Suh DaeHee, Kim Su Yeon, Yoo Byunghoon, Lee Sangseok
Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Anesth Pain Med (Seoul). 2021 Jan;16(1):108-115. doi: 10.17085/apm.20081. Epub 2020 Dec 17.
Perioperative patients are potentially at risk for pressure injuries due to anesthetic agents and surgical positioning. Pressure injury increases discomfort and pain in patients and causes complications, which lead to an increase in mortality and hospitalization duration. Most previous studies did not focus on specific types of surgery or surgical positioning. We tried to identify the incidence of perioperative pressure injury during spinal surgery and perioperative risk factors that contribute to pressure injury.
We retrospectively analyzed electronic medical records of 663 patients who underwent spinal surgery between March 2016 and May 2018. The primary outcome was occurrence of pressure injury. Potential risk factors of pressure injury were selected based on previous studies and expert opinion, and divided into two sub-categories: preoperative and intraoperative risk factors. We compared the clinical characteristics of patients in the pressure injury and non-injury groups. Perioperative risk factors for pressure injury were analyzed by logistic regression.
Among 663 patients, the incidence of all stages of pressure injury was 5.9%. The face and inguinal regions were the most injured sites (both 28.6%). The pressure injury group showed a 13% longer hospitalization period. Preoperative plasma concentration of protein was associated with 0.5-fold lower pressure injury (OR: 0.50; 95% CI: 0.27 to 0.95; P = 0.034).
The incidence of pressure injury was similar to that previously reported and occurred in the direct weight-bearing areas, which led to longer hospitalization. We found that a lower preoperative serum protein level is significantly associated with intraoperative pressure injury occurrence during spinal surgery.
围手术期患者因麻醉药物和手术体位而有发生压力性损伤的潜在风险。压力性损伤会增加患者的不适和疼痛，并引发并发症，进而导致死亡率和住院时间增加。以往大多数研究并未聚焦于特定类型的手术或手术体位。我们试图确定脊柱手术围手术期压力性损伤的发生率以及导致压力性损伤的围手术期风险因素。
我们回顾性分析了2016年3月至2018年5月期间接受脊柱手术的663例患者的电子病历。主要结局是压力性损伤的发生情况。基于以往研究和专家意见选择压力性损伤的潜在风险因素，并将其分为两个子类别：术前和术中风险因素。我们比较了发生压力性损伤患者组和未发生压力性损伤患者组的临床特征。通过逻辑回归分析压力性损伤的围手术期风险因素。
在663例患者中，各阶段压力性损伤的发生率为5.9%。面部和腹股沟区域是损伤最严重的部位（均为28.6%）。发生压力性损伤的患者组住院时间长13%。术前血浆蛋白浓度与压力性损伤降低0.5倍相关（比值比：0.50；95%置信区间：0.27至0.95；P = 0.034）。
压力性损伤的发生率与先前报道的相似，且发生在直接承重区域，这导致住院时间延长。我们发现术前血清蛋白水平较低与脊柱手术期间术中压力性损伤的发生显著相关。
