Hospital acquired pressure injury in adult orthopedic spine surgery patients: risk factors and risk assessment tools

Abstract

[EMBARGOED UNTIL 6/1/2023] Approximately 25 percent of all hospital acquired pressure injuries (HAPI) begin in the perioperative area. The study purposes were to identify risk factors in adult surgical patients undergoing orthopedic spine surgery in the prone position and compare three HAPI risk assessment tools in perioperative patients. This was a single center, retrospective study electronic medical record (EMR) data. HAPI incidence was 1.14 percent (51/4466). Person, nursing, and environmental factors were analyzed using logistic regression. Factors from each domain predicted HAPI development. HAPI was associated with longer length of stay and discharge to home with support or a sub-acute facility (p [less than].001). Using Receiver-operating characteristic (ROC) analysis, area under the curve (AOC) of the ROC for the Braden Risk Assessment Scale (BRAS) was not different from 0.5 (p [less than].200). AUC of the ROC for Scott Triggers Tool and Munro PACU Total score were different from 0.5 (p [less than].001). preoperative BRAS cutoff value of 18 yielded Sensitivity 36 percent and Specificity 75 percent. Munro PACU Total cutoff value of 29 yielded Sensitivity 87 percent and Specificity 42 percent. Scott Triggers cutoff value of 1 yielded Sensitivity 76 percent and Specificity 44 percent. A Munro Preoperative score may be more useful than a preoperative BRAS score to guide nurses in planning and implementing preoperative HAPI interventions. Given the low Specificity, the Munro Risk Assessment Tool requires refinement to improve the psychometrics. Prospective research is needed to test perioperative interventions to decrease HAPI in this specialty population and refine the Munro Tool.