Optimizing the hospital management of leg ulcers.
BACKGROUND
Leg ulcers are common and are often the cause of a long hospital admission. However, little information is available on the efficacy and efficiency of inpatient leg ulcer management. The inpatient management of leg ulceration was examined and areas for improvement were sought.


METHODS
The management of patients admitted to a teaching hospital with a primary diagnosis of leg ulceration was examined, the costs estimated and areas for improvement identified. A retrospective analysis of 174 admissions to Heidelberg Repatriation Hospital between 1 January 1991 and 31 December 1992 was performed.


RESULTS
Of 119 patients, 61 had ulcers due to arterial disease and 34 due to venous disease. Over 2 years, leg ulcers accounted for 5259 inpatient bed days, a mean of 44.2 days per patient. The estimated cost exceeded $2,750,000, averaging over $12,000 per admission. Thirty-three percent of patients had no recorded investigations into the cause of their ulcer and fewer than 50% had documented improvement at discharge.


CONCLUSIONS
Leg ulcers are costly due to their extended treatment on an inpatient basis. Unfortunately, hospital admission does not guarantee optimal wound healing rates. A leg ulcer protocol is proposed to minimize inpatient stay and improve investigation and management in an outpatient or community setting.
Gruen
R L
RL
Department of Surgery, University of Melbourne, Australia.
Chang
S
S
MacLellan
D G
DG
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000191:economics / Q000628:therapy; D001509:Bed Occupancy / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006784:Hospitals, Teaching; D006801:Humans; D007871:Leg Ulcer / Q000175:diagnosis / Q000191:economics / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay / Q000191:economics; D008297:Male; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000191:economics / Q000628:therapy; D014945:Wound Healing