A Longitudinal Study of the Incidence of Pressure Sores and the Associated Risks and Strategies Adopted in Italian Operating Theatres

Abstract

To explore the incidence of intraoperative pressure sores, the associated risk factors and the preventive strategies adopted by nurses, we adopted a longitudinal study in a 900-bed teaching hospital with multiple operating theatres, located in the North of Italy. Patients who underwent major surgery were evaluated four times: at the moment of operating theatre admission, at operating theatre discharge, and on their third and sixth postoperative day. Of the patients included (n = 102) who had an average age of 62.3 years (range 20-87), 12.7% (13/102) developed a pressure ulcer in the operating theatre; 46.1% (6/13) of these ulcers were still present on the third postoperative day. Some health conditions (diabetes mellitus, cardiac diseases) and intra-operative factors (lying on the operating table for more than 6.15 hours, intraoperative hypothermia) are associated with the occurrence of pressure sores.

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies

“…Totally, 16 studies including 24,112 participants met our eligibility criteria and were involved in the meta-analysis [12–23, 26–29]. Figure 1 gives the detailed process for study selection of this meta-analysis.…”

“…Despite the fact that some studies have reported significant association between diabetes and risk of surgery-related bedsore, some others have reported varying results on this association. It was noted in several studies that surgical patients with diabetes had higher risk of bedsore than those without diabetes [12–18], while still others showed null association [19–23]. Although two previous meta-analyses have explored this topic and found significant association between diabetes and surgery-related bedsore [24, 25], limited sample size and significant heterogeneity which was not sufficiently examined made the results less reliable.…”

Impact Assessment on a Newly Implemented Service Utilising Recovery Nurses as Transfer Nurses, Incorporating a Literature Review of Pressure Ulcer Reduction Strategies, i.e. Mattress and Overlay Types, for Patients on Hospital Trolleys

“…Berlowitz and Wilking [1990] highlight that patients with existing pressure sores and morbidity rather than age had an increased risk of developing pressure sores. Diabetes Mellitus, cardiac diseases, vascular failure [Bulfone et al, 2012], respiratory diseases, renal failure and cancer [Shewchuk et al, 2006] were statistically and significantly associated with pressure sore occurrence. Hartley [2003] confirmed that identification of surgical patients at risk of developing pressure sores and activating effective risk management strategies are internationally well-established practices of prevention.…”

“…A specific tool for Peri-operative Nurses to standardise evaluations of the effectiveness of preventative strategies for patients at risk needs to be developed [Bulfone et al, 2012]. Nurses' clinical judgements were found to be superior to any current risk assessment tool [Thompson, 2005], and team working was found to improve both practice and monitoring [Morris, 2002].…”

Positioning the neurosurgical patient

“…5 Pressure ulcers involve the skin and subcutaneous region and can extend into the underlying muscle. The tissue is typically of necrotic evolution and is characterized by ulceration and ischemic necrosis.…”