Identification of Risk Factors for Intraoperative Acquired Pressure Injury in Patients Undergoing Neurosurgery: A Retrospective Single-Center Study

Abstract

Background Risk factors for intraoperative acquired pressure injury (IAPI) in patients undergoing various surgical procedures have been described in previous studies. However, whether risk factors for IAPI in patients undergoing neurosurgery differ remains unknown. The aim of the present study was to explore independent risk factors for IAPI in patients undergoing neurosurgery. Material/Methods Data from 465 patients who underwent neurosurgery between October 2017and December 2018 and who were at high risk of IAPIs were retrospectively analyzed. Independent risk factors for IAPI were evaluated using univariate and multivariate logistic regression models. Results Sixty-nine IAPIs (14.8%) in 465 patients undergoing neurosurgery were assessed. Multivariate logistic regression analyses showed that being overweight (odds ratio [OR] 2.685; 95% confidence interval [CI] 1.206–5.975; P =0.016), prone position (OR 7.502, 95% CI 2.470–22.787. P <0.001), lateral position (OR 15.301, 95% CI 4.903–47.753, P <0.001), use of a head frame (OR 3.716, 95% CI 1.431–9.653, P =0.007), surgical times of 4 to 8 h (OR 7.276, 95% CI 2.249–23.542, P <0.001), and surgical times ≥8 h (OR 173.248, 95% CI 32.629–919.896, P <0.001) all were associated with an increased risk of IAPI in patients undergoing neurosurgery. The factors associated with reduced risk of IAPI were high serum albumin levels (OR 0.099, 95% CI 0.016–0.608, P =0.013) and use of memory sponge pads (OR 0.064, 95% CI 0.020–0.202, P <0.001). Conclusions The present study indicates that being overweight, prone and lateral positioning, use of a head frame, and longer surgical times are associated with an increased risk of IAPI in patients undergoing neurosurgery. Prospective studies should be conducted to verify these findings and consideration should be given to use of these factors in clinical practice to identify high-risk patients.

The comparison of fluidized positioners and traditional gel pads for skin protection in neurosurgical patients undergoing lateral and prone positions: A retrospective analysis with propensity score matching method

“…The study indicates that being overweight, prone and lateral positioning, use of a head frame and longer surgical times are associated with an increased risk of IAPI in patients undergoing neurosurgery. Prospective studies should be conducted to verify these findings and consideration should be given to the use of these factors in clinical practice to identify high‐risk patients 8 . These individuals have a high risk of IAPIs because their procedures are longer, continuous irrigation with saline is used during these surgeries and craniotomy requires the use of air and electric drills, which results in vibration.…”

“…The use of intraoperative pneumatic drills, extensive water irrigation, mannitol dehydration, prone or lateral positioning, use of a head frame and operative times of 4-8 are all risk factors for IAPU in neurosurgery. [4][5][6][7][8] Surgical patient characteristics, such as age, diagnosis and body mass index (BMI), were significantly associated with IAPU(intraoperative skin pressure injuries). 9 Studies have shown that fluidized positioners applied to the occipital area of patients can prevent pressure damage to the occipital skin and hair loss.…”

“…Local tissues are under prolonged intraoperative pressure, which can easily lead to pressure ulcers and negatively affect the patient's prognosis. The use of intraoperative pneumatic drills, extensive water irrigation, mannitol dehydration, prone or lateral positioning, use of a head frame and operative times of 4–8 are all risk factors for IAPU in neurosurgery 4–8 . Surgical patient characteristics, such as age, diagnosis and body mass index (BMI), were significantly associated with IAPU（intraoperative skin pressure injuries) 9 …”

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery

“…Compared to non-surgical patients admitted to the ICU, surgical patients may have some specific risk factors for the incidence of PI [ 26 ]. For instance, in a study of PI in patients undergoing neurosurgery, it was found that being overweight and having a longer surgical time was strongly associated with the occurrence of PI [ 27 ]. In another study about risk factors for PI in patients undergoing hepatobiliary surgery, prolonged operative time, open surgery, and intraoperative hypotension were found to be associated with an increased incidence of PI [ 28 ].…”

Intraoperative pressure injury and risk factors in long-term surgical interventions

“…Studies draw attention to the risk of pressure injury for 2-5 hours or more (. The reason why it was taken over 60 minutes in this study was to include the cases in which general anesthesia was applied and to obtain a sample for statistical comparison (Wu et al, 2021;Webster et al, 2015;Aydin et al, 2021).…”