Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park‐bench position: A prospective observational study

Abstract

Preventing pressure ulcers is important in patients undergoing procedures in the park-bench position. We hypothesized that the microclimate around the skin is a significant risk factor for developing pressure ulcers. This research continuously assessed factors of the microclimate in terms of skin temperature and perspiration as well as the interface pressure in order to determine whether the microclimate is an independent risk factor for the development of park-bench position-related pressure ulcers (PBP-PUs). A prospective observational study was conducted among patients undergoing elective surgery in the park-bench position at a general hospital in the metropolitan area of Japan between April and November 2014. Factors of the microclimate, including skin temperature and perspiration, in addition to the interface pressure were continuously measured throughout surgery. Twenty-nine patients were analyzed (mean age 44.4 ± 13.2 years, male 44.8%). Of these 29 patients, seven (24.1%) developed Category I PBP-PUs. The change in skin temperature from baseline to the end of surgery (2.7 ± 0.3 °C vs. 1.9 ± 0.8 °C) and the average peak pressure (119.1 ± 36.8 mmHg vs. 94.5 ± 23.1 mmHg) were significantly higher in the patients with PBP-PUs than in those without PBP-PUs. There were no significant differences in the amount of perspiration between the two groups. A hierarchical logistic regression analysis showed that the change in skin temperature was significantly related to the development of PBP-PUs (unit = 0.1 °C: odds ratio 1.44, 95% confidential interval 1.09-2.33) when adjusted for the average peak pressure and length of surgery. Our results suggest that a change in skin temperature toward a higher value is an independent risk factor for the development of PBP-PUs. Proper intraoperative management of skin temperature may therefore be a promising candidate as a preventive method against PBP-PU development.

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

“…45,46 Sweat and climate affect the skin microclimate, which affects skin vulnerability to pressure ulcers from friction and shearing. 47,48 In our patient cohort, we found that gender had no significant association with many of the expected risk variables, such as BMI, ASA grade, pre-op Braden score, and age. However, a recent nationwide survey in Singapore reported that older Singaporean females were more malnourished and frail compared with their male counterparts.…”

“…A humid environment delays evaporation of sweat, but residents of tropical areas sweat less and more slowly than residents of temperate areas . Sweat and climate affect the skin microclimate, which affects skin vulnerability to pressure ulcers from friction and shearing …”

Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: A retrospective study

“…However, there was no statistically significant relation between skin oedema condition and the occurrence of blanchable erythema, which might be associated with the rapid development of pressure injuries in patients with skin oedema. Yoshimura et al () pointed out that intraoperative temperature was an independent risk factor for intraoperative pressure injuries. Patients with higher body temperature of above 38.1°C were more likely to develop intraoperative pressure injuries.…”

Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the Border Operating room Spinal Surgery (BOSS) trial in Japan

“…We previously reported that hyperthermia was an independent risk factor for the development of IAPUs in neurosurgery performed in the park‐bench position . There has also been recent discussion that microclimate control may play a key role in preventing pressure ulcers .…”