The Costs and Outcomes of Treating a Deep Pressure Ulcer in a Patient with Quadriplegia
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A clinical series14 of 52 decubitus ulcers (sacral, trochanteric, ischial, and heel), a clinical series15 of 74 pressure ulcers (foot and ankle), and a clinical series16 of 16 dehisced abdominal wounds — all supported using tissue expansion to close the wounds.
When a Stage III or Stage IV pressure ulcer develops, a basic management decision has to be made. Nonsurgical secondary intention healing can take months. A 1990 study17 of 19,889 elderly patients at 51 nursing homes showed that, when using traditional gauze-based dressings, 29% of Stage III pressure ulcers and 38% of Stage IV pressure ulcers remained unhealed after 2 years. A 2-year study18 in a Canadian urban health region involving seven healthcare organizations (acute, home, and extended care) revealed a pressure ulcer can increase nursing time up to 50%, as well as increase direct costs. In addition to its effect on patient quality of life, an open wound also remains at risk for the development of complications including infections, anemia, and osteomyelitis that, as illustrated by the passing of Christopher Reeves, can lead to death. Emotional suffering and physical pain are an important cost often quantified in litigation. A review19 of medical malpractice cases regarding patients at risk for pressure ulcers in long-term care facilities indicated that the patient achieved a verdict or settlement in 68% of cases, and the median monetary recovery was $250,000. In a 2003 case in California, a jury awarded $3 million in damages against a nursing home for allowing an elderly woman to die of bedsores.20 Using external tissue expansion, most pressure ulcers are closed in 7 to 14 days.8
In this case study, Mr. K was discharged after 16 days, sutures were removed after 1 month, and he returned to work 6 weeks following surgery. Insurance company costs for his treatment were $43,814. This is in stark contrast with attempted wound closure during a period of 15 months at a cost of $242,350, of which $52,992 were rental charges for the NPWT system. The final result was an unhealed pressure ulcer. If the ulcer initially had been closed by external tissue expansion, $198,356 would have been saved. According to data from the CMS and the Healthcare Cost and Utilization Project,9 a nationwide database of hospital inpatient stays, in 2006, 503,300 hospital stays noted pressure ulcers as a diagnosis, and pressure ulcer hospital costs totaled $11 billion.
Pressure ulcer treatment represents a significant expenditure of private health insurance as well as Medicare and Medicaid funding. A pressure ulcers is both a high-cost and high-volume adverse event. With limited resources and manpower available, the open nonhealing pressure ulcer is a challenge to the healthcare professional. It is essential to find new modalities to provide a better quality of life for these patients at a reduced cost to the healthcare system. This case study illustrates the potential of the external tissue expansion technique to close deep pressure ulcers within a relatively short amount of time while reducing cost. Studies including control treatments are needed to confirm these conclusions.
1. A Profile of Older Americans 2009 Administration of Aging, US Department of Health and Human Services. www.aoa.gov/aoaroot/aging_statistics/profile/2009/docs/2009profile_509.pdf. Accessed January 20, 2012.
2. Lyder C. Pressure ulcer prevention and management. JAMA. 2003;289:223–226.
3. Allman RM. Pressure ulcers among the elderly. N Engl J Med. 1989;320(13):850–853.
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