Perioperative factors associated with pressure ulcer development after major surgery

Abstract

BackgroundPostoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers.MethodsThis retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities.ResultsThe pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07–2.71; P < 0.05) were independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P < 0.001).ConclusionsThe present study revealed that preoperative low albumin levels and high lactate levels were significantly associated with pressure ulcer development after surgery.

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

“…Our study found low BMI and low preoperative Braden score to be significant predictors of HAPU, which is consistent with other similar studies . However, there are also studies that identified the postoperative Braden score as a significant predictor of HAPU . Therefore, we performed an additional secondary analysis on the postoperative Braden score and found that it was also statistically significant in our univariate analysis.…”

“…7,12,21,24 However, there are also studies that identified the postoperative Braden score as a significant predictor of HAPU. 33,34,41 Therefore, we performed an additional secondary analysis on the postoperative Braden score and found that it was also statistically significant in our univariate analysis. However, we did not include it in our prediction model because we wanted to use variables that are available preoperatively to determine a patient's pressure ulcer risk.…”

The Effect of Selected Risk Factors on Perioperative Pressure Injury Development

“…Other studies report that the Braden Scale had no effect on determining the risk of perioperative pressure injury . Conversely, a 2018 study reported that higher Braden Scale scores upon admission were correlated with perioperative pressure injuries . The Braden Scale may not play a role in determining perioperative pressure injury risk because perioperative risk factors such as procedure duration and type, intraoperative blood pressure, and intraoperative vasopressor use cannot be assessed in the variables included in that scale.…”

“…17,37 Conversely, a 2018 study reported that higher Braden Scale scores upon admission were correlated with perioperative pressure injuries. 24 The Braden Scale may not play a role in determining perioperative pressure injury risk because perioperative risk factors such as procedure duration and type, intraoperative blood pressure, and intraoperative vasopressor use cannot be assessed in the variables included in that scale. The Braden Scale was developed based on risk factors relevant for patients receiving home care and may not be appropriate for assessing patients undergoing operative and other invasive procedures.…”

“…Risk factors for perioperative pressure injuries are categorized as preoperative, intraoperative, or postoperative . Studies have reported that preoperative risk factors include advanced age; male sex; low body mass index (BMI); low hematocrit (ie, less than 38%), hemoglobin, and albumin levels; inadequate nutrition; diabetes mellitus and other chronic diseases (eg, respiratory, heart); and immobilization . Intraoperative risk factors include type of anesthesia, procedure type and duration, intraoperative position of patient, materials used for positioning, the type of surface on the OR bed, moist skin, intraoperative vasopressor use, intraoperative hypotension, intraoperative hypothermia (ie, temperature less than 36.5° C [97.7° F]) or hyperthermia (ie, temperature greater than 37.5° C [99.5° F]), and use of warming devices .…”