[Retrospective analysis of 2 997 inpatients with skin and soft tissue injuries]

Objective: To analyze the epidemiological characteristics and the related information on the diagnosis and treatment of inpatients with skin and soft tissue injuries. Methods: The medical records of inpatients with skin and soft tissue injuries who were admitted to the Fourth Medical Center of PLA General Hospital (hereinafter referred to as the author's unit) from January 1, 2014 to December 31, 2018, conforming to the study criteria, were retrospectively analyzed. The indexes included inpatients'gender, age, wound course, underlying disease, wound type, wound site, and wound microbiological culture result, methods and outcome of treatment, type of medical payment, hospital day, and hospitalization cost. Data were statistically analyzed with Mann-Whitney U test, Kruskal-Wallis H test, and chi-square test. Results: (1) A total of 2 997 inpatients, conforming to the study criteria, were admitted to the author's unit during the 5 years. There were 1 803 (60.16%) males and 1 194 (39.84%) females. The distribution of gender of patients showed significant differences during the 5 years (χ(2)=13.203, P<0.05). The age of female patients was significantly older than that of male patients (Z=-6.387, P<0.01). There were 882 (29.43%) patients with acute wounds and 2 115 (70.57%) patients with chronic wounds. The distribution of acute wounds and chronic wounds of patients showed significant differences during the 5 years (χ(2)=66.806, P<0.01). The age of patients with chronic wounds was significantly older than that of patients with acute wounds (Z=-12.582, P<0.01). A total of 1 910 patients (3 847 cases) were complicated with underlying diseases. The common underlying diseases orderly were diabetes 1 151 (29.92%) cases, hypertension 884 (22.98%) cases, coro-nary atherosclerotic heart disease 414 (10.76%) cases, old cerebral infarction 258 (6.71%) cases, and paraplegia 258 (6.71%) cases. More patients with chronic wounds were complicated with various underlying diseases compared with patients with acute wounds (χ(2)=130.649, P<0.01). (2) The common types of wounds were postoperative non-healing wounds, burn wounds, diabetic foot ulcers, pressure ulcers, and skin and soft tissue infection. The distribution of types of wounds showed significant differences during the 5 years (χ(2)=342.265, P<0.01). There were 3 957 wounds. The common wound sites were feet, legs, chests, and so on. A total of 976 patients underwent microbiological examination. The results of 719 (73.67%) patients were positive and 257 (26.33%) patients were negative. The positive rate of wound microbiological culture of patients with chronic wounds was significantly higher than that of patients with acute wounds (χ(2)=33.981, P<0.01). Among the patients with acute wounds, 111 patients (72.08%) were simply infected, 43 (27.92%) patients were mixed infected. Among the patients with chronic wounds, 364 (64.42%) patients were simply infected, and 201 (35.58%) patients were mixed infected. A total of 1 010 strains of pathogenic bacteria were detected in 719 patients, including 447 (44.26%) Gram-positive bacteria, 548 (54.26%) Gram-negative bacteria, and 15 (1.48%) fungi. There was a significant difference in the distribution of pathogenic microorganisms between patients with acute wounds and chronic wounds (χ(2)=12.215, P<0.01). In this group of patients, the common strains of wounds were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and so on. The common strains of patients with acute wounds were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, and so on. The common strains of patients with chronic wounds were Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia colis, and so on. (3) The patients in this group were mainly treated by surgery. Finally, 1 330 patients were cured, 1 393 patients were improved, 257 patients were not cured, and 17 patients died. There was a significant difference in the distribution of outcome in patients with acute wounds and chronic wounds (Z=-7.622, P<0.01). (4) The main types of payment of medical expenses for patients in this group were local medical insurance, remote medical insurance, and self-paying. The total hospitalization cost of patients in this group was 169 268 523.65 yuan, which was mainly consist of the costs of materials and drugs. The hospital day of patients in this group was 21.00 (11.00, 36.00) d, and the hospitalization cost was 30 016.34 (14 439.41, 63 685.60) yuan. There were significant differences in the hospital day and hospitalization cost among patients with different medical payment types (χ(2)=285.986, 327.436, P<0.01). There were significant differences in the hospital day and hospitalization cost among patients with different wound types (χ(2)=125.912, 131.485, P<0.01). Conclusions: The patients with skin and soft tissue injuries are mainly middle-aged and elderly patients, with more males than females, more chronic wounds than acute wounds. Skin and soft tissue injuries are prone to occur in sites with prominent bone, thin subcutaneous fat, and poor blood supply. The result of wound microbiological culture is mainly Gram-negative bacteria, and the positive rate of wound microbiological culture of patients with chronic wounds is higher than that of patients with acute wounds. The proportion of Gram-positive bacterial infection ranks the highest in patients with acute wounds. The proportion of Gram-negative bacterial infection ranks the highest in patients with chronic wounds. Patients with chronic wounds are often complicated with various underlying diseases, and the course of disease is long, so the constituent ratio of cured patients is lower than that of patients with acute wounds. Patients with skin and soft tissue injuries have long hospital days and high proportion of material cost, which are directly related to the clinical characteristics and long treatment cycle of chronic wounds. Therefore, it is suggested that the medical insurance administration department should adjust the consumption ratio and other management indicators according to the actual clinical needs of elderly patients with chronic wounds.