Pressure Ulcers Are Painful, Dangerous, Costly, and Preventable

By John Henry Dreyfuss, MDalert.com staff.
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  • Pressure ulcers are common throughout the world.
  • Many different types of pressure wounds and treatments exist.
  • The annual cost of pressure ulcers in the U.S. is about $11 billion.
  • Pressure ulcers are easily prevented.
  • Prevention is much less costly than treatment.

Each day in the United States pressure ulcers cause unnecessary suffering and undue risk for as many as 2.5 million patients at a cost estimated in 2013 at $11 billion per year. A number of systematic reviews published recently in the medical literature indicate that  pressures ulcers — bed sores — are quite common, exceedingly expensive, and easily preventable. Treatment, however, can be more expensive and difficult, but is generally effective.

However, pressure ulcers vary significantly in type, and matching therapy to wound type is a key to successful treatment. Also, the cost-effectiveness data on the variety of treatments are not conclusive (http://www.ncbi.nlm.nih.gov/pubmed/25012958), according to a number of recent meta-analyses.

The Good News

The good news is that there are numerous techniques for preventing or mitigating all types of pressure ulcers. The National Library of Medicine makes the following suggestions:

  • When washing, use a soft sponge or cloth. Do not scrub hard.
  • Use moisturizing cream and skin protectants on your skin every day.
  • Clean and dry areas underneath your breasts and in your groin
  • Do not use talcum powder (it is irritating and is carcinogenic) or strong soaps
  • Try not to take a bath or shower every day. It can dry out your skin more.
  • Eat enough calories and protein to stay healthy.
  • Drink plenty of water every day.

Make sure that your clothes are not increasing your risk of developing pressure ulcers:

  • Avoid clothes that have thick seams, buttons, or zippers that press on your skin.
  • Do not wear clothes that are too tight.
  • Keep your clothes from bunching up or wrinkling in areas where there is any pressure on your body.

After a bowel movement or after urinating:

  • Clean the area right away. Dry well.
  • Ask your healthcare provider about creams to help protect your skin in this area.

According to Mayo Clinic:

  • Ask the patient to shift weight frequently or to ask for assistance in doing so. Every 15 minutes is appropriate; every 60 minutes is required.
  • Ask the patient to lift him or herself, if possible. If the patient has the upper body strength, wheelchair pushups are an excellent exercise.
  • Suggest a specialty wheelchair. Some wheelchairs can be tilted, which can relieve pressure.
  • Suggest a cushion that relieves pressure. Use cushions to relieve pressure and help ensure the body is well-positioned in the chair. A physical therapist can advise how to place the cushion and how to regularly reposition it.

Nutritional Support

A statistical analysis — a non-clinical study — conducted in Australia found that nutritional support significantly reduced, the incidence, severity, and duration of pressure ulcers.

The researchers reported that, “Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximized at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million.

“Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalized patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.”

Chronic Pressure Sores Can Be Effectively Treated

A study reported conducted by the National Health Service in Wales found that:

“Chronic wounds are known to represent a significant burden to patients and National Health Service (NHS) alike. However, previous attempts to estimate the costs associated with the management of chronic wounds have been based on literature studies or broad estimates derived from incidence rates and extrapolations from relatively small-scale studies. The aim of this study is therefore to determine the extent of resource utilization by patients classed as having chronic wounds within Wales using linked routine data - available through the Secure Anonymized Information Linkage (SAIL) database — to estimate the costs associated with the management of these patients by the NHS in Wales. The SAIL database brings together, and anonymously links, a wide range of person-based data from general practitioner (GP) practices within Wales, which includes primary and secondary care consultations to create an encrypted anonymized linking field for each individual.

“This linkage allows the patient pathway to be tracked through the NHS system both retrospectively and prospectively from a specific reference date. The estimated costs were derived by extrapolating to an all-Wales level from the results gleaned from the SAIL database using the respective READ codes to capture relevant patients with chronic wounds. The number of patients identified as having chronic wounds within the SAIL database was 78 090, which equates to 190,463 across Wales as a whole and a prevalence of 6% of the Welsh population. The total cost of managing patients with chronic wounds in Wales amounted to £328.8 million — an average cost of £1727 per patient and 5.5% of total expenditure on the health service in Wales. A relatively few READ codes represented a significant proportion of expenditure, with diabetic foot ulcers, leg ulcers, foot ulcers, varicose eczema, bed sores and postoperative wound care constituting 93% of total expenditure.

“When a more conservative perspective was used in relation to classification of chronic wounds, the total cost amounted to £303 million. However, these are likely to be underestimates because of the lack of information for patients with treatments lasting over 6 months and not including patients who might have entered the health care system of wound management elsewhere - such as patients contracting pressure ulcers in hospitals and having surgical wound infections.”

Treatment is Frequently Effective

A systematic analysis published in BMC Medicine found that the full variety of pressure ulcers could be treated optimally by a specific treatment.

“Overall,” the researchers wrote, “59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.

Our results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings.”


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