Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park-bench position: A prospective observational study

Mine Yoshimura; Gojiro Nakagami; Shinji Iizaka; Mikako Yoshida; Yoko Uehata; Michihiro Kohno; Yusuke Kasuya; Tomoko Mae; Takashi Yamasaki; Hiromi Sanada

doi:10.1111/wrr.12340

Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park-bench position: A prospective observational study

Wound Repair Regen. 2015 Nov-Dec;23(6):939-47. doi: 10.1111/wrr.12340. Epub 2015 Nov 4.

Authors

Affiliations

¹ Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
⁴ Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
⁵ Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.

PMID: 26171566
DOI: 10.1111/wrr.12340

Abstract

Preventing pressure ulcers is important in patients undergoing procedures in the park-bench position. We hypothesized that the microclimate around the skin is a significant risk factor for developing pressure ulcers. This research continuously assessed factors of the microclimate in terms of skin temperature and perspiration as well as the interface pressure in order to determine whether the microclimate is an independent risk factor for the development of park-bench position-related pressure ulcers (PBP-PUs). A prospective observational study was conducted among patients undergoing elective surgery in the park-bench position at a general hospital in the metropolitan area of Japan between April and November 2014. Factors of the microclimate, including skin temperature and perspiration, in addition to the interface pressure were continuously measured throughout surgery. Twenty-nine patients were analyzed (mean age 44.4 ± 13.2 years, male 44.8%). Of these 29 patients, seven (24.1%) developed Category I PBP-PUs. The change in skin temperature from baseline to the end of surgery (2.7 ± 0.3 °C vs. 1.9 ± 0.8 °C) and the average peak pressure (119.1 ± 36.8 mmHg vs. 94.5 ± 23.1 mmHg) were significantly higher in the patients with PBP-PUs than in those without PBP-PUs. There were no significant differences in the amount of perspiration between the two groups. A hierarchical logistic regression analysis showed that the change in skin temperature was significantly related to the development of PBP-PUs (unit = 0.1 °C: odds ratio 1.44, 95% confidential interval 1.09-2.33) when adjusted for the average peak pressure and length of surgery. Our results suggest that a change in skin temperature toward a higher value is an independent risk factor for the development of PBP-PUs. Proper intraoperative management of skin temperature may therefore be a promising candidate as a preventive method against PBP-PU development.

Keywords: interface pressure; neurosurgery; perioperative nursing; perspiration; skin temperature.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Beds
Female
Humans
Japan / epidemiology
Male
Microclimate
Middle Aged
Practice Guidelines as Topic
Pressure Ulcer / etiology
Pressure Ulcer / physiopathology
Pressure Ulcer / prevention & control*
Prospective Studies
Risk Factors
Skin Care / methods*
Skin Temperature
Surgical Procedures, Operative / adverse effects*
Time Factors
Wound Healing*