Evaluation of pressure ulcer risk in hospitalized patients after metabolic surgery

Year 2020, Volume: 4 Issue: 9, 830 - 834, 01.09.2020

Fatih Can Karaca , Kıvılcım Ulusan

https://doi.org/10.28982/josam.799157

Abstract

Aim: Patients who underwent surgery are in the risk group for development of pressure ulcers (PU) due to several factors including surgery time, immobilization and preexisting comorbidities. We aimed to evaluate the PU risk using The Braden Scale in patients during their hospitalization after sleeve gastrectomy with transit bipartition (SG+TB) surgery.
Methods: This is a retrospective cohort study evaluating the PU risk using The Braden Scale, which consists of six subscales including sensory perception, moisture, activity, mobility, nutrition, and friction/shear. The patients were sub-grouped in terms of PU risk based on total Braden score.
Results: The study group consisted of 33 patients who underwent SG+TB. The mean Braden score was 19.2(2.77) (range 12-23) during the hospitalization period. The Braden scores of the patients were lower on the 2nd (P<0.001), 3rd (P<0.001), 4th (P=0.005), and 5th (P=0.004) postoperative days compared to postoperative day 1, and on the 3rd, 4th, 5th, and 6th postoperative days compared to postoperative day 2 (P<0.001 for each). According to our data, the PU risk was significantly different between the 1st postoperative day and the 2nd, 3rd, 4th, and 5th postoperative days (P<0.001 for each).
Conclusion: Metabolic surgery patients have an elevated risk for PU during the hospitalization period. Protein supplementation is among the factors that might improve the nutritional status of patients and decrease PU risk during hospitalization.

Keywords

pressure ulcer risk, metabolic surgery, The Braden Scale

Metabolik cerrahi sonrası hospitalize hastalarda bası yarası riskinin değerlendirilmesi

Abstract

Amaç: Operasyon geçiren hastalar, ameliyat süresi, immobilizasyon ve varolan komorbiditeleri nedeniyele bası yarası gelişimi için risk grubunda bulunmaktadır. Bu çalışmada sleeve gastrektomi ve transit bipartisyon (SG+TB) ameliyatı sonrası hastanede yatış sırasında bası yarası riskini Braden Ölçeği ile değerlendirmeyi amaçladık.
Yöntemler: Bu retrospektif kohort çalışmada, Braden Ölçeği değerlendirmesi, duyusal algılama, nem, aktivite, hareketlilik, beslenme ve sürtünme/yırtılma olmak üzere altı alt ölçekten oluşan çizelge ile hastanede yatış süresince günlük olarak yapıldı. Hastalar bası yarası riski açısından toplam Braden skoruna göre alt gruplara ayrıldı.
Bulgular: Çalışma grubu SG+TB uygulanan 33 hastadan oluşturuldu. Ortalama Braden skoru hastanede kalış süresi boyunca 19,2(2,77) idi (12-23 arası). Hastaların Braden skorları postoperatif 2. (P<0,001), 3. (P<0,001), 4. (P=0,005) ve 5. (P=0,004) günlerde postoperatif 1. güne göre anlamlı olarak düşüktü. Braden skorları postoperatif 3., 4., 5. ve 6. günlerde postoperatif 2. güne göre anlamlı olarak düşüktü (her biri için P<0.001). Verilerimize göre PU riski açısından oranlar ameliyat sonrası 2., 3., 4. ve 5. günlerde 1. güne göre anlamlı olarak farklıydı (her biri için P<0,001).
Sonuç: Metabolik cerrahi hastaları, hastanede kaldıkları süre boyunca yüksek bası yarası riski taşır. Protein takviyesi, hastaların beslenme durumlarını iyileştirebilecek ve hastanede yatış sırasında bası yarası riskini azaltabilecek faktörler arasındadır.

Keywords

Bası yarası riski, Metabolik cerrahi, Braden skalası

References

• 1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. National Pressure Ulcer Advisory Panel; Washington DC: 2009. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline.
• 2. Chen H, Chen X, Wu J. The incidence of pressure ulcers in surgical patients of the last 5 years. Wounds. 2012;24(9):234–41.
• 3. Lindgren M, Unosson M, Krantz AM, Ek AC. Pressure ulcer risk factors in patients undergoing surgery. Journal of Advanced Nursing. 2005;50(6):605–12.
• 4. Sala JJ, Mayampurath A, Solmos S, Vonderheid SC, Banas M, D'Souza A, et al. Predictors of pressure injury development in critically ill adults: A retrospective cohort study. Intensive Crit Care Nurs. 2020;25:102924. doi: 10.1016/j.iccn.2020.102924.
• 5. Aloweni F, Ang SY, Fook-Chong S, Agus N, Yong P, Goh MM, Tet al. A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. Int Wound J. 2019;16(1):164-75. doi: 10.1111/iwj.13007.
• 6. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36:205-10.
• 7. Bhandari M, Fobi MAL, Buchwald JN; Bariatric Metabolic Surgery Standardization (BMSS) Working Group. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg. 2019;29(Suppl 4):309-345. doi: 10.1007/s11695-019-04032-x.
• 8. Santoro S, Castro LC, Velhote MC, Malzoni CE, Klajner S, Castro LP, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg. 2012;256(1):104-10. doi: 10.1097/SLA.0b013e31825370c0.
• 9. Hyun S, Li X, Vermillion B, Newton C, Fall M, Kaewprag P, et al. Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients. Am J Crit Care. 2014 Nov;23(6):494-500; quiz 501. doi: 10.4037/ajcc2014535. PMID: 25362673; PMCID: PMC4385001.
• 10. Liang M, Chen Q, Zhang Y, He L, Wang J, Cai Y, Li L. Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies. Oncotarget. 2017 Feb 28;8(9):14516-24. doi: 10.18632/oncotarget.1432
• 11. Kang Z, Zhai X. The Association between Pre-existing Diabetes Mellitus and Pressure Ulcers in Patients Following Surgery: A Meta-analysis. Sci Rep. 2015;5:13007. https://doi.org/10.1038/srep13007
• 12. Ahn H, Cowan L, Garvan C, Lyon D, Stechmiller J. Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents: Analysis of National Minimum Data Set 3.0. Adv Skin Wound Care. 2016;29(4):178-90; quiz E1. doi: 10.1097/01.ASW.0000481115.78879.63.
• 13. Montalcini T, Moraca M, Ferro Y, Romeo S, Serra S, Raso MG, et al. Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury. J Transl Med. 2015;13:305.
• 14. Primiano M, Friend M, McClure C, Nardi S, Fix L, Schafer M, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011 ;94(6):555-66. doi: 10.1016/j.aorn.2011.03.014.
• 15. Margolis DJ, Knauss J, Bilker W, Baumgarten M. Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age Ageing. 2003;32(3):259-64. doi: 10.1093/ageing/32.3.259.
• 16. Adıyeke E, Adıyeke L . Neutrophil to lymphocte ratio and mean platelet volume may predict the development of the pressure ulcers. J Surg Med. 2020;4(7):578-81.
• 17. Chamberlain CS, Leiferman EM, Frisch KE, Brickson SL, Murphy WL, Baer GS, et al. Interleukin expression after injury and the effects of interleukin-1 receptor antagonist. PLoS One. 2013;8(8):e71631. doi: 10.1371/journal.pone.0071631.
• 18. Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Interleukin-6 in surgery, trauma, and critical care part II: clinical implications. J Intensive Care Med. 2011;26(2):73-87. doi: 10.1177/0885066610384188.
• 19. MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition. 2000;16(10):983-95.
• 20. Bluestein D, Javaheri A. Pressure ulcers: Prevention, evaluation, and management. Am Fam Physician. 2008;78:1186–94.
• 21. Cox J, Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients. Crit Care Nurse. 2014;34:15–27.
• 22. Crowe T. Nutrition therapy in the prevention and treatment of pressure ulcers. Wound Practice Res. 2009;17:90–9.
• 23. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc. 1993;41(4):357-62. doi: 10.1111/j.1532-5415.1993.tb06940.x.
• 24. Gefen A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage. 2008;54(10):26-8, 30-5. PMID: 18927481.
• 25. Skogestad IJ, Martinsen L, Børsting TE, Granheim TI, Ludvigsen ES, Gay CL, et al. Supplementing the Braden scale for pressure ulcer risk among medical inpatients: the contribution of self-reported symptoms and standard laboratory tests. J Clin Nurs. 2017;26(1-2):202-14. doi: 10.1111/jocn.13438. Epub 2016 Oct 20. PMID: 27322501.
• 26. Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, et al. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care. 2010;19(11):465-6, 468, 470 passim. doi: 10.12968/jowc.2010.19.11.79695.
• 27. Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of Thermal Imaging to Identify Deep-Tissue Pressure Injury on Admission Reduces Clinical and Financial Burdens of Hospital-Acquired Pressure Injuries. Adv Skin Wound Care. 2019;32(7):312-20. doi: 10.1097/01.ASW.0000559613.83195.f9.