High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial

Yoshimura, Mine; Ohura, Norihiko; Santamaria, Nick; Watanabe, Yorikatsu; Akizuki, Tanetaka; Gefen, Amit

doi:10.1111/iwj.13287

Cited by 16 publications

(21 citation statements)

References 33 publications

(35 reference statements)

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“…The duration of surgery is a well-known risk factor for ulcers. [4,7,[14][15][16] A study conducted across multiple departments reported that the mean length of surgery for patients who developed ulcers was 234 min [4].…”

Section: Discussionmentioning

confidence: 99%

“…Their frequency ranges from 2.5 to 66%, [3][4][5][6][7] and their incidence is high in orthopedic surgeries (up to 11.8%) [6]. Other factors associated with ulcers include age, [8][9][10] sex, [9,10] low Braden scale score, [9,11,12] low body mass index (BMI), [7,12] diabetes, [13] duration of surgery, [4,7,[14][15][16] surgical positioning (prone and park-bench position), [7,16] application of external force, [7] and the amount of blood loss [7]. In addition, medical device-related pressure ulcers defined as resulting from the use of devices designed and applied for diagnostic or therapeutic purposes [9] have been reported to be increased owing to the development of technology and the increased use of medical devices for patients [17].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

et al. 2020

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Background: Intraoperatively acquired pressure ulcers are serious postsurgical complications requiring additional treatment, reoperation, and extended hospitalization. No study has investigated the frequency of the ulcers caused by compression with a pelvic positioner, which is used in hip surgeries to stabilize patients in the lateral decubitus position. Methods: This retrospective study investigated the risk factors and the frequency of the ulcers caused by the use of pelvic positioners in hip surgeries. The records of patients who underwent surgical procedures under general anesthesia at our institution between January 1, 2016 and March 31, 2018 were reviewed. The inclusion criterion for the assessment of risk factors was hip surgery in the lateral decubitus position stabilized by a pelvic positioner. The exclusion criteria were patients with trauma, missing data, or a pre-existing pressure ulcer. Finally,.the study included 229 patients (265 hip surgeries). All the patients were positioned in the lateral decubitus position with the assistance of either a pelvic positioner, which had a single support fixture located over the pubic symphysis or a double support fixture located over the bilateral anterior superior iliac spine. Intraoperatively acquired pressure ulcers were diagnosed when ulcers were absent on admission and the redness that was observed immediately after surgery remained after 24 h. Multivariate analysis was used to identify factors associated with an increased risk for ulcers. Results: Ulcers developed in 8 of 1810 (0.44%) patients who underwent orthopedic surgery. Seven of the 265 (2.64%) patients who underwent hip surgery in the lateral decubitus position stabilized by a pelvic positioner developed ulcers. All ulcers were located on areas of the body that were compressed by the pelvic positioner. After identifying controls for patient height (less than 154 cm), surgery duration (longer than 180 min), blood loss (more than 355 ml), and type of pelvic positioner used, we identified the independent risk factors for ulcers to be patient height < 154 cm (adjusted odds ratio, 12.8; p-value, 0.032) and the use of pelvic positioners with pubic bone support (adjusted odds ratio, 10.53; p-value, 0.047). Conclusion: The use of pelvic positioners with pubic bone support should be avoided in patients with a height of < 154 cm to decrease the risk of ulcers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

et al. 2020

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“…The OTs used for spine corrections can be, for example, two V‐shaped supports, one under the upper thoracic cage and the other under the pelvis, or can comprise parallel, longitudinal curved pads that support both sides of the torso. In all configurations, however, the authors recommend to use an integrative protective suite of products, including an advanced overlay designed for the specific prone frame, fluidised positioners, and prophylactic dressings applied to the face, chest, iliac crests, and shins for maximising tissue protection 105 . Computer modelling work conducted in the research group of author AG (reviewed in 95 ) allows to test the biomechanical efficacy of interventions, for example, positioners and prophylactic dressings in protecting soft tissue structures in prone‐positioned patients (Figure 5B).…”

Section: Challenges In Positioning Prone Surgical Patientsmentioning

confidence: 99%

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

Gefen

Creehan²,

Black

2020

International Wound Journal

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An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning‐related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.

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“…A literatura aponta como fatores intrínsecos, ou seja, relacionados diretamente ao paciente, o Índice de Massa Corporal (IMC), alterações laboratoriais, a classificação da American Society of Anesthesiologists (ASA), a idade e a presença de doenças crônicas (WALTON-GEER, 2009;BATEMAN, 2012;ENGELS et al, 2016;YOSHIMURA et al, 2020).…”

Section: Lesão Por Pressão No Período Intraoperatóriounclassified

“…Pacientes com obesidade ou sobrepeso tendem a ter comprometimento da irrigação da pele e camada subcutânea, o que propicia a isquemia local quando expostos as pressões de interface maiores. Além disso, algumas medidas preventivas de lesão (curativos de espuma, coxins e superfícies de suporte) têm melhores resultados em pacientes magros, portanto, ao serem utilizadas, em pacientes com IMC maior, podem não funcionar adequadamente (ENGELS et al, 2016;PEIXOTO, 2017;YOSHIMURA, et al, 2020).…”

Section: Lesão Por Pressão No Período Intraoperatóriounclassified

Superfícies de suporte para prevenção de lesão por pressão no período intraoperatório: revisão sistemática com metanálise

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Obrigada meu Deus por mais esse sonho realizado. Obrigada pela vida, pela oportunidade e por ser quem eu sou. À minha mãe Benedita e ao meu pai Pedro (in memorian),Obrigada por tudo o que vocês fizeram para que eu pudesse chegar até aqui. Toda a confiança e amor incondicional que depositaram em mim. Agradeço por cada puxão de orelha, por cada bronca, pelos conselhos, por terem investido tanto em minha educação. É um privilégio, um verdadeiro presente divino, ser filha de vocês. Essa conquista é de vocês! Amo vocês mais que tudo! Ao meu esposo Diego, Meu amor, obrigada por tudo, tudo... Por me apoiar incondicionalmente, por estudar junto comigo, por entender as minhas ausências e os meus surtos... Você é parte fundamental disso tudo. Obrigada por não ter permitido que eu esmorecesse... por ter renovado a minha fé e minha esperança constantemente. É um privilégio poder dividir a vida e crescer cada dia mais ao seu lado. Você é um ser humano sem igual. Eu amo você. Á, minha querida Gabi, Minha pequena, obrigada por encher meus dias de amor e de alegria. Por cada xícara de café, por cada sorriso, por fazer parte disso tudo. Você torna a minha vida mais leve... te amo. Dedico essa vitória a vocês, meus amores.... AGRADECIMENTOS Agradeço do fundo do meu coração... Em especial a minha orientadora Profa. Dra Cristina Maria Galvão que foi um presente na minha vida. Que me ensinou a ser muito mais que uma pesquisadora, um ser humano melhor. Obrigada professora por tanta generosidade e carinho que teve comigo durante esses quatro anos. Sei que não foi fácil para você também. Você é um ser humano raro e cheio de luz. Continue a iluminar o caminho de tantos outros. Obrigada por tudo sempre!!!

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High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial

Cited by 16 publications

References 33 publications

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

Superfícies de suporte para prevenção de lesão por pressão no período intraoperatório: revisão sistemática com metanálise

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