Impact of pressure-related injury on hospitalized patients with colorectal cancer: A United States population-based cohort study.

Abstract

e15688 Background: Colorectal cancer is the third most common cancer worldwide. Newer treatment options have significantly helped improve quality of life, albeit with the potential for more adverse effects. Pressure-related injuries, including pressure ulcers, sacral wounds, heel ulcers, and full-thickness wounds, continue to be significant comorbidity in hospitalized patients. Patients with underlying malignancy are more prone to developing pressure-related injury, especially in cases with poor performance status. Our study aims to explore the impact of pressure-related injury on hospitalized patients with colorectal cancer. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with colorectal cancer and pressure-related injury using appropriate ICD-10 diagnostic codes. We stratified patients with colorectal cancer based on the presence or absence of pressure-related injury. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of < 0.05 was considered statistically significant. Results: We identified a total of 77130 hospitalized patients with colorectal cancer, of which 0.26% (205/77130) had comorbid pressure-related injury. The overall in-hospital mortality among patients with colorectal cancer was 2.74% (2115/77130). Among those with concomitant pressure-related injury, the mortality rate was significantly higher at 12.20% (25/205, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, pressure-related injury was found to be an independent predictor of increased in-hospital mortality (adjusted OR 3.22; 95% (confidence interval [CI] 1.22-8.51; p= 0.018), longer LOS (coefficient 7.41 days; CI 2.15-12.66; p= 0.006), but not higher total hospitalization charge ($25963; CI -$4867-$56794; p=0.099) or increased need for mechanical ventilation (adjusted OR 3.27; CI 0.95-11.23; p= 0.059). Conclusions: Our analysis demonstrated that pressure-related injury was prevalent in hospitalized patients with colorectal cancer. It was associated with significantly worsened in-hospital mortality and longer LOS. Efforts should be made for early diagnosis and accurate documentation of pressure-related injuries. Strategies focused on establishing institutional protocols for preventing and managing pressure-related injuries, including wound care teams as indicated, may help improve clinical outcomes. Further prospective studies are needed to describe these associations better.