Evaluating Pressure Ulcer Risk in Cardiac Surgery Patients

Pressure ulcers (PU) that develop during hospitalization can cause undue pain, harm, require complicated treatments, and can burden healthcare resources.  Research supports surgical related risk factors associated with PU and cardiac surgery have been recognized to increase risk.  Tools are available to assess risk but may not adequately predict population risk.  The objectives were to determine if there was a relationship between extrinsic (procedures) and intrinsic factors (co-morbidities) and the development of PU in cardiac surgery patients.

This study was a retrospective chart review using a representative sample of two randomly selected cohorts of cardiac surgical patients (106 patients without HAPU; 104 patients with HAPU) discharged from an urban teaching hospital 2009 - 2012.  The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to code survey responses, compute composite scores, calculate descriptive statistics about variables of interest, and conduct inferential statistical analyses to draw conclusions about the sample population tested.  An initial 9609 cardiac surgery patients were identified as discharged without PU and 219 were screened to meet inclusion and exclusion criteria.  A total of 282 cardiac surgery patients were identified as discharged with PU, and 166 met enrollment criteria. Combined intrinsic variables of respiratory disease and diabetes where found to have a statistically significant relationship (p = .035) to the development of PU.  Extrinsic variables found to have a statistically significant relationship to PU development were related to vasoactive infusion (p = <.001) and hospital-to-hospital transfer (p = .004). This information contributes to the body of knowledge for PU prevention.  Combining these intrinsic and extrinsic factors with Braden assessment as indicators of risk for cardiac surgery patients will lead to development of an individualized prevention plan for each cardiac surgery patient. Having this individual plan may decrease PU in this population.