The burden of pressure ulcers among inpatients in a tertiary physical medicine and rehabilitation center: a retrospective analysis

Aims: This study aimed to describe the clinical characteristics, risk factors, and treatment outcomes of pressure ulcers (PUs) among inpatients in a tertiary Physical Medicine and Rehabilitation (PM&R) center. We hypothesized that advanced-stage ulcers would be associated with longer hospitalization, lower healing rates, and adverse laboratory parameters. Methods: This retrospective cross-sectional study included 240 adult patients with PUs admitted to the PM&R Hospital of Ankara Bilkent City Hospital between June 1, 2022, and June 1, 2023. Demographic, clinical, laboratory, and wound-related data were extracted from medical records and standardized wound care forms. PUs were staged according to the 2019 EPUAP/NPIAP/PPPIA guideline. Treatment modalities and outcomes were analyzed. Linear regression was performed to identify predictors of residual wound size. Results: The mean age of patients was 52.8±22.1 years; 63.3% were male. Frequent comorbidities included arterial hypertension (34.6%), hyperlipidemia (40.4%), diabetes mellitus (15.4%), and coronary artery disease (10.8%). The most common admission diagnoses were spinal cord injury (45.0%) and stroke (26.7%). Sacral ulcers (56.1%) predominated, with stage 2–3 lesions representing 77.1% of cases. Overall healing rate was 78.5%, but declined sharply in stage 4 ulcers (25.0%). Predictors of larger residual ulcer size included pre-admission ulcer presence (p=0.028), baseline ulcer size (p<0.001), and lower albumin (p=0.002). Debridement significantly reduced ulcer size (p<0.001). Functional outcomes improved, with 57.6% of non-ambulatory patients achieving therapeutic ambulation at discharge (p<0.001). Conclusion: PUs remain a persistent challenge in rehabilitation, limiting both medical care and functional progress. Advanced-stage ulcers, malnutrition, and osteomyelitis predict poor outcomes, whereas surgical debridement is pivotal for healing. Integrating preventive strategies, nutritional optimization, and evidence-based therapies into structured rehabilitation programs can enhance recovery and reduce healthcare burden.