Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room

Development of A Surgery-Related Pressure Injury Risk Assessment Scale (SURPIRAS): A Methodological Study

AIM

To develop the Surgery-Related Pressure Injury Risk Assessment Scale (SURPIRAS) and conduct validity and reliability analyses.

DESIGN

A methodological study.

METHODS

Data were collected from 200 patients with "Patient Identification Form", "Postoperative Patient Assessment Form", "SURPIRAS", "Risk Assessment Scale for Injuries Related to Surgical Position (ELPO)" and "Perioperative Pressure Injury Risk Assessment Scale (Munro Scale)". Number, percentage and mean, standard deviation were calculated in descriptive statistics. Intraclass correlation coefficient was used to evaluate the validity and reliability of the scale to determine content validity, criterion-related validity and interobserver agreement. The scale's cut-off point, sensitivity and selectivity values were calculated. The study was prepared according to the STARD publication checklist, following EQUATOR guidelines.

RESULTS

Pressure injuries occurred in 20.5% of the patients. The total score of the SURPIRAS was found to be statistically significant in terms of postoperative pressure injury development. A positive correlation was found between the developed scale and ELPO and Munro Scale. The strength of this correlation is higher between SURPIRAS and Munro Scale. The cut-off point for the SURPIRAS was determined as 27, and patients with a total score of 28 points and above were classified as high risk.

CONCLUSION

It was determined that the SURPIRAS is a valid and reliable measurement tool in determining the risk of pressure injury in surgical patients in the Turkish population.

RELEVANCE TO CLINICAL PRACTICE

The first thing to do to prevent pressure injuries in surgical patients is risk assessment. The study provides a new contribution to the literature because it is the development of a risk assessment scale.

PATIENT OR PUBLIC CONTRIBUTION

Patients were included in the study after being informed about the study before surgery and giving written and verbal consent. Patients were monitored for pressure injury by the researchers after surgery.

The accuracy of the risk assessment scale for pressure ulcers in adult surgical patients: a network meta-analysis

BACKGROUND

This study aims to synthesize existing evidence regarding the accuracy of different scales to assess the risk of intraoperative acquired pressure injury (IAPI), thus providing guidance for the accurate clinical screening of IAPI risk and helping to prevent and reduce the occurrence of IAPI.

METHODS

We searched the following electronic databases to identify relevant studies on scales to assess the risk of IAPIs among adults: PubMed, the Cochrane Library, Embase, Web of Science, CNKI, VIP, the WanFang Database, and the Chinese Biomedical Literature Database. Two authors independently screened the literature, evaluated the quality of the included studies, and extracted the data. The QUADAS-2 tool was used to rate the quality of evidence. ANOVA was performed via Stata and R software to implement diagnostic network meta-analysis via the Bayesian method to evaluate the predictive power of the dominance index.

RESULTS

A total of 24 studies (6721 patients) were included, and the incidence of IAPIs was 12.30% (827/6721). Six IAPI risk assessment tools were used, and their rankings on the basis of the Bayesian dominance index were as follows: the ELPO Scale, 3.12 (95% CI: 0.14, 9); the Norton Scale, 2.63 (95% CI: 0.14, 11); the Waterlow Scale, 2.44 (95% CI: 0.14, 7); the Munro Scale, 2.39 (95% CI: 0.20, 7); the Scott Triggers tool, 1.55 (95% CI: 0.11, 5); and the Braden Scale, 0.36 (95% CI: 0.09, 3).

CONCLUSIONS

We found that the ELPO Scale has good diagnostic test accuracy, and it is recommended that clinical workers prioritize the use of this scale in assessing the risk of pressure injuries among surgical patients, thereby enhancing the effectiveness of risk assessment for pressure injuries among surgical patients.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD42023470664).

Determination the incidence of surgery related pressure injury and to examine the effects of risk factors on pressure injury formation

Surgical patients are at risk for pressure injuries throughout the entire surgical process. Prevalence and incidence studies are critical to determine risk groups in surgical patient groups. This study was conducted to determine the incidence of pressure injury development in patients hospitalized in surgical clinics and to examine the effects of risk factors on it. The sample of this descriptive study consisted of 138 patients hospitalized in surgical wards. Data collection tools included a patient information questionnaire, The National Pressure Injury Advisory Panel (NPIAP) Pressure Injury and Stages Form, and the Munro Perioperative Pressure Ulcer Risk Assessment Scale. Data were analyzed on the SPSS 24.0 software package by using descriptive statistical tests such as frequency and percentage distribution, chi-square test, independent groups t-test, and univariate logistic regression analysis. The incidence of surgery-related pressure injuries was found to be 18.8 %. Patients' mean scores on the Munro scale were 10.23 ±0 .2.95 before surgery, 12.80 ± 2.57 during surgery, and 23.03 ± 5.07 following surgery, with the mean total score being 24.47 ± 5.44. The mean score on the total Munro scale was statistically significantly higher in patients who developed pressure injuries than in those who did not. Patients' age, blood albumin level, body mass index, presence of oedema, use of medical equipment, mobility status, type of anaesthesia used in surgery, and duration of surgery were determined as effective risk factors in pressure injury development. In conclusion, it was found that pressure injuries developed at a considerable rate in patients undergoing surgical operations. It is recommended that surgical nurses should take the necessary precautions in time.

Incidence and Risk Factors for Perioperative Pressure Injuries: Prospective Descriptive Study

PURPOSE

Pressure injuries can often occur in patients undergoing surgical, diagnostic, or other invasive procedures, so it is important to assess patients in the perioperative period. This study was conducted to determine the incidence and risk factors of perioperative pressure injury.

DESIGN

A cross-sectional, prospective, and descriptive study.

METHODS

This study involved 158 patients who met the study's eligibility criteria between May 2022 and July 2022. The data were collected using the Patient Information Form, Munro Scale, Braden Scale, and pressure injury staging form. The patients were monitored postoperatively or for 3 days.

FINDINGS

Pressure injury developed in 13.9% of the patients. Perioperative risk factors were age, edema, mobilization time, parenteral nutrition, blood transfusion, and glucose level, while preoperative albumin level was lower in patients with pressure injury. In the postoperative period, the risk factors were duration of mobilization and transition to oral feeding, length of intensive care unit stay, and low Braden score. In multivariate analysis, the variables that showed significance with the risk of pressure injury were postoperative Munro score and edema.

CONCLUSIONS

It is crucial to evaluate the risk factors for pressure injury in patients who have undergone surgical procedures.

Association between hypertension and pressure ulcer: A systematic review and meta-analysis

This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were searched for studies from their inception until September 12, 2023. Literature search, data extraction, and quality assessment were conducted independently by two researchers. The random-effects model was used to calculate the combined odds ratio (OR) and corresponding 95% confidence interval (CI) of hypertension in patients with PU; subgroup analyses were performed to explore the source of between-study heterogeneity; sensitivity analysis was used to test the robust of the combined result; and funnel plot and Egger's test were used to assess the publication bias. Finally, a total of 19 studies with 564 716 subjects were included; the overall pooled result showed no significant association between hypertension and risk of developing PU (OR = 1.15, 95% CI = 0.90-1.47, p = 0.27); and the sensitivity analysis and publication bias analysis showed robust of the combined result. Subgroup analysis indicated a significant association between hypertension and PU when the primary disease was COVID-19 (OR = 1.73, 95% CI = 1.35-2.22, p < 0.0001). No association between hypertension and PU was seen in subgroup analysis on the patient source and study design. In sum, there is no significantly statistical association between hypertension and the occurrence of PU in most cases, while the risk of PU significantly elevates among COVID-19 patients combined with hypertension regardless of patient source and study design.

A nomogram to predict the risk of surgery-related pressure ulcers in patients undergoing cardiovascular surgery

OBJECTIVE

In this study, we aimed to establish a new nomogram score to predict the occurrence of surgery-related pressure ulcers (SRPU) in patients undergoing cardiovascular surgery.

METHODS

We conducted a retrospective study among patients who underwent cardiovascular surgery between February 2016 and November 2020.

RESULTS

We established a prediction model based on a logistic regression model and tested the calibration and discrimination. We included 1163 patients who had undergone cardiovascular surgery. We formulated the logistic regression model, with Logit(P) = -11.745 + 0.024 preoperative hemoglobin value + 0.118 serum sodium value - 0.014 prealbumin value - 0.213 intraoperative mean temperature - 0.058 minimum mean arterial pressure + 0.646 preoperative blood potassium value + 0.264 smoking frequency + 0.760 hypertension history + 0.536 age ≥70 years. In this model ,"+" indicates that the factor is positively related to the occurrence risk of SRPU and "-" indicates that the factor is negatively associated with SRPU risk. The predictive model and nomogram had good accuracy in estimating the risk of SRPU, with a C-index of 0.755 (95% confidence interval: 0.719-0.792).

CONCLUSIONS

The present model can be used to effectively screen patients with a high risk of SRPU to devise targeted nursing intervention strategies and ultimately reduce the incidence rate of SRPU.

Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project

INTRODUCTION

The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning.

METHODS

We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding.

RESULTS

There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented.

CONCLUSION

This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

Comparison of four risk assessment scales in predicting the risk of intraoperative acquired pressure injury in adult surgical patients: a prospective study

OBJECTIVE

To develop and compare four predictive models for intraoperative acquired pressure injury (IAPI) in surgical patients.

METHODS

One hundred patients undergoing various surgeries (hepatobiliary, pancreas, spleen, gastrointestinal, and cardiac surgeries) at Ruijin Hospital from November 2021 to September 2022 were included in this prospective cohort study. Four pressure injury risk assessment scales were used to measure the pressure injury risk: the Braden scale, Munro Pressure Injury Risk Assessment Scale, Scott Triggers tool, and CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale. The patients were divided into the IAPI group and non-IAPI group.

RESULTS

In total, 37% of patients (37/100) developed class I/stage pressure injury (erythema) after surgery, which resolved within 2 hours after surgery in 86.49% of cases and further progressed to class II/stage or higher pressure injury within 6 days in 15.63% of cases. The application effects of the four commonly used risk assessment tools were compared with the sensitivity, specificity, and area under the receiver operating characteristic curve. The Munro Scale showed the best sensitivity and area under the receiver operating characteristic curve among the four tools for postoperative assessment, but its specificity was only 20.63.

CONCLUSIONS

More appropriate assessment tools are required for IAPI risk evaluation.

Assessment of the risk factors for intraoperative pressure injuries in patients

AIM

This study was conducted to assess the risk factors for pressure injuries in patients during surgery.

METHODS

In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS).

RESULTS

The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05).

CONCLUSIONS

According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

The prediction model for intraoperatively acquired pressure injuries in orthopedics based on the new risk factors: a real-world prospective observational, cross-sectional study

Introduction: Orthopedic patients are at high risk for intraoperatively acquired pressure injuries (IAPI), which cause a serious issue and lead to high-expense burden in patient care. However, there are currently no clinically available scales or models to assess IAPI associated with orthopedic surgery. Methods: In this real-world, prospective observational, cross-sectional study, we identified pressure injuries (PI)-related risk factors using a systematic review approach and clinical practice experience. We then prepared a real-world cohort to identify and confirm risk factors using multiple modalities. We successfully identified new risk factors while constructing a predictive model for PI in orthopedic surgery. Results: We included 28 orthopedic intraoperative PI risk factors from previous studies and clinical practice. A total of 422 real-world cases were also included, and three independent risk factors-preoperative limb activity, intraoperative wetting of the compressed tissue, and duration of surgery-were successfully identified using chi-squared tests and logistic regression. Finally, the three independent risk factors were successfully used to construct a nomogram clinical prediction model with good predictive validity (area under the ROC curve = 0.77), which is expected to benefit clinical patients. Conclusion: In conclusion, we successfully identified new independent risk factors for IAPI-related injury in orthopedic patients and developed a clinical prediction model to serve as an important complement to existing scales and provide additional benefits to patients. Our study also suggests that a single measure is not sufficient for the prevention of IAPI in orthopedic surgery patients and that a combination of measures may be required for the effective prevention of IAPI.