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

Patient Safety in Surgery - Tập 14 - Trang 1-9 - 2020
Takuro Ueno1, Tamon Kabata1, Yoshitomo Kajino1, Daisuke Inoue1, Takaaki Ohmori1, Junya Yoshitani1, Ken Ueoka1, Yuki Yamamuro1, Hiroyuki Tsuchiya1
1Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan

Tóm tắt

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. 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. 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). 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.

Tài liệu tham khảo

National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: a clinical practice guideline. Washington, DC: National Pressure Ulcer Advisory Panel; 2009. Fritz A, Gericke L, Höch A, Josten C, Osterhoff G. Time-to-treatment is a risk factor for the development of pressure ulcers in elderly patients with fractures of the pelvis and acetabulum. Injury. 2020;51:352–6. Schultz A, Bien M, Dumond K, Brown K, Myers A. Etiology and incidence of pressure ulcers in surgical patients. AORN J. 1999;70:434 437–40, 443–449. Lumbley JL, Ali SA, Tchokouani LS. Retrospective review of predisposing factors for intraoperative pressure ulcer development. J Clin Anesth. 2014;26:368–74. Nixon J, Cranny G, Bond S. Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: a cohort study. Int J Nurs Stud. 2007;44:655–63. Versluysen M. How elderly patients with femoral fracture develop pressure sores in hospital. Br Med J (Clin Res Ed). 1986;292:1311–3. Gao L, Yang L, Li X, Chen J, Du J, Bai X, Yang X. The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer. Clin Nurs. 2018;27:2984–92. O’Brien DD, Shanks AM, Talsma A, Brenner PS, Ramachandran SK. Intraoperative risk factors associated with postoperative pressure ulcers in critically ill patients: a retrospective observational study. Crit Care Med. 2014;42:40–7. Rashvand F, Shamekhi L, Rafiei H, Nosrataghaei M. Incidence and risk factors for medical device-related pressure ulcers: the first report in this regard in Iran. Int Wound J. 2020;17:436–42. Coyer FM, Stotts NA, Blackman VS. A prospective window into medical device-related pressure ulcers in intensive care. Int Wound J. 2014;11:656–64. Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. Int Wound J. 2010;7:358–65. Luo M, Long XH, Wu JL, Huang SZ, Zeng Y. Incidence and risk factors of pressure injuries in surgical spinal patients: a retrospective study. J Wound Ostomy Continence Nurs. 2019;46:397–400. Kang ZQ, Zhai XJ. The association between pre-existing diabetes mellitus and pressure ulcers in patients following surgery: a meta-analysis. Sci Rep. 2015;5:13007. Yoshimura M, Ohura N, Tanaka J, Ichimura S, Kasuya Y, Hotta O, et al. Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the border operating room spinal surgery (BOSS) trial in Japan. Int Wound J. 2018;15:188–97. Yoshimura M, Ohura N, Santamaria N, Watanabe Y, Akizuki T, Gefen A. 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. Int Wound J. 2020. https://doi.org/10.1111/iwj.13287 [Epub ahead of print]. Yoshimura M, Iizaka S, Kohno M, Nagata O, Yamasaki T, Mae T, Haruyama N, Sanada H. Risk factors associated with intraoperatively acquired pressure ulcers in the park-bench position: a retrospective study. Int Wound J. 2016;13:1206–13. Liversedge H. Preventing medical device-related skin damage. Nurs Stand. 2019;34:72–6. Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya H. Does degree of the pelvic deformity affect the accuracy of computed tomography-based hip navigation? J Arthroplast. 2012;27:1651–7. Fujita K, Kabata T, Maeda T, Kajino Y, Iwai S, Kuroda K, Hasegawa K, Tsuchiya H. The use of the transverse acetabular ligament in total hip replacement: an analysis of the orientation of the trial acetabular component using a navigation system. Bone Joint J. 2014;96:306–11. Hasegawa K, Kabata T, Kajino Y, Inoue D, Tsuchiya H. Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res. 2017;475:484–94. Inoue D, Kabata T, Maeda T, Kajino Y, Yamamoto T, Takagi T, Ohmori T, Tsuchiya H. The correlation between clinical radiological outcome and contact state of implant and femur using three-dimensional templating software in cementless total hip arthroplasty. Eur J Orthop Surg Traumatol. 2016;26:591–8. Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Tsuchiya H. Risk factors and cup protrusion thresholds for symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective case-control study. J Arthroplast. 2018;33:3288–96. Ueno T, Kabata T, Kajino Y, Ohmori T, Yoshitani J, Tsuchiya H. Three-dimensional host bone coverage required in total hip arthroplasty for developmental dysplasia of the hip and its relationship with 2-dimensional coverage. J Arthroplast. 2019;34:93–101. Hasegawa Y, Iwase T, Kitamura S, Yamauchi Ki K, Sakano S, Iwata H. Eccentric rotational acetabular osteotomy for acetabular dysplasia: follow-up of one hundred and thirty-two hips for five to ten years. J Bone Joint Surg Am. 2002;84:404–10. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden scale for predicting pressure sore risk. Nurs Res. 1987;36:205–10. Grammatopoulos G, Pandit HG, da Assunção R, Taylor A, McLardy-Smith P, De Smet KA, Murray DW, Gill HS. Pelvic position and movement during hip replacement. Bone Joint J. 2014;96-B:876–83. Milone MT, Schwarzkopf R, Meere PA, Carroll KM, Jerabek SA, Vigdorchik J. Rigid patient positioning is unreliable in total hip arthroplasty. J Arthroplast. 2017;32:1890–3. Iwakiri K, Kobayashi A, Ohta Y, Takaoka K. Efficacy of the anatomical-pelvic-plane positioner in total hip arthroplasty in the lateral decubitus position. J Arthroplast. 2017;32:1520–4. Schwarzkopf R, Muir JM, Paprosky WG, Seymour S, Cross MB, Vigdorchik JM. Quantifying pelvic motion during total hip arthroplasty using a new surgical navigation device. J Arthroplast. 2017;32:3056–60. Holcomb JB. Methods for improved hemorrhage control. Crit Care. 2004;8:S57–60.