Long-term outcomes of full-thickness pressure ulcers: healing and mortality

A non-experimental, retrospective analysis of pressure ulcer quality-assurance data was conducted from October 1997 to October 2002 to ascertain the relationship between the occurrence of nosocomial full-thickness pressure ulcers, healing, and mortality. The records of 74 patients (one woman, 73 men) who developed full-thickness pressure ulcers as inpatients at a regional Veterans Affairs medical center with acute, intensive, and long-term care units were assessed. Start day was the day that the ulcer was determined to have occurred and end day was the date the patient was pronounced dead. Major diagnoses for all patients, 70.7% for whom end-of-life planning was in effect, were cerebrovascular accident, diabetes, and cancer. The majority of ulcers were located in the sacral/coccygeal area (66.2%) and heel (16.2%). None of the ulcers healed in patients who died within 180 days of ulcer onset. A 180-day mortality rate of 68.9% was noted in people who developed nosocomial full-thickness pressure ulcers, with an average of 47.0 days from ulcer onset to death. No deaths were related to the presence of the pressure ulcer. In this data set of people with a heavy disease burden who were approaching the end of life, the development of full-thickness pressure ulcers appeared to be a comorbid pathologic process. Collecting and analyzing long-term pressure ulcer healing and mortality outcomes is a missing component of pressure ulcer quality-assurance data.