Perioperative Pressure Injuries: A Systematic Literature Review

Abstract

OBJECTIVE: To conduct a systematic review to investigate risk factors, incidence, and preventive strategies for perioperative pressure injuries (PIs). METHODS: The authors reviewed four databases for literature published from January 2001 to December 2017. Selected articles included primary quantitative studies with prospective, descriptive, and longitudinal design or randomized controlled trials that evaluated risk factors, incidence, and preventive strategies for perioperative PIs. The studies included were evaluated for methodological quality using the Edwards Method Score. The authors used a standardized extraction form to extract inclusion and exclusion criteria, participant demographics, methodology, PI risk instrument and classification systems, type of surgery and anesthesia, PI risk factors, incidence, preventive strategies, and outcomes evaluation. MAIN RESULTS: Of the 115 publications identified, 11 met the inclusion criteria. The risk assessment and PI classification instruments used differed in every study. Incidence of PI varied throughout the studies and was reduced by warming therapy and by a skin care intervention program. CONCLUSIONS: Further studies are necessary to develop a standard risk assessment instrument and preventive strategies and to clarify some contradictions evident in the literature.

Modeling and prediction of pressure injury in hospitalized patients using artificial intelligence

“…The health system uses the EPIC © vendor for inpatient documentation. Inclusion criteria for extraction of patient records included: [ 1 ] adults (≥ 18 years of age); [ 2 ] undergoing a surgical procedure; and [ 3 ] hospitalized for two or more days between June 2014 and June 2016. Administrative data, including nurse staffing data, were extracted for all nursing units where the patients were admitted during the study timeframe.…”

“…Bufone et al . [ 1 ] conducted a systematic review of perioperative PIs. Of the eleven articles that met their inclusion criteria, the incidence range was between 1.3% and 54.8%.…”

“…The authors note that likely contributors to their heterogeneous findings were that the studies varied on the PI stages that were included (e.g., Stage I, I & II, III & IV), assessment tool used (Braden, Norton, RAPS or not reported), and type of surgery (orthopedics, cardiac, ENT, others). Recommendations for future research included clarifying the differences in PI among different surgical services and using risk assessment tools that include intraoperative variables [ 1 ].…”

Using Continuous Intraoperative Pressure Mapping to Describe Patterns of Tissue Interface Pressure

“…A variety of risk factors contribute to the development of pressure injuries and can be classified as intrinsic (ie, originating in the patient) or extrinsic (ie, originating outside the patient). Intrinsic risk factors for pressure injury include nutritional status and body mass index (BMI), 2,3 cardiovascular and hemodynamic imbalances, 2 comorbidities and clinical condition (eg, peripheral vascular disease, diabetes), 2,3 demographic characteristics (eg, older age, female gender), 2,3 decreased mobility, 3 and decreased tissue perfusion and oxygenation 3 …”

“…Extrinsic risk factors for pressure injury cause increased pressure and shearing forces; such factors include the length of the procedure, operative position (eg, prone, lateral), type of surgery (eg, orthopedic, general), and type of anesthesia (eg, general) 2 …”