title: Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture.
abstract: OBJECTIVE
  To identify care-related factors associated with hospital-acquired pressure ulcers (HAPUs).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nine hospitals in Baltimore Hip Studies network.
  
  
  METHODS
  Six hundred fifty-eight individuals aged 65 and older who underwent surgery for hip fracture.
  
  
  METHODS
  Skin examinations at baseline and on alternating days until hospital discharge. Participants were deemed to have a HAPU if they developed one or more new Stage 2 or higher pressure ulcers (PUs) during the hospital stay.
  
  
  RESULTS
  Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio (aIRR) = 0.68, 95% confidence interval (CI) = 0.48-0.96; >6 hours: aIRR = 0.68, 95% CI = 0.46-0.99, both vs ≤ 4 hours). Participants with 24 hours or longer between admission and surgery had a higher postsurgery HAPU rate than those with less than 24 hours (aIRR = 1.62, 95% CI = 1.24-2.11). Surgery with general anesthesia had a lower postsurgery HAPU rate than surgery with other types of anesthesia (aIRR = 0.66, 95% CI = 0.49-0.88). There was no significant association between HAPU incidence and timing of transport to the hospital, type of transport to the hospital, or surgery duration.
  
  
  CONCLUSIONS
  Most of the factors hypothesized to be associated with higher PU incidence were associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice.
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA. mbaumgar@epi.umaryland.edu
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
authors.forename: Shayna E
authors.initials: SE
authors.lastname: Rich
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Shardell
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkes
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.forename: Patricia
authors.initials: P
authors.lastname: Langenberg
authors.forename: Denise L
authors.initials: DL
authors.lastname: Orwig
authors.forename: Mary H
authors.initials: MH
authors.lastname: Palmer
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Jones
authors.forename: Robert
authors.initials: R
authors.lastname: Sterling
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Kinosian
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors