Heel Ulcer Incidence Following Orthopedic Surgery: A Prospective, Observational Study
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Pressure ulcers (PU) are a common and serious health concern. Prospective studies involving acute surgical patients have provided similar estimates of cumulative PU incidence in the Netherlands (21.2%)1 and in the U.S. (21.5%).2,3 In other prospective research conducted in European countries, cumulative HPU incidence in acute care patients with fractured hips was found to range from 16% to 66%.4,5-7 The highest incidence of PU (66%) was observed in an acute care study conducted in England among older participants (70 to 94 years).4 A Pan European study7 involving six countries in the north and south of Europe prospectively followed a large sample (635 participants) from admission to discharge and reported a 16% cumulative PU incidence, the majority of PUs classified as Stage I, suggesting they were less severe.
Several US studies8-10 have reported a prospectively determined 0% cumulative PU incidence in rehabilitation centers and the community. Cumulative PU incidence in retrospective studies has been estimated to be 6% in rehabilitation centers11,12 and 3.2% in individuals living in the community.13 In a retrospective study of a similar population of community-dwelling seniors in the UK, Margolis et al14 reported an incidence rate of 0.58 PU per hundred persons. Although study comparison is hampered by the different methods employed, this research might suggest that PU incidence in all anatomical locations tends to be lower in rehab and community care settings compared to acute care facilities.
Heel pressure ulcer (HPU) incidence is of particular interest in the orthopedic population but information about HPU incidence in the orthopedic population in Canada is limited. Campbell et al15 conducted a prospective study among orthopedic patients in an acute care facility in Canada and followed participants from admission to the average length of stay (LOS = 5 days) or discharge, whichever came first. The estimated HPU incidence in this population was found to be 13.3%. Because people undergoing orthopedic surgery receive care at many points along the healthcare continuum and in many healthcare settings, it is important to understand when and where most HPUs develop. Care sites often blame each other for causing HPU.
The purpose of this prospective study was to evaluate: 1) the cumulative incidence of HPUs in orthopedic patients across the continuum of care, and 2) the outcome of HPUs once they occurred.