{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:06:35Z","timestamp":1784268395990,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"abstract":"ABSTRACT<\/jats:title>\n \n Aims<\/jats:title>\n To estimate the nationwide incidence of pressure ulcers among hospitalized patients in Korea and to examine their associations with in\u2010hospital mortality, length of stay, and total inpatient costs.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A cross\u2010sectional study using retrospective cohort data.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analysed hospitalization\u2010level data using a nationally representative sample cohort from the National Health Insurance database. Pressure ulcers were identified using secondary diagnosis codes to approximate hospital\u2010acquired cases. Multivariable regression models were used to examine factors associated with pressure ulcer development, in\u2010hospital mortality, length of stay, and total inpatient costs.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n National Health Insurance sample cohort data from 2016 to 2019.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The incidence of pressure ulcers among hospitalized patients was low but showed clear associations with adverse outcomes. Older age, severe disability, medical aid coverage, admission to long\u2010term care hospitals, and lower nurse staffing levels were associated with a higher likelihood of pressure ulcer development. Pressure ulcers were also associated with increased in\u2010hospital mortality, longer hospital stays, and higher total inpatient costs.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Pressure ulcers are associated with substantial clinical and economic burden and may serve as indicators of patient vulnerability and healthcare quality. Strengthening preventive strategies may improve patient outcomes and reduce avoidable healthcare utilization.<\/jats:p>\n <\/jats:sec>\n \n Implications for the Profession and\/or Patient Care<\/jats:title>\n Pressure ulcers represent not only a clinical complication but also a marker of healthcare quality at the organizational level. Adequate nurse staffing and strengthened preventive care processes are essential to reduce pressure ulcer risk, particularly among high\u2010risk populations such as older adults and patients in long\u2010term care hospitals.<\/jats:p>\n <\/jats:sec>\n \n Patient of Public Contribution<\/jats:title>\n This study used de\u2010identified secondary data from a national database, and therefore no patients, service users, care\u2010givers, or members of the public were involved in the design, conduct, analysis, or interpretation of the study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jan.70678","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:36:24Z","timestamp":1784266584000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Pressure Ulcer Development and In\u2010Hospital Outcomes: A Nationwide Hospitalization\u2010Level Study in Korea"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4642-8318","authenticated-orcid":false,"given":"Seohyun","family":"Woo","sequence":"first","affiliation":[{"name":"Department of Medical Science Soonchunhyang University Graduate School Asan\u2010Si Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health System, College of Nursing The Catholic University of Korea Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medical Science Soonchunhyang University Graduate School Asan\u2010Si Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Management College of Medical Science, Soonchunhyang University Asan\u2010Si Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e1717","article-title":"Patient Safety, Satisfaction, and Quality of Hospital Care: Cross Sectional Surveys of Nurses and Patients in 12 Countries in Europe and the United States","volume":"344","author":"Aiken L. H.","year":"2012","journal-title":"BMJ"},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijnsa.2023.100125","article-title":"Safety Culture, Quality of Care, Missed Care, Nurse Staffing and Their Impact on Pressure Injuries: A Cross\u2010Sectional Multi\u2010Source Study","volume":"5","author":"Alanazi F. K.","year":"2023","journal-title":"International Journal of Nursing Studies Advances"},{"issue":"1","key":"e_1_2_14_4_1","first-page":"22","article-title":"Pressure Ulcers, Hospital Complications, and Disease Severity: Impact on Hospital Costs and Length of Stay","volume":"12","author":"Allman R. M.","year":"1999","journal-title":"Advances in Skin & Wound Care"},{"issue":"4","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1093\/gerona\/63.4.408","article-title":"Extrinsic Risk Factors for Pressure Ulcers Early in the Hospital Stay: A Nested Case\u2013Control Study","volume":"63","author":"Baumgarten M.","year":"2008","journal-title":"Journals of Gerontology Series A: Biological Sciences and Medical Sciences"},{"issue":"2","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0029-6465(22)01289-0","article-title":"A Clinical Trial of the Braden Scale for Predicting Pressure Sore Risk","volume":"22","author":"Bergstrom N.","year":"1987","journal-title":"Nursing Clinics of North America"},{"issue":"1","key":"e_1_2_14_7_1","first-page":"122","article-title":"Epidemiologic Study on Clinical Features of Patient With Pressure Ulcer\u2010A Prospective Study","volume":"29","author":"Cho K. H.","year":"2005","journal-title":"Journal of the Korean Academy of Rehabilitation Medicine"},{"issue":"4","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4094\/jkachn.2012.18.4.177","article-title":"Incidence and Associated Factors of Pressure Ulcers in Newborns","volume":"18","author":"Choi W.\u2010Y.","year":"2012","journal-title":"Journal of Korean Academy of Child Health Nursing"},{"issue":"4","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/wrr.13182","article-title":"Trends in Inpatient Burden From Pressure Injuries in the United States: Cross\u2010Sectional Study National Inpatient Sample 2009\u20132019","volume":"32","author":"Choragudi S.","year":"2024","journal-title":"Wound Repair and Regeneration"},{"issue":"44","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.7748\/ns2000.07.14.44.45.c2879","article-title":"Pressure Sore Prevention in Nursing Homes","volume":"14","author":"Clay M.","year":"2000","journal-title":"Nursing Standard"},{"issue":"4","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/0003-9993(85)90161-3","article-title":"Special Mattresses: Effectiveness in Preventing Decubitus Ulcers in Chronic Neurologic Patients","volume":"66","author":"Daechsel D.","year":"1985","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"e_1_2_14_12_1","volume-title":"To Err Is Human: Building a Safer Health System","author":"Donaldson M. S.","year":"2000"},{"issue":"7","key":"e_1_2_14_13_1","first-page":"64S","article-title":"Cost\u2010Effective Pressure Ulcer Management in Extended Care","volume":"41","author":"Erwin\u2010Toth P.","year":"1995","journal-title":"Ostomy\/Wound Management"},{"issue":"9","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1111\/j.1532-5415.1988.tb04264.x","article-title":"Occurrence and Predictors of Pressure Sores in the National Health and Nutrition Examination Survey Follow\u2010Up","volume":"36","author":"Guralnik J. M.","year":"1988","journal-title":"Journal of the American Geriatrics Society"},{"issue":"4","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/SLA.0000000000003567","article-title":"Pressure Injury","volume":"271","author":"Hajhosseini B.","year":"2020","journal-title":"Annals of Surgery"},{"issue":"3","key":"e_1_2_14_16_1","article-title":"A Systematic Review of Length of Stay Linked to Hospital\u2010Acquired Falls, Pressure Ulcers, Central Line\u2013Associated Bloodstream Infections, and Surgical Site Infections","volume":"9","author":"Hasan B.","year":"2025","journal-title":"Mayo Clinic Proceedings: Innovations, Quality & Outcomes"},{"issue":"1","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12877-018-0997-7","article-title":"An Overview of Co\u2010Morbidities and the Development of Pressure Ulcers Among Older Adults","volume":"18","author":"Jaul E.","year":"2018","journal-title":"BMC Geriatrics"},{"key":"e_1_2_14_18_1","volume-title":"Health and Welfare Policy Forum","author":"Jung Y. H.","year":"2011"},{"issue":"3","key":"e_1_2_14_19_1","first-page":"321","article-title":"Experience and Perception on Patient Safety Culture of Employees in Hospitals","volume":"13","author":"Kim E. K.","year":"2007","journal-title":"Journal of Korean Academy of Nursing Administration"},{"issue":"5","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16050704","article-title":"Prevalence of Pressure Injuries Nationwide From 2009 to 2015: Results From the National Inpatient Sample Database in Korea","volume":"16","author":"Kim G. H.","year":"2019","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"5","key":"e_1_2_14_21_1","first-page":"O1","article-title":"Risk Factors for Newly Acquired Pressure Ulcer and the Impact of Nurse Staffing on Pressure Ulcer Incidence","volume":"30","author":"Kim J.","year":"2022","journal-title":"Journal of Nursing Management"},{"issue":"37","key":"e_1_2_14_22_1","first-page":"495","article-title":"Feasibility of Using Administrative Data to Compare Healthcare\u2010Associated Infection Performance","volume":"37","author":"Kim N.","year":"2017","journal-title":"Health and Social Welfare Review"},{"issue":"1","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.21032\/jhis.2017.42.1.89","article-title":"Data Issues and Suggestions in the National Health Insurance Service\u2010National Sample Cohort for Assessing the Long\u2010Term Health Effects of Air Pollution Focusing on Mortality","volume":"42","author":"Kim O.","year":"2017","journal-title":"Journal of Health Informatics and Statistics"},{"issue":"2","key":"e_1_2_14_24_1","first-page":"267","article-title":"The Relationship of Risk Assessment Using Braden Scale and Development of Pressure Sore in Neurologic Intensive Care Unit","volume":"15","author":"Lee J.\u2010K.","year":"2003","journal-title":"Korean Journal of Adult Nursing"},{"key":"e_1_2_14_25_1","doi-asserted-by":"crossref","unstructured":"Li X. J.Wang Z.Xu andQ.Yang.2026. \u201cRisk Factors for Hospital\u2010Acquired Pressure Ulcers in Patients With Pelvic Fractures: A Retrospective Cross\u2010Sectional Study.\u201d","DOI":"10.21203\/rs.3.rs-7538232\/v1"},{"issue":"3","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.22467\/jwmr.2022.02285","article-title":"Policy Proposals for Infection Control in Patients With Chronic Wounds","volume":"18","author":"Moon K. C.","year":"2022","journal-title":"Journal of Wound Management and Research"},{"issue":"7","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.5762\/KAIS.2013.14.7.3390","article-title":"The Characteristics Related to the Development of Pressure Ulcers in Long Term Care Facilities: The Use of 2009 National Patient Sample","volume":"14","author":"Moon M.","year":"2013","journal-title":"Journal of the Korea Academia\u2010Industrial Cooperation Society"},{"issue":"3","key":"e_1_2_14_28_1","first-page":"197","article-title":"Analysis on the Situation of Inpatients With Pressure Ulcer by Patient Safety Indicators","volume":"10","author":"Nam M.\u2010H.","year":"2012","journal-title":"Journal of Digital Convergence"},{"issue":"3","key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/iwj.13071","article-title":"The National Cost of Hospital\u2010Acquired Pressure Injuries in the United States","volume":"16","author":"Padula W. V.","year":"2019","journal-title":"International Wound Journal"},{"key":"e_1_2_14_30_1","unstructured":"Patient Safety Indicators.2007.http:\/\/www.docstoc.com\/docs\/70390105."},{"issue":"1","key":"e_1_2_14_31_1","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1186\/s12913-024-11210-w","article-title":"Accuracy Assessment of Patient Safety Incident (PSI) Codes and Present\u2010On\u2010Admission (POA) Indicators: A Cross\u2010Sectional Analysis Using the Patient Safety Incidents Inquiry (PSII) in Korea","volume":"24","author":"Pyo J.","year":"2024","journal-title":"BMC Health Services Research"},{"key":"e_1_2_14_32_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.a1702","article-title":"Patient Safety Indicators for England From Hospital Administrative Data: Case\u2010Control Analysis and Comparison With US Data","volume":"337","author":"Raleigh V. S.","year":"2008","journal-title":"BMJ"},{"issue":"2","key":"e_1_2_14_33_1","first-page":"242","article-title":"Pressure Ulcer Assessment and Management","volume":"3","author":"Ratliff C.","year":"1999","journal-title":"Lippincott's Primary Care Practice"},{"issue":"3","key":"e_1_2_14_34_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.12968\/jowc.1994.3.3.157","article-title":"Towards a Consensus: Classification of Pressure Sores","volume":"3","author":"Reid J.","year":"1994","journal-title":"Journal of Wound Care"},{"key":"e_1_2_14_35_1","volume-title":"Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology)","author":"Rivard P. E.","year":"2005"},{"key":"e_1_2_14_36_1","volume-title":"Health and Welfare Policy Forum","author":"Seo J.","year":"2016"},{"issue":"1","key":"e_1_2_14_37_1","first-page":"16","article-title":"Predicting Risk Factors for Pressure Sores","volume":"21","author":"Song M.","year":"1991","journal-title":"Journal of Korean Academy of Adult Nursing"},{"issue":"3","key":"e_1_2_14_38_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/01.ASW.0000653152.36482.7d","article-title":"Pressure Ulcer Risk Factors in Persons With Mobility\u2010Related Disabilities","volume":"33","author":"Sprigle S.","year":"2020","journal-title":"Advances in Skin & Wound Care"},{"issue":"3","key":"e_1_2_14_39_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/jnu.12136","article-title":"A Two\u2010Arm Cluster Randomized Control Trial to Determine the Effectiveness of a Pressure Ulcer Prevention Bundle for Critically Ill Patients","volume":"47","author":"Tayyib N.","year":"2015","journal-title":"Journal of Nursing Scholarship"},{"issue":"2","key":"e_1_2_14_40_1","first-page":"280","article-title":"The Influence of the Risk Factors and Nutritional Status on the Development of Pressure Sores for the Risk Patients in ICU","volume":"5","author":"Yang Y.\u2010H.","year":"1998","journal-title":"Journal of Korean Academy of Fundamentals of Nursing"},{"issue":"3","key":"e_1_2_14_41_1","first-page":"147","article-title":"Pressure Ulcer Risk Factors and Preventive Intervention in Long\u2010Term Care Facilities: A Mixed Method Study","volume":"21","author":"Yun H.","year":"2020","journal-title":"Journal of the Korea Academia\u2010Industrial Cooperation Society"}],"container-title":["Journal of Advanced Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jan.70678","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jan.70678","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jan.70678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:36:30Z","timestamp":1784266590000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jan.70678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":40,"alternative-id":["10.1111\/jan.70678"],"URL":"https:\/\/doi.org\/10.1111\/jan.70678","archive":["Portico"],"relation":{},"ISSN":["0309-2402","1365-2648"],"issn-type":[{"value":"0309-2402","type":"print"},{"value":"1365-2648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"2026-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jan.70678"}}