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Publication Briefs

Study Shows Veterans with Spinal Cord Injury and Pressure Ulcers have More Hospitalizations and Higher Costs of Care

Veterans comprise about 17% of the 250,000 individuals with spinal cord injury/disorder (SCI/D) in the United States, and SCI/D is the most costly medical condition for Veterans ($34,551 per person annually in 2008 dollars). Pressure ulcers are a common complication among individuals with SCI/D, and can substantially impact health-related quality of life and increase morbidity and mortality. This retrospective study compared the annual healthcare utilization and costs of Veterans, with and without pressure ulcers, who used the VA healthcare system. Using VA data, investigators identified all Veterans with SCI/D who were diagnosed with a pressure ulcer in FY07 (n=1,220), as well as Veterans with SCI/D but without pressure ulcers (n=9,757). Healthcare utilization and costs were examined for the12-month period following diagnosis in the case of Veterans with a pressure ulcer, or during FY08 for Veterans without a pressure ulcer. Investigators also examined patient characteristics (i.e., demographics), comorbid conditions, and injury characteristics.


  • Among Veterans with SCI/D, pressure ulcers were associated with greater rates of hospitalization and higher healthcare costs.
  • After adjusting for patient demographics, comorbidities, and other characteristics, total annual healthcare costs per patient were $73,021 higher for Veterans with pressure ulcers ($100,953 vs. $27,914) – and annual hospitalizations were nearly 52 days longer (61 days vs. 9 days). This represents more than $89 million in total additional costs to the VA healthcare system.
  • Higher total costs were due primarily to higher total inpatient costs for Veterans with pressure ulcers compared to Veterans without pressure ulcers ($91,341 vs. $13,754).
  • Factors associated with more total inpatient days included: older age, hospitalization within the 12-month period prior to the index date, and a history of depression.
  • The authors note that VA’s SCI/D system of care could benefit from more efficient ways to promote early identification and treatment of new skin problems, including conceptualizing pressure ulcer prevention as an ongoing chronic care self-management activity for Veterans with SCI/D.


  • Investigators were unable to adjust for pressure ulcer characteristics (i.e., number, severity) and completeness of injury.
  • This cross-sectional study design does not prove that higher health care costs among patients with pressure ulcers is a consequence of the ulcers, and does not evaluate the potential impact of improved pressure ulcer care on health care costs.
  • Only direct VA costs were measured, excluding Medicare and Medicaid costs.

This study was funded by HSR&D (IIR 07-188). Drs. Stroupe and Evans are part of HSR&D’s Center for Management of Complex Chronic Care in Hines, IL.

Stroupe K, Manheim L, Evans C, et al. Cost of Treating Pressure Ulcers for Veterans with Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation Spring 2011;16(4):62-73.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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