Trends In Decubitus Ulcers In The US 2012-2017
Phoebe B. McAuliffe, BA, Ankoor A. Talwar, MBA, Abhishek A. Desai, MD, Robyn B. Broach, PhD, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Decubitus ulcers are a morbid and costly problem faced by healthcare systems and patients nationwide. We examine current patterns and characteristics in the US.
METHODS: Using 2012-2017 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a cross sectional review of hospital discharges with an ICD-9/10-identified diagnosis of pressure ulcer was performed. Discharge data were collected and analyzed.
RESULTS: Between 2012-2017 there were 3,683,219 discharges associated with pressure ulcers, 192.1/100K US population, with average growth of 3.6% per year. Mean total charges were $89,082 per discharge, over $320 billion USD total. Severity III/IV ulcers accounted for 33.8% of the discharges, increasing from 32.4% to 35.3% over the time period (p<0.01). Locations were 63.4% sacral, 8.7% lower extremity, 18.9% multiple locations and 9.0% other. Lower extremity ulcers decreased at 2.2% per year, sacral decreased at .03% and multiple locations increased at 6% per year. The most common primary diagnoses were sepsis (19.0%), acute kidney failure (2.9%) and urinary tract infection (2.9%); the most common comorbidities were hypertension (36.1%), arrhythmia (34.3%) and renal failure (30.6%). The average age and proportion female both decreased significantly over the time period (71.0 vs 69.0, p<0.01 and .51 vs .39, p<0.01) with no change in mortality or length of stay.
CONCLUSION: Despite preventative efforts and incentives by healthcare systems pressure ulcers are growing in prevalence with increasing severity. 
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