title: Predictors of pressure ulcer development in patients with vascular disease.
abstract: BACKGROUND
  Although pressure ulcer (PU) risk factors are well known in the general population, little research is available in hospitalized surgical patients admitted with vascular diseases.
  
  
  METHODS
  Using a retrospective medical records review, characteristics of hospitalized surgical patients with vascular diseases were assessed. Variables were based on literature review of PUs and availability of medical records and administrative data. Trained registered nurses collected data. Analyses included descriptive and comparative statistics, and multivariable modeling was used to determine predictors of PU.
  
  
  RESULTS
  In 849 adult admissions, 18.9% had a PU; 11.8% were hospital-acquired PU (HAPU). Patients were more likely to be elderly, male (n = 575; 67.7%), and Caucasian (n = 704; 83.3%). Common diagnoses were aneurysms/embolisms (43.2%) and atherosclerosis (31.2%). Patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with home (P < .001). In univariate analyses, 12 patient characteristics were associated with HAPU presence: Female gender, non-married status, current smoker, non-Caucasian race, non-intensive care unit (ICU) stay, primary diagnosis of atherosclerosis, higher analgesic use, higher right ankle brachial index (ABI), lower Braden score, higher blood urea nitrogen (BUN) higher serum creatinine and higher total protein levels. In multivariate analyses, nine factors predicted HAPU: Lower right ABI and Braden score, an ICU stay, low and high hematocrit values, female gender, non-White race, atherosclerosis history, and higher BUN and body mass index (BMI). The concordance index for the nine-item model was 0.854.
  
  
  CONCLUSIONS
  The rate of HAPU in hospitalized surgical patients with vascular diseases was greater than expected. Assessment of important HAPU factors and implementation of interventions are needed to decrease risk and improve clinical outcomes.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio. Electronic address: corniea@ccf.org.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Corniello
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tonya
authors.initials: T
authors.lastname: Moyse
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Bates
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Karafa
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chad
authors.initials: C
authors.lastname: Hollis
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000175:diagnosis / Q000209:etiology / Q000451:nursing*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital; D014652:Vascular Diseases / Q000150:complications / Q000451:nursing*