Timing of rehabilitation and occurrence of pressure ulcers in patients with cervical spinal cord injuries

Abstract Study design: A retrospective cohort study using a nationwide Japanese inpatient database. Objectives: To investigate the association between the timing of rehabilitation interventions and the occurrence of pressure ulcers in hospitalized patients with cervical spinal cord injuries between 2010 and 2022 in a real-world clinical setting. Setting: We used the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database. Methods: We included patients with cervical spinal cord injury who underwent spinal surgery within 3 days of admission between July 2010 and March 2022. We defined rehabilitation within 2 days of surgery as early rehabilitation and ≥3 days of surgery as non-early rehabilitation. The primary outcome was treating severe pressure ulcers ≥4 days after admission, and the secondary outcomes were length of hospital stay, hospitalization costs, and in-hospital mortality. Propensity score inverse probability of treatment weighting was conducted to compare the outcomes between the early and non-early rehabilitation groups. Results: We identified 5,162 eligible patients, 3,434 (66.1%) of whom underwent early rehabilitation. After weighting, the occurrence of treating severe pressure ulcers showed no significant difference between the early and non-early rehabilitation groups (odds ratio [OR], 1.30; 95% confidence interval [CI], 0.79–2.12; P=0.297). The early rehabilitation group had lower total hospitalization costs (difference, –3.2%; 95% CI, –6.1% to 0.0%; P=0.043) and shorter length of hospital stay (difference, –4.5%; 95% CI, –8.4% to 0.0%; P=0.034) than the non-early rehabilitation group. Conclusion: This study found no significant difference in the development of severe pressure ulcers between the early and non-early rehabilitation groups.