Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study

Abstract

Objective: To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. Method: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. Results: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806–0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183–2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010–1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006–1.019) and diaper (HR: 1.007; 95% CI 1.001–1.013) in the postoperative period. Conclusion: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.