The Association Between Pressure Ulcer Development and In‐Hospital Outcomes: A Nationwide Hospitalization‐Level Study in Korea

AIMS: To estimate the nationwide incidence of pressure ulcers among hospitalized patients in Korea and to examine their associations with in-hospital mortality, length of stay, and total inpatient costs. DESIGN: A cross-sectional study using retrospective cohort data. METHODS: We analysed hospitalization-level data using a nationally representative sample cohort from the National Health Insurance database. Pressure ulcers were identified using secondary diagnosis codes to approximate hospital-acquired cases. Multivariable regression models were used to examine factors associated with pressure ulcer development, in-hospital mortality, length of stay, and total inpatient costs. DATA SOURCES: National Health Insurance sample cohort data from 2016 to 2019. RESULTS: 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-term 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-hospital mortality, longer hospital stays, and higher total inpatient costs. CONCLUSION: 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. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: 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-risk populations such as older adults and patients in long-term care hospitals. PATIENT OF PUBLIC CONTRIBUTION: This study used de-identified secondary data from a national database, and therefore no patients, service users, care-givers, or members of the public were involved in the design, conduct, analysis, or interpretation of the study.