Pressure injury related to surgical positioning and associated factors

An observational and longitudinal study, involving 239 patients undergoing elective surgery. Data collection was performed using an instrument for sociodemographic and clinical characteristics, and a risk assessment scale for the development of injuries due to surgical positioning. Descriptive statistics and multiple binominal logistic regression were used for data analysis, and the level of significance considered was α = 0.05.

Results:

Most of the patients were adult male Caucasians. The occurrence of pressure injury resulting from surgical positioning was 37.7%, and 81 (90.0%) patients developed stage 1 pressure injury, and the most frequent sites were sacral (19; 13.9%), and right (16; 11.7%) and left (13; 9.5%) calcaneus regions. Age (adult) and those identified at higher risk according to the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO) were predictors for occurrence of pressure injury.

Conclusion:

The high incidence and associated factors (age and higher risk on the administered scale) for pressure injuries resulting from surgical positioning provide results to help understand the problem within the national scenario, and to implement interventions to reduce the patient's risk of being affected by this type of injury in the perioperative period.

Keywords
Pressure ulcer; Patient positioning; Perioperative nursing; Patient safety; Nursing care

Items/ELPO		n(%)
Type of surgical position
	Supine	171(71.5)
	Lateral	27(11.3)
	Trendelenburg	27(11.3)
	Prone	6(2.5)
	Lithotomy	8(3.3)
Surgery time (hours)
	≤ 1	4(1.7)
	1 to ≤ 2	50(20.9)
	>2 to <4	95(39.7)
	> 4 to <6	67(28.0)
	>6	23(9.6)
Type of anesthesia
	Sedation	3(1.3)
	Regional	75(31.4)
	General	109(45.6)
	General + Regional	52(21.8)
Type of support surface
	Foam mattress + foam pads	18(7.5)
	Foam mattress + cotton pads	182(76.2)
	No use of support surfaces; rigid supports without padding; narrow leg supports	39(16.3)
Surgical limb positioning
	Anatomic position	72(30.1)
	Opening of upper limbs <90°	112(46.9)
	Knees raised <90°, and opening of lower limbs < 90°, or neck without sternal alignment	16(6.7)
	Knees raised >90° or opening of lower limbs >90°	13(5.4)
	Knees raised >90° and opening of lower limbs >90°, or opening of upper limbs >90°	26(10.9)
Comorbidities
	No comorbidities	104(43.5)
	Vascular disease	57(23.8)
	Diabetes mellitus	22(9.2)
	Obesity or malnutrition	51(21.3)
	Previously diagnosed pressure injury, neuropathy, or deep vein thrombosis	5(2.1)
Age of patient (years)
	18 - 39	59(24.7)
	40 - 59	94(39.3)
	60 - 69	54(22.6)
	70 - 79	24(10)
	>80	8(3.3)

Variables	Pressure injury due to surgical positioning
Variables	Odds ratio (95% CI*)	Adjusted odds ratio (95% IC*)	p-value^‡ ‡ p - logistic regression, significance level;
Age group	1.70 (0.97 – 2.98)	2.16 (1.17 – 3.98)	0.01
Self reported skin color	1.54 (0.90 – 2.62)	1.35 (0.77 – 2.37)	0.28
Sex	1.02 (0.60 – 1.72)	0.96 (0.54 – 1.70)	0.9
BMI classification^§ § BMI - Body Mass Index;	0.66 (0.38 – 1.12)	0.60 (0.34 – 1.06)	0.08
Hypothermia (Taur 60min)	1.54 (0.88 – 2.70)	1.37 (0.75 – 2.50)	0.3
Risk for injury (ELPO) ^II II ELPO - Risk Assessment Scale for the Development of Injuries due to Surgical Positioning; Dichotomous variables - age group (adult or older people-reference category); self-reported skin color (white or non-white-reference category); sex (male or female-reference category); BMI classification (altered or eutrophic-reference category); hypothermia (yes or no-reference category); risk for injury (higher risk or lower risk-reference category)	1.46 (0.86 – 2.47)	1.79 (1.00 – 3.20)	0.04

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Maria Helena Barbosa E-mail: mhelena331@hotmail.com