Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization.
While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown.



Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non-decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition.



A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non-decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non-decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non-decubitus ulcer cohort (non-decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001).



Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
J Hunter
JH
Mehaffey
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Amani D
AD
Politano
Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA.
Castigliano M
CM
Bhamidipati
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Margaret C
MC
Tracci
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Kenneth J
KJ
Cherry
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
John A
JA
Kern
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Irving L
IL
Kron
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA. Electronic address: gru6n@virginia.edu.
Gilbert R
GR
Upchurch
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D003668:Pressure Ulcer / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods