Abstract
Study DesignRetrospective cohort study including spinal cord injured patients with anus-near pressure ulcers.ObjectiveThe primary objective was to evaluate the impact of stool diversion via stoma on the decubital wound healing. Secondary objectives included the risk of complications and ulcer recurrence. Associations between the wound healing and potentially interfering parameters were determined.SettingUniversity hospital with a spinal cord injury unit.MethodsA total of 463 consecutive patients who presented with a decubitus were retrospectively included. Patients with and without a stoma were compared using descriptive and explorative statistics including multiple regression analysis.ResultsThe severity of the pressure ulcers was determined as stage 3 in two-thirds and stage 4 in one-third of all cases. The wound healing lasted longer in the 71 stoma-presenting patients than in the 392 patients with undeviated defecation (77 vs. 59 days, p = 0.02). The age (regression coefficient b = 0.41, p = 0.02), the ASA classification (b = 16.04, p = 0.001) and the stage of the ulcers (b = 19.65, p = 0.001) were associated with prolonged ulcer treatment in the univariate analysis. The multiple regression analysis revealed that the fecal diversion (b = −18.19, p = 0.03) and the stage of the ulcers (b = 21.62, p = 0.001) were the only predictors of delayed wound healing.ConclusionThe presence of a stoma is not related to improved wound healing of ulcers near the anus. On the contrary, stoma patients needed more time until complete wound healing, conceivably related to selection bias. Nonetheless, we currently do not recommend fecal diversion to be the standard concept for decubitus treatment.
Highlights
Pressure skin ulcers are a common complication and reason for hospitalization in patients with spinal cord injury (SCI) leading to a huge medical, social, and economic burden [1, 2]
The healthcare costs for the treatment of pressure ulcers in SCI patients are significantly higher than the costs for those without pressure ulcers, partly explained by longer inpatient care [3]
There were slight differences between the study groups regarding the etiology and severity of Definition of ulcer characteristics and staging of disability The anus-near localization was defined as any ulcer that spread out with at least a substantial surface within the following anatomical structures: The connecting line between both posterior superior iliacal spines formed the cranial margin, the ventrocaudal margin was compartmentalized by the SCI with higher grades in the fecal diversion group
Summary
Pressure skin ulcers are a common complication and reason for hospitalization in patients with spinal cord injury (SCI) leading to a huge medical, social, and economic burden [1, 2]. The concomitant neurogenic bowel dysfunction, fecal incontinence, and defecation difficulties of patients with SCI are assumed to further aggravate the risk, of sacral ulcerations [6, 9, 10]. Whereas data regarding those with SCI are missing, fecal incontinence increases the probability of ulcers in the general adult hospitalized population by twenty-two times [11]
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