Analyzed the epidemiological characteristics of inpatients with chronic refractory wounds in a wound repair center in Hubei province by reviewing the data of them, in order to provide reference for the formulation of prevention and treatment strategies for the disease.

The case data of inpatients with chronic refractory wounds admitted to the Wound Repair Center of Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019 were retrospectively analyzed. The collected information includes the patient's gender, living area, occupation, underlying disease, smoking history, wound type, age, hospital stay, hospitalization cost, treatment method (surgical treatment, conservative treatment), clinical outcome, various medical expenses and wound surface detection of pathogenic bacteria. Data were compared by chi-square test and Kruskal-Wallis H test.

(1) A total of 2 402 inpatients with chronic refractory wounds were included in this study, including 1 593 males (66.3%) and 809 females (33.7%); there were 1 459 (60.7%) of the urban population and 943 cases (39.3%) of the rural population; the proportion of patients engaged in retirement and manual labor was relatively large, 52.1% and 28.8%, respectively; 74.4% of the patients had diabetes, followed by hypertension (57.5%) and heart disease (31.8%); 52.7% of patients had a history of smoking. (2) Among different wound types, diabetic wounds were the most common, accounting for 62.3% (1 497/2 402); followed by pressure wounds, accounting for 13.9% (334/2 402); arterial wounds accounted for 6.2% (148/2 402); venous wounds accounted for 5.0% (121/2 402), and wounds caused by other reasons accounted for 12.6% (302/2 402). (3) The gender and age distribution of chronic refractory wound patients with different types of wounds were compared, and the differences were statistically significant (χ²=30.564, 28.536; P<0.05); the age group with the highest prevalence rate was 61-80 years old (54.7%), followed by 41-60 years old (29.4%) and over 80 years old (11.8%); 41-60 years old and 61-80 years old with high incidence of diabetic wounds and venous wounds, and 61-80 years old and over 80 years old were the high incidence of pressure wounds and arterial wounds. (4) Among the 2 402 inpatients with chronic refractory wounds, the patients with pressure wounds had the longestaverage hospital stay, which was 31 (19, 35) d, and the patients with arterial wounds and venous wounds had the shortest average hospitalization time, which were 19 (9, 25) d and 19 (11, 26) d, respectively. The average hospitalization cost of patients with arterial wounds was the highest, which was 91 361.5 (17 033.5, 143 090.4) yuan, followed by patients with diabetic wounds, which was 45 008.4 (10 574.0, 57 020.7) yuan. There were statistically significant differences in hospitalization time and hospitalization expenses among patients with different types of chronic refractory wounds (χ²=25.346, 32.460; P<0.05). (5) Among the patients treated by surgery, patients with pressure wounds had the longest hospitalization time 39 (26, 42) d, and patients with arterial wounds had the highest hospitalization costs, which was 118 341.1 (77 151.3, 162 281.1) yuan; among the patients with conservative treatment, other wound patients had the longest hospitalization time, and patients with arterial wounds had the highest hospitalization costs; the hospitalization costs and hospitalization time of patients with different treatment methods were statistically significantly differents (χ²=110.260, 120.765; P<0.05). (6) Among the 2 402 patients, 22.0% (529/2 402) were cured, 76.3% (1 833/2 402) were markedly effective, 1.7% (40/2 402) were not cured, and 12 of them died, accounting for 0.5% of the total number of patients. The hospitalization time of the cured, markedly effective and unhealed patients were 31 (15, 39), 25 (12, 30), and 19 (5, 24) d, respectively, and the hospitalization expenses were 45 360.6 (11 664.3, 56 208.8), 42 824.2 (10 107.1, 52 415.1), 37 017.4 (8 031.3, 31 942.9) yuan, respectively. The hospitalization time of cured patients was longer than that of markedly effective and unhealed patients, and the hospitalization cost was higher than that of markedly effective and unrecovered patients. There were no statistically significant differences in hospitalization time and hospitalization cost among patients with different clinical outcomes (χ²=3.031, 6.780; P>0.05). (7) The total medical expenses of the 2 402 inpatients with chronic refractory wounds were 103 973 107 yuan. Consumables and medicines accounted for a relatively high proportion of various medical expenses, accounting for 42.1% and 23.4%, respectively. Nursing expenses and blood transfusion expenses accounted for a relatively low proportion, at 1.2% and 0.2%, respectively. (8) Among the 2 402 patients, 926 (38.6%) were examined for pathogenic bacteria on the wound surface, of which 681 were positive for pathogenic wounds, with a positive rate of 73.5% (681/926). Among them, Gram-negative bacteria accounted for 50.8% (346/681), mainly Pseudomonas aeruginosa (13.5%), Escherichia coli (11.6%), and Acinetobacter baumannii (6.2%); Gram-positive bacteria accounted for 42.4% (289/681), mainly Staphylococcus aureus (17.8%), Staphylococcus epidermidis (7.2%), and Enterococcus (9.2%); fungi accounted for 6.8% (46/681), mainly Candida albicans (2.5%).

The inpatients with chronic refractory wounds are mainly middle-aged and elderly people, and there are more males than females. Diabetic wounds, pressure wounds and vascular wounds are the main causes of the disease. Patients with pressure wounds had the longest average hospital stay, and patients with arterial wounds had the highest average hospitalization costs. The main treatment method is surgery. The unit adopts a multidisciplinary diagnosis and treatment mode for wound treatment, and the healing rate is high. Gram-negative bacteria are the most common pathogens on the wound surface, mainly Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. It is necessary to advocate and improve the two-way referral mechanism between wound treatment centers in large general hospitals and community health service centers, and establish wound repair and nursing centers, strengthen publicity and education about the disease, and improve awareness of prevention and treatment.