Readmission and Clinical Outcomes of Hospital-Acquired Pressure Injury Patients by Stage

Background: Although available data confirm that hospital-acquired pressure injuries (HAPIs) are costly and often preventable, the burden associated with the management of HAPIs is significant. Limited data exist on the impact of HAPI stage on hospital readmission and other hospital-acquired clinical outcomes.

Objective: To determine the risk of readmission and hospital-acquired clinical outcomes by stage of HAPI.

Methods: This observational, retrospective study of the Premier Healthcare Database (PHD) evaluated HAPI patients between October 1, 2009, and September 30, 2014, with six months of follow-up through March 31, 2015. Inpatient adults ≥18 years with HAPIs not present on admission were matched with non-HAPI patients using 1:3 propensity score matching.  Multivariate conditional logistic regression was used to examine the associations of HAPI stages with readmissions, osteomyelitis, pneumonia, and urinary tract infections (UTI).

Results: A total of 83,106 non HAPI patients were matched to 27,702 HAPI patients., with 5,468 stage 1, 11,398 stage 2, 1,307 stage 3, 384 stage 4, 1,811 unstageable, 4,291 unspecified, and 3,043 missing stage. All HAPI stages were significantly associated with higher odds of 180-day all-cause readmission in a dose response pattern, with the highest for stage 4 (OR=2.11, 95% CI (1.56–2.84), p<0.001). Results for 30 and 90 day readmissions were similar. Increasing odds were also observed across stage for osteomyelitis and UTIs, with stage 4 having approximately 4.2-fold (95% CI 2.38–7.42, p<0.001) higher odds for osteomyelitis and 3.4-fold (95% CI 1.42–8.23, p<0.001) higher odds for UTIs. Stages 1–3 all had approximately twofold greater odds of pneumonia (p<0.001); however, stage 4 was not significant due to a smaller number of pneumonia cases.

Conclusion: HAPIs are a significant burden to our health-care system, with patients suffering significantly higher risks of costly readmissions and other hospital-acquired conditions and outcomes.