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. 2025 Sep;29(47):1-150.
doi: 10.3310/DWKT1327.

Effectiveness of surgical interventions in patients with severe pressure ulcers: the SIPS mixed-methods exploratory study (VSports最新版本)

Barnaby Reeves  1 , Maria Pufulete  2 , Jessica Harris  1 , Jo Dumville  3 , Una Adderley  4 , Ashley Burton  5 , Michael Burton  5 , Ross Atkinson  6 , Madeleine Clout  1 , Nicky Cullum  3 , Abby O'Connell  1 , Louise O'Connor  7 , Stephen Palmer  1 , Matthew Ridd  2 , Jeremy Rodrigues  8 , Jason Wong  9
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"V体育2025版" Effectiveness of surgical interventions in patients with severe pressure ulcers: the SIPS mixed-methods exploratory study

Barnaby Reeves et al. Health Technol Assess. 2025 Sep.
Free article

Abstract

Background: Surgical reconstruction to close a severe pressure ulcer has not been evaluated VSports手机版. .

Aim and objectives: We aimed to investigate the feasibility of research to evaluate surgical reconstruction for severe pressure ulcers by: systematically reviewing evidence about: the effectiveness of surgical reconstruction for severe pressure ulcers; the impact of pressure ulceration on health-related quality-of-life (review 2) surveying primary and secondary care healthcare professionals about surgical referrals of patients with severe pressure ulcers and severe pressure ulcer management, including surgical reconstruction describing patients with incident pressure ulcers and with severe pressure ulcers having surgical reconstruction comparing outcomes in patients with severe pressure ulcers having/not having surgical reconstruction seeking consensus about treatments and management strategies for severe pressure ulcers V体育安卓版. .

Design: Systematic reviews; surveys; binary choice experiment; retrospective cohort studies using routine data; consensus meeting V体育ios版. .

Participants: General practitioners; nurses; and surgeons managing pressure ulcers; people with incident pressure ulcers and hospitalised with severe pressure ulcers. VSports最新版本.

Intervention: Surgical reconstruction. V体育平台登录.

Comparator: No surgical reconstruction VSports注册入口. .

Outcomes: Surgical reconstruction, time to next admission with a severe pressure ulcer time to next admission, hospital stay, all-cause mortality, surgical reconstruction after discharge. V体育官网入口.

Results: Review 1 included three studies comparing different surgical reconstruction techniques. None reported wound-free time. Recurrence occurred in ≈ 20%. Review 2 included three randomised controlled trials measuring health-related quality of life, but none observed benefits of interventions evaluated. Among primary care survey respondents, 54% did not know surgical reconstruction can treat severe pressure ulcers; > 50% had never referred a patient to a surgeon. Among nurses, 72% had considered surgical reconstruction for a severe pressure ulcer; 54% believed surgical reconstruction should be more available. Among surgeons, 39% had never offered surgical reconstruction and 52% offered surgical reconstruction to < 50%; 68% believed surgical reconstruction should be more available. Routine data recorded 367,884 admissions with severe pressure ulcer diagnoses in England over 7. 5 years; surgical reconstructions were performed in at least 404 and at most 1018 admissions. Twenty English hospitals performed > 70% of the surgical reconstructions. Comparing surgical reconstruction (n = 325) versus no surgical reconstruction (n = 1474) patients, time to next admission with a severe pressure ulcer was longer in patients having surgical reconstruction (hazard ratio = 0. 79, 95% confidence interval 0. 61 to 1. 03; p = 0. 07). Estimated pressure ulcer incidence in primary care was ≈ 5/10,000, but the true incidence was believed to be ≈ 7 times higher. Episodes of pressure ulcer care could not be identified. There was consensus about a referral pathway for severe pressure ulcer patients wanting surgical reconstruction, including both community-led and surgically led multidisciplinary team meetings, and about the influence of several patient and severe pressure ulcer characteristics on suitability for surgical reconstruction VSports在线直播. .

Limitations: Surveys only considered factors one by one. Analyses of the Hospital Episode Statistics cohort depended on coding accuracy. For the comparison of surgical reconstruction and no surgical reconstruction, the no surgical reconstruction group had to be admitted. Routine data do not record wound healing outcomes. Primary care data underestimated pressure ulcer incidence; pressure ulcer care episodes could not be identified. The consensus meeting did not include surgeons. The COVID-19 pandemic caused delays, made team members unavailable and restricted face-to-face meetings.

Conclusions: There is insufficient evidence to determine the effectiveness of surgical reconstruction on health-related quality of life or wound healing for severe pressure ulcers. Too few procedures are carried out to enable a randomised controlled trial to be feasible.

Future work: We identified three areas: qualitative research on the acceptability of surgical reconstruction and the impact of a SPU on a patient's quality-of-life; a core outcome set for interventions to treat pressure ulcers; and economic modelling of surgical reconstruction cost-effectiveness.

Study registration: This study is registered as PROSPERO 2019 CRD42019156436, 2019 CRD42019156450; ISRCTN13292620.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127850) and is published in full in Health Technology Assessment; Vol. 29, No. 47. See the NIHR Funding and Awards website for further award information.

Keywords: COHORT STUDY; PRESSURE ULCER; SURGICAL RECONSTRUCTION; SURVEY; SYSTEMATIC REVIEW.

Plain language summary

Is it feasible to research how well an operation to treat severe pressure ulcers works? We reviewed previous studies about the effectiveness of surgery and the impact of a severe pressure ulcer on health-related quality of life. We surveyed surgeons, specialists and community nurses and general practitioners who manage patients with severe pressure ulcers to identify which people with severe pressure ulcers would benefit most from surgery. We analysed information about patients who have had severe pressure ulcers to find out how many operations are being carried out. We compared health outcomes for patients with severe pressure ulcers who had and did not have surgery. Reviewing previous studies added very little to what was already known because high-quality research on the questions we asked has not been done. The surveys showed that healthcare professionals generally agree about who should be offered surgery. They also highlighted that decisions for individual patients were complicated and barriers exist to patients having surgery. It was difficult for us to identify exactly how many operations had been done but, between 2011 and 2018, the number of operations done in the National Health Service has been very low (estimated as between 54 and 136 per year). We found that the National Health Service carries out too few operations to treat severe pressure ulcers to enable future high-quality research on the cost-effectiveness of surgery. For people who might be suitable, the opportunity to have surgery varies in different parts of the United Kingdom. If patients in areas with limited opportunity had the same opportunity as those in areas with more opportunity, such research would probably be possible. The National Health Service should find out whether patients are suitable for surgery early on, and patients willing to consider an operation should be referred to a surgeon to discuss the appropriateness of surgery.

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References

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