SURGICAL PROGNOSTICATION OF ADVANCED PRESSURE ULCERS BY RACE: A DISPARITY OR RARITY?

Objectives: Pressure ulcers (PU) continue to be a prominent part of the management of chronically ill patients, particularly those with limited mobility, and remain a costly component of our healthcare system. However, there exists a gap in our understanding of how certain patient factors influence outcomes. Thus, it is often difficult for providers to provide accurate prognostic information to patients and caregivers in order to set realistic expectations.

Methods: We performed a retrospective study under Institutional Review Board approval (ORA #: 21112101-IRB01). We identified patients who were diagnosed with stages 3 and 4 PU of the sacrum, ischium, trochanter, leg, chest, and back. These patients received medical and surgical wound care from the Acute Care Surgery Service at Rush University Medical Center between 2017 and 2022. We collected demographic and clinic information for these patients.

Results: We identified 76 patients who met the criteria for our study. 68.4%, 21.1%, and 10.5% of patients defined their racial identity as African American, White, and Other, respectively; 62.5% of those who identified as Other further identified themselves as ethnically Hispanic. Follow up at 1 month, 3 months, 6 months, 9 months, 1 year, and 2 years was respectively 40.4%, 26.9%, 17.3%, 17.3%, 17.3%, and 15.4% among the African American study population; 43.8%, 25%, 31.3%, 12.5%, 12.5%, and 12.5% among the White study population; and 12.5%, 12.5%, 12.5%, 0%, 0%, and 12.5% among the Other study population. Closure by 3 months was achieved in 1 PU examined within the African American study population; one additional PU achieved closure by 6 months. Among those who racially identified as Other, closure was achieved by 6 months in 1 PU. No PU achieved closure by 2 years amongst those who identified as White.

Conclusion: This study not only provides insight into the grim prognosis amongst those who have advanced PU necessitating surgical intervention, but also highlights the racial disparity that exists in PU development. African Americans made up a disproportionate amount of the patients examined; their degree of follow up was relatively similar to their White counterparts and superior to their Other counterparts. Despite this, closure was rare across all races. Thus, while there may be a greater proportion of patients who identify as African American who develop advanced PU, race appears to have no bearing on rates of closure following surgical intervention. Further study is warranted to collect more information on this important topic.