met the following criteria: age > 14 years, paraplegia following a gunshot wound, and presence of a pressure ulcer.  Medical records were reviewed. Readmissions were captured through June 2010.  Total hospital days and total cost per admission were calculated the initial hospitalization only.  Association between infection and time to readmission was determined by Cox regression.

Results: 201 total patients with 411 total hospital admissions were included.  Patients were predominantly male (n=179; 89%), African-American (n=191, 95%) and receiving Medicaid or Medicare (n=104; 52%).  Mean age was 37 ± 8.9. Most patients were admitted from home (n=169, 84%) or a nursing home (n=21; 10%). Total costs per patient for the initial hospitalization were highly skewed with a mean of $14,500 ± $29571.6 and a median of $6534 (IQR $458-$262168).The median number of total hospital days per patient (for the initial hospitalization only) was 8(IQR-5-13).

 Infection of a pressure ulcer was confirmed in 76 cases (38%), and was more common in  stage III and stage IV ulcers (61/113, or 80% were infected) compared to 20% (n=15/88) of stage I or II ulcers (p<0.001). Median Charlson's index was higher in patients with infected ulcers compared to those without (2, IQR: 1-3; and 1, IQR: 0-2, respectively, p=<.001].Median hospital costs were greater among patients with infected ulcers compared to those without, although this did not reach statistical significance (median $7,424 (IQR:$3,936-$16,473) and $5873 (IQR:$3,192-$14,525) respectively p=0.3).  Four patients accounted for extremely high costs (Figure), that were attributable to prolonged hospital stay and multiple surgical procedures. Risk of readmission was significantly higher for patients with infected ulcers compared to those without (HR: 2.6, 95% Confidence Interval: 1.5, 4.2).No deaths were observed in the study cohort within 30 days of initial admission and 2 were observed within one year.

Conclusions:   Infected pressure ulcers in GSW victims with paraplegia accounted for more than $2,859,343 dollars and 2412 hospital days during the study period. These figures do not include readmissions, and thus are greatly underestimated.  Measures to prevent the development of pressure ulcers in this population would likely be cost-effective.