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The Incidence of Pressure Ulcers in Surgical Patients of the Last 5 Years: A Systematic Review

Hong-Lin Chen; Xiao-Yan Chen; Juan Wu

Index: WOUNDS. 2012;24(9):234–241.

  Abstract: This systematic review looks at the incidence of pressure ulcers in surgical patients of the last 5 years. Methods. The authors searched Pubmed and Web of Science for studies published after 2005. Screening and data abstraction were performed independently by 2 reviewers. Results. Seventeen studies (5,451 patients) met the inclusion criteria. The incidence of surgery-related pressure ulcers ranged from 0.003 to 0.574. The pooled incidence was 0.15 (95% CI 0.14-0.16, I² = 98.2%). For cardiac surgery, hip fracture surgery, and patients on the surgical intensive care unit, the pooled incidence was 0.18 (95% CI 0.14-0.22, I² = 62.8%), 0.22 (95% CI 0.20-0.24, I²= 98.4%), and 0.11 (95% CI 0.09-0.13, I² = 98.5%), respectively. Conclusion. The data on the incidence of surgery-related pressure ulcers indicates that appropriate monitoring and treatment need to be performed.

Introduction

  Pressure ulcers are a common problem for patients, causing significant pain and additional costs. Many studies have investigated the incidence and the prevalence of pressure ulcers. The incidence of pressure ulcers is 0.4% to 38%; within long-term care, 2.2% to 23.9%; and in home care, 0% to 17%.^1-2

  Patients undergoing an operation are prone to develop pressure ulcers during the procedure.³ It has been accepted that pressure ulcers are caused by 3 different tissue forces: pressure, shear force, and friction, all of which have an important role in the occurrence of surgery-related pressure ulcers. Contributing factors to the incidence of surgery-related pressure ulcers include the fact that during surgery, patients are immobile, and not able to feel pain caused by prolonged pressure on the operating table; the use of anesthetic agents can cause a loss of muscle tone that increases pressure over bony prominences; and prolonged pressure causes decreased perfusion, leading to ischemia and tissue necrosis. In addition, shearing and friction injury can occur as patients are repositioned on tables then transported. Shear force can cause the pinching off of blood vessels, which may aggravate ischemia and tissue necrosis, and friction may cause excess shedding of layers of epidermis. Some cardiac surgery patients have to use intra-aortic balloon pumps postoperatively; movement is not allowed when these are in use. This combination of factors may cause surgery-related pressure ulcers, which exhibit some different epidemiological characteristics compared with general pressure ulcers.

  In 1999, a national survey on 104 usable facilities with a total of 1,128 surgical patients showed the overall incidence based on a beta binomial was 8.5% (95% confidence interval: 6.1% to 10.9%).⁴ But after that, there wasn’t a large-scale survey to show the incidence of surgery-related pressure ulcers.

  Over the past decade, pressure ulcer prevention and treatment strategies have changed as many new methods are emerging. The objective of this systematic review was to describe the incidence of surgery-related pressure ulcers reported in prospective longitudinal studies of the last 5 years.

Methods

  Data sources and search strategy. The authors searched Pubmed and Web of Science databases.