Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지

Risk Factors of Pressure Sore in Patients undergoing General Anesthesia

전신마취를 받는 환자에서 발생하는 압박 욕창의 발생률과 위험인자의 조사

Hwang, Hee-Youn;Shin, Yong-Sup;Cho, Hyun-Sung;Yeo, Jin-Seok
황희윤;신용섭;조현성;여진석

  • Published : 20070700
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Abstract

Background: The occurrences of pressure sores have an extensive impact on patients and the medical team. Pressure sores decrease quality of life and productivity, as well as increase the overall cost of treatment. The purpose of this study was to identify the risk factors associated with pressure ulcers among surgical patients. Methods: Data were collected from 588 patients who underwent general anesthesia. The data included age, gender, weight, height, body mass index, ASA status, surgical position, anesthesia time, pre-and postoperative hemoglobin concentration, serum albumin, NYHA class, co-morbidity, steroid use, body temperature, use of warming water mattress and preoperative hospital admission day. The patient's skin was inspected closely before surgery and again within 24 hours after surgery and the locations and severity of skin breakdowns were assessed. Results: Twenty-five patients (4.3%) developed pressure sores during surgery. The hemoglobin concentration change between the preoperative and postoperative period (≥2 g/dl), position during surgery, length of stay before operation (≥4 days), anesthesia time (≥5 hours) and decrease in body temperature (≥0.5℃) were significantly related to the development of pressure sores (P ＜ 0.05). Conclusions: Five risk factors for pressure ulcers were confirmed. The anesthesiologist can decrease hemoglobin and modify body temperature; therefore, attention should be given to these risk factors during the operation.

Keywords

References

  1. Shea JD: Pressure sores: classification and management. Orthop Relat Res 1975; 112: 89-100
  2. Grous CA, Reilly NJ, Gift AG: Skin integrity in patients undergoing prolonged operations. J Wound Ostomy Continence Nurs 1997; 24: 86-91
  3. Stordeur S, Laurent S, D'Hoore W: The importance of repeated risk assessment for pressure sores in cardiovascular surgery. J Cardiovasc Surg 1998; 39: 343-9
  4. Pokorny ME, Koldjeski D, Swanson M: Skin care intervention for patients having cardiac surgery. Am J Crit Care 2003; 12: 535-44
  5. Stevens J, Nichelson E, Linehan WM, Thompson N, Liewehr D, Venzon D, et al: Risk factors for skin breakdown after renal and adrenal surgery. Urology 2004; 64: 246-9 https://doi.org/10.1016/j.urology.2004.03.024
  6. Bergstrom N, Braden BJ, Laguzza A, Holman V: The braden scale for predicting pressure sore risk. Nurs Res 1987; 36: 205-10
  7. Aronovitch SA: Intraoperatively acquired pressure ulcer prevalence: a national study. J Wound Ostomy Continence Nurs 1999; 26: 130-6
  8. Allman RM: Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med 1997; 13: 421-36
  9. Hicks DJ: An incidence study of pressure sores following surgery. ANA Clin Sess 1970; 49-54
  10. Lewicki LJ, Mion L, Splane KG, Samstag D, Secic M: Patient risk factors for pressure ulcers during cardiac surgery. AORN J 1997; 65: 933-42 https://doi.org/10.1016/S0001-2092(06)62976-1
  11. Jesurum J, Joseph K, Davis JM, Suki R: Balloons, beds, and breakdown. Effects of low-air loss therapy on the development of pressure ulcers in cardiovascular surgical patients with intra-aortic balloon pump support. Crit Care Nurs Clin North Am 1996; 8: 423-40
  12. Vermillion C: Operating room acquired pressure ulcers. Decubitus 1990; 3: 26-30
  13. Versluysen M: How elderly patients with femoral fracture develop pressure sores in hospital. Br Med J (Clin Res Ed) 1986; 292: 1311-3 https://doi.org/10.1136/bmj.292.6531.1311
  14. Ek AC, Boman G: A descriptive study of pressure sores: the prevalence of pressure sores and the characteristics of patients. J Adv Nurs 1982; 7: 51-7 https://doi.org/10.1111/j.1365-2648.1982.tb03276.x
  15. Scott EM, Baker EA, Kelly PJ, Stoddard EJ, Leaper DJ: Measurement of interface pressures in the evaluation of operating theatre mattresses. J Wound Care 1999; 8: 437-41 https://doi.org/10.12968/jowc.1999.8.9.26200
  16. Papantonio CT, Wallop JM, Kolodner KB: Sacral ulcers following cardiac surgery: incidence and risks. Adv Wound Care 1994; 7: 24-36
  17. Stotts NA: Nutritional parameters at hospital admission as predictors of pressure ulcer development in elective surgery. JPEN J Parenter Enteral Nutr 1987; 11: 298-301 https://doi.org/10.1177/0148607187011003298
  18. Choi SJ, Kim DW, Chung SH, Ahn HJ, Gwak MS, Yang M, et al: The incidence rate and risk factors or pressure-induced skin breakdown during operation. Korean J Anesthesiol 2006; 50: 525-529 https://doi.org/10.4097/kjae.2006.50.5.525
  19. Stotts NA, Deosaransingh K, Roll FJ, Newman J: Underutilization of pressure ulcer risk assessment in hip fracture patients. Adv Wound Care 1998; 11: 32-8
  20. Versluysen M: Pressure sores in elderly patients. The epidemiology related to hip operations. J Bone Joint Surg Br 1985; 67: 10-3
  21. Goldstone LA, Goldstone J: The Norton score: an early warning of pressure sores? J Adv Nurs 1982; 7: 419-26 https://doi.org/10.1111/j.1365-2648.1982.tb00258.x
  22. Roberts BV, Goldstone LA: A survey of pressure sores in the over sixties on two orthopaedic wards. Int J Nurs Stud 1979; 16: 355-64' https://doi.org/10.1016/0020-7489(79)90044-0
  23. Hommel A, Ulander K, Thorngren KG: Improvements in pain relief, handling time and pressure ulcers through internal audits of hip fracture patients. Scand J Caring Sci 2003; 17: 78-83 https://doi.org/10.1046/j.1471-6712.2003.00212.x
  24. Kemp MG, Keithley JK, Smith DW, Morreale B: Factors that contribute to pressure sores in surgical patients. Res Nurs Health 1990; 13: 293-301 https://doi.org/10.1002/nur.4770130505
  25. Kemp MG, Keithley JK, Smith DW, Morreale B: Factors that contribute to pressure sores in surgical patients. Res Nurs Health 1990; 13: 293-301 https://doi.org/10.1002/nur.4770130505
  26. Defloor T, Grypdonck MF: Pressure ulcers: validation of two risk assessment scales. J Clin Nurs 2005; 14: 373-82 https://doi.org/10.1111/j.1365-2702.2004.01058.x
  27. Kokate JY, Leland KJ, Held AM, Hansen GL, Kveen GL, Johnson BA, et al: Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil 1995; 76: 666-73 https://doi.org/10.1016/S0003-9993(95)80637-7
  28. Crino MH, Nagel EL: Thermal burns caused by warming blankets in the operating room. Anesthesiology 1968; 29: 149-50 https://doi.org/10.1097/00000542-196801000-00038
  29. Jonsson A, Linden M, Lindgren M, Malmqvist LA, Backlund Y: Evaluation of antidecubitus mattresses. Med Biol Eng Comput 2005; 43: 541-7 https://doi.org/10.1007/BF02351025