Determining Incidence and Risk Factors of Pressure Injury After Orthopaedic Surgery in Children and Adolescents With Neuromuscular Complex Chronic Conditions

Abstract

Background: Pressure injuries are serious yet often preventable alterations in skin integrity prevalent in orthopaedics, especially in pediatric patients with neuromuscular complex chronic conditions (NCCC). The aims of this study were to (1) estimate incidence of pressure injury in children with NCCC after orthopaedic surgery; (2) determine risk factors for pressure injury development; and (3) describe severity and location of pressure injuries. Methods: Children and adolescents (< 22 y old) with NCCC who underwent orthopaedic surgery at a single tertiary-care children's hospital between 2016 and 2020 were retrospectively identified. A matched case-control design was used to match patients who developed a pressure injury within 1.5 months after surgery to subjects who did not develop a pressure injury using a 1:1 matching based on neuromuscular diagnosis, age, sex, and type of surgery. Patient characteristics, comorbidities, pressure injury characteristics, and a pressure injury risk assessment score utilizing the Braden QD scale were compared across pressure injury groups. Results: Of 564 children with NCCC who underwent orthopaedic surgery, 43 (7.6%) developed a postoperative pressure injury. Pressure injuries were primarily located on the heel, followed by sacral/groin/buttocks, then knee. The most common diagnosis was cerebral palsy with associated neuromuscular scoliosis, and hip reconstruction was the most common surgical procedure. The pressure injury cohort had significantly more patients who were non-ambulatory (GMFCS IV/V), with a seizure disorder, g-tube, nonverbal status, wheelchair usage, and had additional medical devices. Median Braden QD risk score was higher in the injury cohort and a cutoff ≥ 12 was optimal for predicting pressure injury development.Conclusions: Pressure injuries after orthopaedic surgery are not uncommon in children with NCCC. The entire care team should be aware of additional risk factors associated with pressure injury development, including the diagnosis of cerebral palsy with neuromuscular scoliosis, seizure disorder, nonverbal status, g-tube, and the presence of multiple medical devices. Implementation of evidence-based pressure injury prevention guidelines on identified high-risk children with NCCC may reduce pressure injury risk and improve the postoperative course. Level of Evidence: Level III.

Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity

“…Stage 1 and 2 ischial pressure injuries are typically treated with proper positioning, seating systems, attention to nutrition, and hygienic care 16,17 . Partial or complete ischial resections have been used successfully, but they involve an incision over the injured area.…”

Explore the effect of pressure and time of compression on the risk of intraoperatively acquired pressure injury based on theoretical framework: A prospective study

“…In previous studies, BMI, height, weight, nutritional status and other indicators were mostly used to assess the risk. [19][20][21][22][23] Based on the theoretical framework of the study, this study adopted objective measurement tools to explore the risk factors from the perspective of the pathogenesis of IAPI, and also provided basis for the accurate assessment of IAPI in the future.…”

Effect of comprehensive nursing intervention on the formation of pressure sore in patients undergoing orthopaedic surgery in prone position

“…The prone position is commonly used in orthopaedic surgery for the posterior manway. 6 This leads to a change in the centre of gravity; that is, most body weight is concentrated in pressure ulcer‐prone areas, such as the chest, jaw and cheeks (fat, thin muscle, etc.). 7 The risk of pressure ulcers is high owing to many factors, such as wet skin, lengthy surgical procedures, static friction caused by intraoperative peeling and other operations.…”

“…In orthopaedics, according to the specific type of disease and the surgical program, choosing a fixed position or multiple positions for surgery is necessary. The prone position is commonly used in orthopaedic surgery for the posterior manway 6 . This leads to a change in the centre of gravity; that is, most body weight is concentrated in pressure ulcer‐prone areas, such as the chest, jaw and cheeks (fat, thin muscle, etc.)…”