Pressure Ulcers: Factors Contributing to Their Development in the OR

Abstract

The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours. We performed a retrospective chart review to determine what factors contribute to the development of pressure ulcers in patients who undergo surgical procedures. The sample population included patients who acquired a pressure ulcer that was not present at admission and developed during their postoperative hospital stay. The project revealed consistent risk factors that may contribute to the development of pressure ulcers in patients who have undergone surgical procedures. These findings can drive the implementation of preventive measures to reduce the occurrence of HAPUs associated with surgical procedures.

A Change in Focus: Shifting From Treatment to Prevention of Perioperative Pressure Injuries

“…Patients scoring below 16 on the Braden Scale are considered at risk. One study determined that the risk of pressure injury occurrence increased 58% with each decreasing unit on the Braden Scale . Approximately 25% of our patients are found to be at risk of pressure injury before undergoing an operative or other invasive procedure.…”

“…All perioperative patients are at risk for pressure injury because they are immobile during the procedure; unable to feel pain caused by pressure, friction, or shear forces; and unable to change position to relieve the pressure on a particular area . Studies correlating the length of the operative or other invasive procedure and pressure injury development are inconclusive . A recent study focusing on sacral pressure injuries in critically ill surgical patients found that a shorter procedure duration increased the risk of pressure injuries .…”

“…Pillows and foam shapes are still commonly used for positioning and cushioning bony prominences at many facilities; however, the AORN “Guideline for positioning the patient” does not discuss the use of pillows for pressure redistribution purposes, stating that “[n]otably, pillows provide only a minimal amount of pressure redistribution.” (p656) The NPUAP notes that pillows may compress and lose their shape over time, becoming ineffective for offloading pressure . One study found that caregivers documented the use of pillows or foam pads for intraoperative positioning for 86.2% of patients who developed a perioperative pressure injury …”

Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators

“…Due to the patient characteristics and procedures in acute care (eg emergency admissions, trauma and critically ill patients, unstable health conditions), PU risk is high in these particular hospital patient groups . Patient transfer, surgical procedures, and the involvement of many disciplines and professions have especially been identified as typical environmental PU risk factors in hospitals . At the same time, PU risk may still be under‐detected .…”

Bioimpedance as an indicator in the distribution of interface pressure in vulnerable regions for pressure ulcers: A preliminary study

“…Extreme changes in body mass index (BMI), as in patients classified as lean or obese, are considered to be predisposing factors for the occurrence of ulcers. Obesity may enhance the complications resulting from positioning, and low weight results in the increased exposure of the patient's bony prominences, leaving the regions more susceptible to PUs (Association of periOperative Registered Nurses [AORN], ; Engels et al, ).…”