# Alternating pressure air mattresses in the intensive care unit as a cost-effective strategy for preventing stage III–IV pressure injuries: a retrospective cohort study

## TL;DR

Alternating pressure air mattresses in ICUs reduce severe pressure injuries by 84% and save over USD 121,750 in five years, making them a cost-effective prevention strategy.

## Contribution

Demonstrates the real-world effectiveness and cost-efficiency of APAMs in preventing severe pressure injuries in ICU patients.

## Key findings

- APAMs reduced Stage III–IV pressure injury risk by 84% in ICU patients.
- Cost recovery for APAMs was achieved in 4.3 months with USD 121,750 in savings over five years.
- APAMs eliminated the need for negative pressure wound therapy in the ICU cohort.

## Abstract

•Alternating Pressure Air Mattresses (APAMs) cut Stage III–IV PI risk by 84 %.•Cost recovery achieved in 4.3-months, saving USD 121,750 over 5-years.•APAMs eliminated the need for negative pressure wound therapy in ICU.

Alternating Pressure Air Mattresses (APAMs) cut Stage III–IV PI risk by 84 %.

Cost recovery achieved in 4.3-months, saving USD 121,750 over 5-years.

APAMs eliminated the need for negative pressure wound therapy in ICU.

Pressure Injuries (PIs) are frequent, preventable complications in Intensive Care Units (ICUs), leading to morbidity, mortality, and increased healthcare costs. Alternating Pressure Air Mattresses (APAMs) have been proposed to reduce PI incidence, but real-world data remain scarce.

To assess the effectiveness and cost-efficiency of APAMs in preventing PIs among critically ill patients.

This retrospective cohort study was conducted in a 10-bed tertiary ICU, comparing patients before and after APAM implementation. Multivariate logistic regression identified independent PI risk factors, and a cost-effectiveness model was developed using Number Needed to Treat (NNT) and treatment costs.

APAM use reduced overall PI risk by 33% (RR = 0.67; 95% CI 0.45–0.98) and Stage III–IV ulcer risk by 84% (RR = 0.16; 95% CI 0.05–0.53). The NNT was 23, corresponding to net savings of USD 121,750 over five years for a 10-bed ICU, with cost recovery achieved within 4.3-months. Length of Stay (LOS) and prolonged mechanical ventilation independently increased PI risk by 19% and 13% per day, respectively. APAMs’ benefit was attenuated in patients with extended LOS and ventilation. Sepsis and respiratory failure increased PI risk in univariate analysis but lost significance after adjustment, indicating mediation by LOS and ventilation. APAMs eliminated the need for negative pressure wound therapy in this cohort.

APAMs significantly reduced severe PI incidence and treatment requirements in critically ill patients, demonstrating cost-effectiveness. Their protective effect was limited in patients with prolonged ICU stay or ventilation. Multicenter randomized trials are warranted, especially in diabetic and septic populations.