(WHS-L1.06) SPINAL CORD INJURY AND POSTOPERATIVE COMPLICATIONS IN PRESSURE ULCER CLOSURE
Thursday, May 16, 2024
10:30 AM – 11:30 AM East Coast USA Time
Background Prior literature has shown that patients with spinal cord injury have higher incidence of pressure ulcers (PUs). However, differences in the rate of complications following debridement and closure, as well as variations in wound size, have not been thoroughly investigated. The purpose of this study is to evaluate these specific criteria to determine whether PU wound healing outcomes following surgical closure are impacted by a past medical history of spinal cord injury. In doing so, the study aims to inform targeted interventions that can enhance the overall quality of care for individuals with a history of spinal cord injury. Methods In this prospective single-institution study, patients with stage III/IV PUs undergoing surgical debridement and closure were included. Follow-up assessments were conducted at 14 days, 1 month, 6 months, and 1 year postoperatively. Complications assessed at 2 weeks included maceration, major or minor dehiscence, epidermolysis, drainage, congestion, and skin necrosis. Results A total of 38 patients were included. Of them, 36.8% (n = 14) had a past medical history of spinal cord injury. Patients with a history of spinal cord injury had a significantly higher number of post-operative complications 2 weeks following surgical PU wound closure (1 vs. 0.36, p < 0.05). The complication with the highest prevalence (21%, n = 8) was major or minor wound dehiscence. Patients with a history of spinal cord injury also had significantly higher risk of open wound status at 14 days post-operatively (RR = 1.4, p < 0.05) and at 1 month post-operatively (RR = 2.18, p < 0.05) compared to those without. However, this increased risk of an open wound was lost at 6 months (RR = 0, p = 0.18) and 1 year (RR = 2.83, p = 0.13) post-operatively. There was no significant difference found in wound length (6.46 cm vs. 5.39 cm, p = 0.20), width (4.59 cm vs. 3.67 cm, p = 0.20), or depth (2.99 cm vs. 2.41 cm, p = 0.20) between patients with a history of spinal cord injury and those without. Conclusion In conclusion, this study sheds light on the impact of a history of spinal cord injury on pressure ulcer (PU) wound healing outcomes following surgical closure. The findings reveal that patients with a past medical history of spinal cord injury experienced a significantly higher incidence of post-operative complications, particularly major or minor wound dehiscence, at 2 weeks post-operatively. Additionally, these individuals faced an increased risk of an open wound status short-term (2 weeks and 1 month post-operatively). Interestingly, this heightened risk diminished long-term (6 months and 1 year post-operatively). While wound dimensions did not exhibit significant differences between patients with and without a history of spinal cord injury, the study underscores the need for tailored interventions and closer monitoring in this patient population to optimize PU wound healing outcomes.