Investigation of Pressure Injury Risk and Affecting Factors in Patients Undergoing Surgical Intervention

Yıl 2024, Cilt: 7 Sayı: 3, 655 - 666, 01.12.2024

Tülay Kılınç , Zeynep Karaman Özlü , Ayşegül Yayla , Nurhan Bağaçlı

https://doi.org/10.38108/ouhcd.1370576

Öz

Objective: The aim of this study was to examination the risk of pressure injury and the factors affecting in patients undergoing surgical intervention.
Methods: The descriptive study was conducted in the operating room department of a university hospital between July and December 2022. The study was completed with 400 patients. "Patient Information Form" and "3S Intraoperative Pressure Injury Risk Assessment Scale" were used to collect the data. The data were evaluated using descriptive statistics (percentage, mean, number, etc.), Mann-Whitney U, Kruskal-Wallis, pearson correlation analysis and multiple linear regression analysis.
Results: The study determined that the mean score of the 3S Intraoperative Pressure Injury Risk Assessment Scale was 15.66±4.21; the risk of pressure injury was 8,5%. Age (β=0.052), BMI (β=0.153), steroid use (β=1.580), intraoperative blood loss status (β=2.470.), intraoperative hypotension development status (β=1.470), intraoperative hypothermia development status (β=2.988), operative time (β=5.164), preoperative albumin (β=-0.435) and blood glucose (β=0.011) levels were found to be statistically significant risk factors for the development of pressure injury (p < 0.05).
Conclusion: In the study, it was determined that the risk of pressure injury was low in surgical patients. Some sociodemographic characteristics, the use of steroid drugs, the level of albumin and blood glucose before surgery, blood loss during surgery, hypotension and the development of hypothermia were found to be factors affecting pressure injury. In addition, it was concluded that the most important factor affecting the development of pressure injury was the operation's duration was longer than 6 hours.

Anahtar Kelimeler

Operating room, Pressure injury, Surgical intervention, Nurse

Cerrahi Girişim Uygulanan Hastalarda Basınç Yaralanması Riski ve Etkileyen Faktörlerin İncelenmesi

Öz

Amaç: Araştırma cerrahi girişim uygulanan hastalarda basınç yaralanması riski ve etkileyen faktörlerin incelenmesi amacıyla yapılmıştır.
Yöntem: Tanımlayıcı nitelikte tasarlanan araştırma Temmuz-Aralık 2022 tarihleri arasında bir üniversite hastanesinin ameliyathane bölümünde yürütülmüştür. Araştırma 400 hasta ile tamamlanmıştır. Verilerin toplanmasında “Hasta Bilgi Formu” ve “3S Ameliyathane Basınç Yarası Risk Tanılama Ölçeği” kullanılmıştır. Veriler tanımlayıcı istatistikler (yüzde, ortalama, sayı vb), Mann-Whitney U, Kruskal-Wallis, pearson korelasyon analizi ve çoklu doğrusal regresyon analizi kullanılarak değerlendirilmiştir.
Bulgular: Araştırmada hastaların 3S Ameliyathane Basınç Yarası Risk Tanılama Ölçeği toplam puan ortalamasının 15.66±4.21; basınç yaralanması riskinin %8.5 olduğu belirlenmiştir. Yaş (β=0.052), BKI (β=0.153), steroid kullanımı (β=1.580), ameliyat sırası kan kaybı gelişme durumu (β=2.470.), ameliyat sırası hipotansiyon gelişme durumu (β=1.470), ameliyat sırası hipotermi gelişme durumu (β=2.988), ameliyat süresi (β=5.164), ameliyat öncesi albümin (β=-0.435) ve kan glukoz (β=0.011) düzeyinin basınç yaralanması gelişimi için istatistiksel olarak anlamlı risk faktörleri olduğu saptanmıştır (p < 0.05).
Sonuç: Araştırmada cerrahi hastalarında basınç yaralanması riskinin düşük olduğu belirlenmiştir. Bazı sosyodemografik özellikler, steroid ilaç kullanımı, ameliyat öncesi albümin ve kan glukoz düzeyi, ameliyat sırasında kan kaybı, hipotansiyon ve hipotermi gelişiminin basınç yaralanmasını etkileyen faktörler olduğu saptanmıştır. Ayrıca basınç yaralanması gelişimini etkileyen en önemli faktörün ameliyatın süresinin 6 saatten uzun olması sonucuna varılmıştır.

Anahtar Kelimeler

Ameliyathane, Basınç yaralanması, Cerrahi girişim, Hemşire

Kaynakça

• Akarsu Ayazoğlu T, Karahan A, Gun Y, Onk D. (2018). Determination of risk factors in the development and prevalence of pressure sores in patients hospitalized in a cardiovascular and thoracic surgery intensive care unit. Eurasian Journal of Medicine and Investigation, 2(1), 12-17. https://doi.org/10.14744/ejmi.2017.43153
• Akın N, Karahan E. (2020). Noninvaziv mekanik ventilasyon desteği alan hastalarda yüz bölgesindeki basınç yarası gelişme sıklığı ve oluşumunu etkileyen faktörlerin incelenmesi. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 6(1), 45-52. https://doi.org/ 10.30934/kusbed.637851
• Aloweni F, Ang SY, Fook Chong S, Agus N, Yong P, Goh MM ve ark. (2019). A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. International Wound Journal, 16(1), 164-75. https://doi.org/10.1111/iwj.13007
• Association of Perioperative Registered Nurses. (2016). Position statement on perioperative pressure ulcer prevention in the care of the surgical patient. AORN Journal, 104(5), 437-438. https://doi.org/10.1016/ J.AORN.2016.08.011
• Bly D, Schallom M, Sona C, Klinkenberg D. (2016). A model of pressure, oxygenation, and perfusion risk factors for pressure ulcers in the intensive care unit. Amerıcan Journal of Critical Care, 25(2), 156-164. https://doi.org/10.4037/ajcc2016840
• Bulfone G, Bressan V, Morandini A, Stevanin S. (2018). Perioperative pressure injuries: a systematic literature review. Advances in Skin & Wound Care, 31(12), 556-564. https://doi.org/10.1097/01.ASW.00005446 13.10878.ed
• Chello C, Lusini M, Schilirò D, Greco SM, Barbato R, Nenna A. (2019). Pressure ulcers in cardiac surgery: Few clinical studies, difficult risk assessment, and profound clinical implications. International Wound Journal, 16(1), 9-12. https://doi.org/10.1111/iwj.129 94
• Chen CY, Chiang IH, Ou KL, Chiu Y, Liu H, Chang C ve ark. (2020). Surgical treatment and strategy in patients with pressure sores: a single-surgeon experience. Medicine, 99(44), e23022. https://doi.org/10.1097/MD.0000000000023022
• Chen HL, Shen WQ, Xu YH, Zhang Q, Wu J. (2015). Perioperative corticosteroids administration as a risk factor for pressure ulcers in cardiovascular surgical patients: a retrospective study. International Wound Journal, 12(5), 581-585. https://doi.org/10.1111/iwj. 12168
• Chen HL, Chen XY, Wu J. (2012). The incidence of pressure ulcers in surgical patients of the last 5 years: A systematic review. Wounds : a Compendium of Clinical Research and Practice, 24(9), 234-241.
• Çelik B, Karayurt Ö, Öğce F. (2019). The effect of selected risk factors on perioperative pressure injury development. AORN Journal, 110(1), 29–38. https://doi.org/0.1002/aorn.12725.PMID:31246295
• Eberhardt TD, Lima SBS, Avila Soares RS, Dutra Siveria ABT, Pozzebon BR, Reis CR ve ark. (2020). Prevention of pressure injury in the operating room:Heels operating room pressure injury trial. International Wound Journal, 17(7), 1-8. https://doi.org/10.1111/iwj.13538
• Edsberg LE, Langemo D, Baharestani MM, Posthauer ME, Goldberg M. (2014). Unavoidable pressure ınjury state of the science and consensus outcomes. Journal of Wound Ostomy & Continence Nursing, 41(4), 313-334. https://doi.org/10.1097/WON. 0000000000000050
• Fernandes LM, Silva L, Oliveira JLC, Souza vS, Nicola AL. (2016). Association between pressure injury prediction and biochemical markers. Rev Rene, 17(4), 490-497.
• Gao L, Yang L, Li X, Chen J, Du J, Bai X, Yang X. (2018). The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer. Journal of Clinical Nursing, 27(15-16), 2984-92. https://doi.org/10.1111/jocn.14491
• Gao XL, Hu JJ, Ma Q, Wu HY, Wang ZY, Li TT ve ark. (2015). Design and research on reliability-validity for 3S intraoperative risk assessment scale of pressure sore. Journal of Huazhong University of Science and Technology [Medical Sciences], 35(2), 291-294. https://doi.org/10.1007/s11596-015-1426-1
• Gefen Amit. (2020). Minimising the risk for pressure ulcers in the operating room using a specialised low-profile alternating pressure overlay. Wounds International, 11(2), 10-16.
• Gül A. (2023). Ameliyat kaynaklı basınç yaralanmalarının önlenmesi. Gürkan A, editör. Cerrahi Hemşireliğinde Bakımı Duyarlı Kalite Göstergeleri. Ankara: Türkiye Klinikleri, s. 27-34.
• Haisley M, Sørensen JA, Sollie M. (2020). Postoperative pressure injuries in adults having surgery under general anesthesia: Systematic review of perioperative risk factors. British Journal of Surgery, 107(4), 338-47. https://doi.org/10.1002/bjs.11448
• Huang W, Zhu Y, Qu H. (2018). Use of an alternating inflatable head pad inpatients undergoing open heart surgery. Medical Science Monitor, 24:970-6. https://doi.org/10.12659/MSM.906018
• İlkhan E, Sucu Dağ G. (2023). The incidence and risk factors of pressure injuries in surgical patients. Journal of Tissue Viability, 32(3), 383-388. https://doi.org/10.1016/j.jtv.2023.06.004
• İpek B, Sayın Y. (2022). Intraoperative pressure injury and risk factors in long-term surgical interventions. Journal of Human Sciences, 19(3), 474-487. https://doi.org/10.14687/jhs.v19i3.6300
• Kandemir D, Temiz Z, Aydın A, Yayla F, Özhanlı Y, Ayoğlu T. (2022). Determination of incidence and risk factors of perioperative pressure ınjury in surgical patients: A descriptive, prospective, and comparative study. Turkiye Klinikleri Journal of Nursing Sciences, 14(2), 296-303. https://doi.org/10.5336/nurses.2021-84832
• Kandemir D, Yüksel S. (2021). Ameliyat kaynaklı basınç yaralanmalarını önlemede etkili kanıt temelli girişimler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 8(1), 85-92. https://doi.org/ 10.31125/hunhemsire.907916
• Karahan E, Uslu Ayri A, Çelik S. (2022). Evaluation of pressure ulcer risk and development in operating rooms. Journal of Tissue Viability, 4(31), 707-713. https://doi.org/10.1016/j.jtv.2022.09.001
• Kim JM, Lee H, Ha T, Na S. (2018). Perioperative factors associated with pressure ulcer development after major surgery. Korean Journal of Anesthesiology, 71(1), 48-56. https://doi.org/10.4097/kjae.2018.71.1. 48
• Kimsey DB. (2019). A Change in focus: shifting from treatment to prevention of perioperative pressure injuries. AORN Journal, 110(4), 379-393. https://doi.org/10.1002/aorn.12806
• Lei L, Zhou T, Xu X, Wang L. (2022). Munro pressure ulcer risk assessment scale in adult patients undergoing general anesthesia in the operating room. Journal of Healthcare Engineering, 4157803, 1-6. https://doi.org/10.1155/2022/4157803
• Liao F, Burns S, Jan YK. (2013). Skin blood flow dynamics and its role in pressure ulcers. Journal of Tissue Viability, 22, 25–36.https://doi.org/10.1016/ j.jtv.2013.03.001
• Menezes S, Rodrigues R, Tranquada R, Muller S, Gama K, Manso T. (2013). Lesões decorrentes do posicionamento para cirurgia: incidência e fatores de risco. Acta Médica Portuguesa, 26(1), 12-6. https://doi.org/10.20344/amp.4006
• Mishu MC, Schroeder JW. (2015). Modeling of pressure ulcer (PU) risk prediction system. In 2015 Science and Information Conference (SAI), 650-656. https://doi.org/10.1109/SKS.2015.7237211
• O’Brien DD, Shanks AM, Talsma A, Brenner PS, Ramachandran SK. (2014). Intraoperative risk factors associated with postoperative pressure ulcers in critically ill patients: A retrospective observational study. Critical Care Medicine, 42(1), 40-47. https://doi.org/10.1097/CCM.0b013e318298a849
• Peixoto C de A, Ferreira MBG, Felix MMDS, Pires P da S, Barichello E, Barbosa MH. (2019). Risk assessment for perioperative pressure injuries. Revista Latino-americana de Enfermagem, 27:e3117. https://doi:10.1590/1518-8345.2677-3117
• Rao AD, Preston AM, Strauss R, Stamm R, Zalman DC. (2016). Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients: a systematic review. Journal of Wound, Ostomy and Continence Nursing, 43(3), 242-247. https://doi.org/ 10.1097/WON.0000000000000224
• Soyer O, Özbayır T. (2018). 3S ameliyathane basınç yarası risk tanılama ölçeğinin Türkçe’ye uyarlanması. Uluslararası Hakemli Hemşirelik Araştırmaları Dergisi, 3, 46-64. https://doi.org/10.17371/UHD. 2018.2.9
• Spruce L. (2017). Back to basics: Preventing perioperative pressure ınjuries. AORN Journal, 105(1), 92-99. https://doi.org/10.1016/j.aorn.2016.10. 018
• Suh D, Kim SY, Yoo B, Lee S. (2021). An exploratory study of risk factors for pressure injury in patients undergoing spine surgery. Anesthesia and Pain Medicine, 16(1), 108-115. https://doi.org/10.17085/ apm.20081
• Tura İ, Arslan S, Türkmen A, Erden S. (2023). Assessment of the risk factors for intraoperative pressure injuries in patients. Journal of Tissue Viability, 32, 349–354. https://doi.org/10.1016/j.jtv. 2023.04.006
• VanGilder C, MacFarlane G, Meyer S, Lachenbruch C. (2009). Body mass index, weight, and pressure ulcer prevalence: An analysis of the 2006–2007 International Pressure Ulcer Prevalence Surveys. Journal of Nursing Care Quality, 24(2), 127-135. https://doi.org/10.1097/01.NCQ.0000347449.83052.1a
• Webster J, Lister C, Corry J, Holland M, Coleman K, Marquart L. (2015). Incidence and risk factors for surgically acquired pressure ulcers: A prospective cohort study investigators. Journal of Wound, Ostomy and Continence Nursing, 42(2), 138-44. https://doi.org/10.1097/WON.0000000000000092
• Weng PW, Chang WP. (2023). Extrinsic factors of pressure injuries in patients during surgery: A frequency matched retrospective study. International Wound Journal, 20, 1934-1942. https://doi.org/ 10.1111/iwj.14053
• Xiong C, Gao X, Ma Q, Yang Y, Wang Z, Yu W ve ark. (2019). Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: A retrospective study. Journal of Clinical Nursing, 28(7-8), 1148-55. https://doi.org/10.1111/jocn.14712
• Yoshimura M, Ohura N, Santamaria N, Watanabe Y, Akizuki T, Gefen A. (2020). 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. International Wound Journal, 17(3), 660-669. https://doi.org/10.1111/iwj.13287
• Yoshimura M, Nakagami G, Iizaka S, Yoshida M, Uehata Y, Kohno M ve ark. (2015). 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 and Regeneration, 23(6), 939-947. https://doi.org/10.1111/wrr.12340