The association between obesity and pressure ulcer development in critically ill patients: A prospective cohort study
Jessica D Workum1, Annechien van Olffen1, Pieter J Vaes1
1Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Insights
Obesity does not independently increase the risk of pressure ulcers (PUs) in intensive care unit (ICU) patients. However, morbidly obese individuals may develop PUs earlier during their ICU stay.
Area of Science:
- Critical Care Medicine
- Patient Safety
- Clinical Research
Background:
- Pressure ulcers (PUs) are a significant preventable adverse event in hospitals, particularly affecting critically ill patients.
- Understanding risk factors for PU development in intensive care units (ICUs) is crucial for patient care.
Purpose of the Study:
- To investigate the relationship between obesity and the development of pressure ulcers in critically ill ICU patients.
- To determine if obesity is an independent risk factor for PU formation in the ICU setting.
Main Methods:
- A prospective cohort study involving adult ICU patients with and without obesity (BMI ≥ 30 kg/m² vs. 18-25 kg/m²).
- Data collected on PU development, severity, location, and time to development/recovery over a 4-year period.
- Multivariate logistic regression analysis was used to assess the correlation between obesity and PU occurrence.
Main Results:
- No significant difference in PU incidence (13.2% vs. 12.7%) or characteristics between obese and non-obese ICU patients.
- Obesity was not found to be an independent risk factor for PU development in the ICU.
- Patients with morbid obesity (BMI ≥ 40 kg/m²) showed a trend towards earlier PU development.
Conclusions:
- Obesity is not an independent risk factor for pressure ulcer development in critically ill ICU patients.
- Morbid obesity may be associated with earlier onset of pressure ulcers during ICU admission.
- Further research into specific risk factors for PU development in morbidly obese ICU patients is warranted.
Background:
Pressure ulcers (PUs) are one of the leading potentially preventable adverse events in the hospital. Critically ill patients are at risk for the development of PUs. The primary aim of the study was to investigate the relation of PUs and obesity in critically ill ICU patients.
Methods:
A single center prospective cohort study was conducted on adult patients with obesity (defined as a body mass index BMI ≥ 30 kg/m2) and patients without obesity (BMI 18-25 kg/m2) admitted to the intensive care unit between May 2013 and July 2017 with an ICU length of stay of at least 3 days without pre-existing PUs at admission.
Results:
851 of 1205 patients (70.6%) had a normal BMI and 354 (29.4%) had a BMI ≥ 30 kg/m2 and were considered obese. Overall, 157 patients (13.0%) developed PUs; 112/851 (13.2%) of patients without obesity and 45/354 (12.7%) of patients with obesity (p = 0.907). There was no difference in the severity (p = 0.609) and PU location (p = 0.261). Mean days to PU development was 11.1; 11.7 days for patients without obesity and 9.5 days for patients with obesity (p = 0.270). Mean days to PU recovery was 13.2, which was 14.1 days for patients without obesity and 10.8 days for patients with obesity (p = 0.215). A multivariate logistic regression model showed no significant correlation between the occurrence of PUs in the ICU and obesity (OR 0.875 with 95% CI 0.528-1.448, p = 0.594). Subgroup analysis showed that patients with morbid obesity (BMI ≥ 40 kg/m2) developed PUs earlier during ICU admission when compared to patients without obesity (p = 0.004).
Conclusion:
Our study demonstrates that obesity is not an independent risk factor for the development of PUs in the ICU. However, patients with morbid obesity might develop PUs earlier compared to patients without obesity.
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