Prevalence and factors associated with pressure injury in patients undergoing open heart surgery: A systematic review and meta‐analysis

Abstract

Pressure injuries (PIs) are one of the major and costliest medical problems with severe implications for patients. Cardiovascular surgery patients are at the higher risk of developing surgery-related PIs. So this study was conducted with the aim of investigating the prevalence and factors associated with PIs in patients undergoing open heart surgery. We identified articles through electronic databases such as Web of Science, Scopus, PubMed, Pro-Quest; and Persian Databases: SID, Magiran and Irandoc without restriction on language or publication period (from inception through June 2022). Finally, 17 studies that fulfilled eligibility criteria were included in final systematic review and meta-analysis. Data analyses were conducted using STATA version 14. The pooled prevalence of PI in patients undergoing open heart surgery was 24.06% (95% CI: 17.85-30.27). High heterogeneity was observed across the included studies (I 2 = 96.0, P < 0.000). The prevalence by gender was reported as in women. The result showed there was statistically significant association between PI and Female sex (Pooled Est: 1.551, 95% CI: 1.199-2.006, z = 3.345, P = 0.001), diabetes (Pooled Est: 1.985, 95% CI:1.383-2.849, z = 3.719, P = 0.000), advanced age (SMD: 0.33 years; 95% CI: 0.09-0.57), Duration of surgery (SMD: 0.47; 95% CI: 0.19-0.75) and preoperative serum albumin level (SMD: 0.56; 95% CI: 0.14-0.98). The relatively high PIs incidence among patients undergoing open heart surgery suggests that typical PI prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented.

Preventing pressure injury in open‐heart surgical patients: A systematic review

“…The bias risk assessment was carried out using Cochrane Risk‐of‐Bias tool for randomized trials (RoB 2), 11 Joanna Briggs Institute (JBI) Checklist for Quasi Experimental Appraisal tool, 12 and The National Institutes of Health (NIH) quality assessment tool for before‐after (pre–post) study with no control group 13 . RoB 2 tool is structured into five domains for individually randomized trials 1 : bias arising from the randomization process 2 ; bias due to deviations from intended interventions 3 ; bias due to missing outcome data 4 ; bias in measurement of the outcome 5 ; bias in selection of the reported result. JBI checklist has five questions, which use to determine the quality of Quasi‐experimental studies (nonrandomized) and NIH tool has 12 questions for quality assessment of before–after (pre–post) study without a control group.…”

“…PIs are a common side effect of many high‐acuity surgeries, and it has known as a major comorbid event due to cardiac surgery 1 . cardiac surgery patients are considered one of the most at‐risk patient populations, with incidence rates reported as high as 24.06% 2 . PIs are potentially preventable but frequently occurring adverse events in hospitalized patients 3 .…”

“…1 cardiac surgery patients are considered one of the most at-risk patient populations, with incidence rates reported as high as 24.06%. 2 PIs are potentially preventable but frequently occurring adverse events in hospitalized patients. 3 Prevention of PIs is an important patient safety priority in healthcare settings because PIs make a significant independent contribution to the excess patients' length of hospitalization.…”

“…5 A systematic review found out Female sex, diabetes, advanced age, Duration of surgery and preoperative serum albumin level as the risk factors for developing PI in cardiac surgical patient that it needs to consider for PI prevention before and during the surgery. 2 A literature review also indicates that there is a variety of clinical studies on the use of dressings in the prevention of PI, such as hydrocolloids, foams, and films during surgery. 6 Some other studies proved that the incidence of PI can be reduced by using the multilayered silicone foam, because of its ability to reduce friction, pressure forces, and transferring shear away from critical spots.…”

“…In addition, patients must pay a significant additional cost for PIs treatment 5 . A systematic review found out Female sex, diabetes, advanced age, Duration of surgery and preoperative serum albumin level as the risk factors for developing PI in cardiac surgical patient that it needs to consider for PI prevention before and during the surgery 2 . A literature review also indicates that there is a variety of clinical studies on the use of dressings in the prevention of PI, such as hydrocolloids, foams, and films during surgery 6 .…”