Pressure injuries beyond acute care hospitals: a multicenter cohort study across rehabilitation settings

Pressure injuries (PIs) are widely recognized as indicators of patient safety and quality of care in acute hospitals, yet their burden in rehabilitation settings remains underexplored. Patients admitted to rehabilitation often present with high clinical complexity and functional dependency, potentially increasing PI-related risks.

This multicenter retrospective cohort study was conducted across 15 inpatient rehabilitation facilities of the Fondazione Don Gnocchi network in Italy. All adult patients admitted for full-time rehabilitation between March 23 and April 23, 2024, were included, excluding those with stays shorter than 5 days. Data extracted from medical records included demographic and clinical characteristics, functional status (Barthel index), PI risk (Braden Scale), presence and characteristics of PIs at admission, incident PIs during hospitalization, healing outcomes, length of stay, and discharge destination. Prevalence and cumulative incidence were estimated, and cause-specific Cox regression models were applied to evaluate the association between PIs and time to routine discharge.

Among 1,013 patients, 175 had at least one PI at admission, corresponding to a prevalence of 17.3% [95% confidence interval (CI): 15.0%-19.8%]. Most lesions were stage 1-2 and primarily located at the sacrum and heels. Patients with PIs were older, more functionally dependent, and had higher rates of neurological comorbidities, dysphagia, incontinence, and medical device use. During rehabilitation, patients with PIs at admission showed a higher cumulative incidence of new PIs than those without (14.3% vs. 4.2%). Overall, 41.5% of lesions present at admission healed during hospitalization, with substantially lower healing rates for advanced-stage injuries. In multivariable analysis, the presence of PIs at admission was independently associated with prolonged time to routine discharge (adjusted hazard ratio 0.67, 95% CI: 0.54-0.83).

Pressure injuries are highly prevalent at admission to rehabilitation and are associated with poorer clinical outcomes and increased resource utilization. These findings support the need for integrated preventive and management strategies spanning acute and rehabilitation care pathways.