Incidence of pressure-related skin injuries in patients operated for spine surgery in prone: A retrospective analysis of 307 patients

Abstract

Background: Spine surgery in prone position frequently results in pressure skin lesions (PSLs). No study from Arabic world has published their incidence in literature. Methods: We retrospectively analyzed patients who underwent prone position spine surgery from December 1, 2017, to November 30, 2018. They received standardized anesthesia care and were made prone on Jackson table. The face was supported on a nonface contoured foam device, whereas the chest and pelvis were supported on soft cushions. Following completion of surgery, they were turned supine and their skin was inspected for any skin lesions. The lesions were categorized into five grades depending on severity. Results: Data of 307 patients were analyzed. Their mean age and weight was 41.5 years and 71 kg, respectively. The mean duration of prone positioning was 470 min. One hundred and three PSLs were observed in 45 patients (14.7%), giving a PSL incidence of 43.7% in affected patients. Majority of patients (18, 40%) with lesions remained in prone position between 421 and 600 min. Multiple lesions were observed in 53.3% of the affected patients. The highest number of patients (21, 46.7%) had one lesion only and it was restricted to face. All lesions were of Grade I, II, or III. Body weight >71 kg was more prone to developing PSLs. Females were more prone to PSLs. Conclusion: PSLs in prone position spine surgery occur frequently, and their incidence is proportional to the duration of positioning and weight of the patients. Face is the most commonly affected area.

Are the Choice of Frame and Intraoperative Patient Positioning Associated With Radiologic and Clinical Outcomes in Long-instrumented Lumbar Fusion for Adult Spinal Deformity?

“…Complications related to the patient’s position, including pressure skin lesions, were also compared between the two groups. Pressure-related skin injury was divided into five grades: I, nonblanching skin erythema; II, blister; III, peeling of the epidermis; IV, peeling of the full-skin thickness; and V, exposure of the underlying muscle [2].…”

Hospital acquired pressure injury in adult orthopedic spine surgery patients: risk factors and risk assessment tools

“…Prone positioning places the patient at increased risk as the ventral surface is not optimal for weight bearing and has a number of significant osseous prominences . Although spinal fusion surgeries have increased dramatically in the last 20 years, research has only recently begun examining HAPI in patients undergoing a surgical procedure in the prone position Bithal et al, 2020a;. The reported incidence of HAPI among patients undergoing spine surgery in the prone position varies widely from a low of 1.34% to 7.1% to a high of 43.7% .…”