<< Back to the abstract archive
Closing the Gap: Predictors of Early Mortality in Patients Following Pressure Ulcer Reconstruction
Shawn Loder MD, Michael Gimbel MD
University of Pittsburgh
2019-02-14
Presenter: Shawn J Loder
Affidavit:
This work in its entirety represents the original work of the resident under guidance of the named faculty mentor.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Pressure ulcers can present a dilemma for the reconstructive surgeon. Durable reconstruction after debridement can provide substantial benefits to the patient, however, post-operative mortality remains high. In this study we sought to better identify characteristics associated with increased post-operative mortality.
Methods: This is a retrospective analysis of 208 ulcer debridements performed between 2000-2016. This series included 77 operation involving reconstruction. Reconstruction was defined as any procedure for closure or coverage for a debrided wound including primary closure, locoregional tissue rearrangement, and flap reconstruction. We assessed social, surgical, peri-operative, and medical history vs post-operative survival at 1-,3-,6-, and 12-months.
Results: First year survival was significantly greater in the reconstructed group. These patients also had significantly lower pre-operative BUN, creatinine, and white cell count with significantly higher prealbumin as well as a lower burden of cardiac, renal, endocrine and pulmonary comorbidities. Within the reconstructed population metastatic malignancy was associated with death in the first month. Personal history of coronary bypass and lymphedema were similarly predictive of death. Paraplegia, however, was significantly associated with survival. When examined at 1 year, paraplegia and metastatic malignancy retained their significance. Cardiac, peripheral vascular, and renal disease as well as stroke and dementia were associated with mortality in the first post-operative year.
Conclusion: Reconstructive surgeons take many factors into account electing to pursue operative closure after debridement, however, post-operative mortality remains a significant concern in this often-fragile population. Here we identify factors which help predict mortality as early as the first post-operative month.