695. Economic Burden Attributable to Infection of Pressure Ulcers in Paraplegic Gunshot Wound Victims in Greater Detroit
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • GSW IDSA Poster.pdf (286.4 kB)
  • Background: Limited data exists on hospital costs attributable to infected pressure ulcers  in gunshot wound (GSW) victims who are paraplegic .

    Methods: Patients admitted to three acute care hospitals in metro Detroit from January 2004 through December 2008 were included if they met the following criteria: age > 14 years, paraplegia following a gunshot wound, and presence of a pressure ulcer.  Medical records were reviewed. Total costs included cost of initial admission and subsequent readmissions for the following one year after each initial patient admission.

    Results: 201 total patients with 411 total hospital admissions were included.  Mean age was 37 ± 8.9; 179 (89%) were male; 191 (95%) were African-American; and 104 (52%) were receiving Medicaid or Medicare.  Most patients were admitted from home (n=169, 84%) or a nursing home (n=21; 10%). Infection of a pressure ulcer was confirmed in 76 cases (38%) during the initial admission, and was more common in stage III - IV ulcers (61/113, 80% were infected) compared to stage I - II ulcers (n=15/88, 20%)(p<0.001). 90 (45%) patients had > 1 readmission in the first year following their initial admission.  Risk of readmission was significantly higher for patients with infected ulcers (57%) compared to those without (38%) (OR: 2.2, 95%CI: 1.2, 3.8). Total hospital costs per patient were highly skewed with a mean of $16,951 ± $30,030.6 and a median of $9,217.5 (IQR $4344-$19864).  Median total hospital costs were greater among patients with infected ulcers, (median$10,007.3(IQR:$4907-$20825.5)  compared to those without (median $8342.9 (IQR:$3715-$17509)(p=0.2).  Four patients accounted for extremely high costs attributable to prolonged hospital stay and multiple surgical procedures; two had infected pressure ulcers.

    Conclusion: Infected pressure ulcers among GSW victims with paraplegia accounted for almost $3 million dollars and 2500 hospital days during the study period.  Measures to prevent the development of pressure ulcer and associated super-infection this population would be cost-effective. 


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Teena Chopra, MD1, Indu Chalana, MD2, Smitha Sathyaprakash, MD3, Miriam Levine, MD3, Farah Ahmad, MD3, Zeinab Tamam, MD3, Sanjeet Panda, MD3, Sylvia Whittington, RN-BC, BSN, MPH3, Kenetra Ruffin, PhD3, Kyrie Wang, BS3, Dror Marchaim, MD4, Kayoko Hayakawa, MD, PhD4, Jack D. Sobel, MD, FIDSA5, Tom Taylor, PhD3, Emily Martin, MPH, PhD3 and Keith Kaye, MD, MPH, FIDSA4, (1)Detroit Medical Center/Wayne State University, Detroit, MI, (2)Wayne State University / Detroit Medical Center, Detroit, MI, Detroit, MI, (3)Detroit Medical Center, Wayne State University, Detroit, MI, Detroit, MI, (4)Detroit Medical Center (DMC) / Wayne State University, Detroit, MI, (5)Wayne State University/Detroit Medical Center, Detroit, MI

    Disclosures:

    T. Chopra, None

    I. Chalana, None

    S. Sathyaprakash, None

    M. Levine, None

    F. Ahmad, None

    Z. Tamam, None

    S. Panda, None

    S. Whittington, None

    K. Ruffin, None

    K. Wang, None

    D. Marchaim, None

    K. Hayakawa, None

    J. D. Sobel, None

    T. Taylor, None

    E. Martin, None

    K. Kaye, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.