The Costs and Outcomes of Treating a Deep Pressure Ulcer in a Patient with Quadriplegia
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Index: Ostomy Wound Manage. 2012;58(2):41–46.
The cost of pressure ulcers, especially Stage III and Stage IV ulcers, is substantial. A 27-year-old man with a 6-year history of quadriplegia developed an ischial pressure ulcer. Twelve months of treatment with wet-to-dry dressings were followed by admission to several facilities and 15 months of care with biological dressings and negative pressure wound therapy (NPWT). When admitted to the authors’ wound care center, the wound measured 4.5 cm x 3.2 cm with exposed bone. A review of his insurance records showed that paid claims totaled $242,350, including $52,992 for NPWT rental costs. The patient was considered a good candidate for minimally invasive surgical intervention with external tissue expanders. Following a 14-day course of antibiotics to treat his infection, the wound was debrided and the tissue expanders applied. After 16 days, the wound was closed. The patient returned to work 6 weeks after the procedure. At the 23-month follow-up, the wound remained closed. Insurance payments for the care that resulted in wound closure totaled $43,814. This case study illustrates the potential of the external tissue expansion technique to close deep pressure ulcers within a relatively short amount of time at comparatively lower cost. Studies including control treatments are needed to confirm these conclusions.
Keywords: pressure ulcer, quadriplegia, ischial, external tissue expanders
Potential Conflicts of Interest: The authors acknowledge that they own stock in Progressive Surgical Products (Westbury, NY), the manufacturer of the external tissue expander.
Demographics indicate the population of persons 65 years and older is expected to increase to 55 million, and the population older than 85 years is expected to reach more than 6.6 million in 2020.1 Because the risk of developing chronic conditions increases with age, this demographic trend is expected to grow the demand for both human and financial resources in the healthcare system.
The elderly and patients with spinal cord injuries are at high risk for developing chronic wounds such as pressure ulcers. It is estimated that 1.3 to 3 million elderly adults develop a pressure ulcer each year,2 and approximately 60,000 people die each year from complications related to pressure ulcers,3 such as infections, loss of albumin, and anemia. Pressure ulceration is among the most common complications of spinal cord injury and can become a life-threatening complication when characterized by necrosis of the fascia, subcutaneous tissue, and muscle.4 The costs of pressure ulcers to the healthcare system is estimated to be $11 billion each year.5
Stage III and Stage IV are the most advanced types of pressure ulcer and the most costly to heal; healing takes twice as long as partial-thickness ulcers occurring in the same practice.6 It is important to close these wounds quickly to reduce healthcare cost and improve patient quality of life. These wounds can be treated using an assortment of methods, from dressings to negative pressure wound therapy (NPWT) to complex surgical flap procedures.7 One option involves a minimally invasive surgical method to close pressure ulcers using external tissue expanders, ongoing wound care, and the judicious use of sutures to quickly close the wound and fill the wound cavity with subcutaneous padding. A clinical series8 on the use of external tissue expansion to close 650 dehisced, chronic, and traumatic wounds found that this method resulted in skin that can withstand the rigors of everyday life, and most wounds were closed in 7 to 14 days.