Risk factors of intraoperative acquired pressure injury: A systematic review and meta-analysis

doi:10.3969/j.issn.1004-583X.2022.03.003

Abstract

Abstract:

Objective To systematically identify the risk factors of intraoperative acquired pressure injury(IAPI) to provide a basis for the prevention IAPI. Methods A systematic search regarding to IAPI risk factors in PubMed, Web of Science, Cochrane library, OVID, EMBASE, Chinese Biomedical Database(CBM), China National Knowledge Infrastructure(CNKI), Wanfang Data from January 2000 to July 2019 was performed to collect from January 2000 to July 2019. According to the criterias for inclusion and exclusion, screening eligible literature and data, evaluating the quality of included studies were all conducted by independent two reviewers, and using RevMan5.3 and Stata15 for a Meta-analysis. Results Totally 22 studies were recruited, including 267, 152 cases. In the Mate-analysis, 13 risk factors were involved, among which age, gender, body mass index(BMI)<23 kg/m², operation duration, low preoperative Braden score, lateral position, supine position were the main risk factors for IAPI. Conclusion The older age, BMI <23 kg/m², lower preoperative Braden score, longer operative duration are related to higher risk for IAPI female patients. Presently, because of insufficient evidence on risk factors of IAPI among patients and sample size of each study varied greatly, the effects of gender, comorbidities, operation position, intraoperative special medication, cardiopulmonary bypass, intraoperative hypotensive episodes are still inconclusive, and more high-quality studies are needed to supplement and improve for future research.

Key words: wounds and injuries, risk factors, systematic review, meta-analysis

CLC Number:

R649.9

Song Siping, Jiang Qixia, Liu Xiaoqing. Risk factors of intraoperative acquired pressure injury: A systematic review and meta-analysis[J]. Clinical Focus, 2022, 37(3): 211-219.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.03.003

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I3/211

Figures/Tables 20

References 37

[1]	National Pressure Ulcer Advisory Panel. NPUAP pressure injury stages[EB/OL].(2016-04-08)[2019-06-24]. https://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/.
[2]	Nilsson UG. Intraoperative positioning of patients under general anesthesia and the risk of postoperative pain and pressure ulcers[J]. J Perianesth Nurs, 2013, 28(3):137-143. doi: 10.1016/j.jopan.2012.09.006 pmid: 23711309
[3]	蒋琪霞, 苗素琴, 陈文芳, 等. 手术获得性压力性损伤流行特征和危险评估新进展[J]. 医学研究生学报, 2019, 32(8):882-885.
[4]	Bulfone G, Marzoli I, Quattrin R, et al. A longitudinal study of the incidence of pressure sores and the associated risks and strategies adopted in Italian operating theatres[J]. J Perioper Pract, 2012, 2(2):50-56.
[5]	戴靖华. 手术患者术中压疮发生危险因素的Meta分析[J]. 中国药物与临床, 2017, 17(3):443-446.
[6]	马红利, 袁晓华, 张文敏, 等. 术中压疮影响因素的Meta分析[J]. 重庆医学, 2016, 45(31):4389-4392.
[7]	李玉, 杨敏萍, 吕忠容, 等. 我国手术病人术中获得性压疮影响因素Meta分析[J]. 全科护理, 2019, 17(6):645-647.
[8]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. doi: 10.1007/s10654-010-9491-z URL
[9]	Aloweni F, Ang SY, Fook-Chong S, et al. A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score[J]. Int Wound J, 2019, 16(1):164-175. doi: 10.1111/iwj.13007 pmid: 30289624
[10]	Chen Y, He L, Qu W, et al. Predictors of intraoperative pressure injury in patients undergoing major hepatobiliary surgery[J]. J Wound Ostomy Continence Nurs, 2017, 44(5):445-449. doi: 10.1097/WON.0000000000000356 URL
[11]	Engels D, Austin M, Mcnichol L, et al. Pressure ulcers: Factors contributing to their development in the OR[J]. AORN J, 2016, 103(3):271-281. doi: 10.1016/j.aorn.2016.01.008 pmid: 26924365
[12]	Fu Shaw L, Chang P, Lee J, et al. Incidence and predicted risk factors of pressure ulcers in surgical patients: Experience at a medical center in Taipei, Taiwan[J]. Biomed Res Int, 2014, 2014:416896.
[13]	Gao L, Yang L, Li X, et al. The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer[J]. J Clin Nurs, 2018, 27(15-16):2984-2992. doi: 10.1111/jocn.2018.27.issue-15pt16 URL
[14]	Gardiner JC, Reed PL, Bonner JD, et al. Incidence of hospital-acquired pressure ulcers-a population-based cohort study[J]. Int Wound J, 2016, 13(5):809-820. doi: 10.1111/iwj.12386 pmid: 25469585
[15]	Huang W, Zhu Y, Qu H. Use of an alternating inflatable head pad inpatients undergoing open heart surgery[J]. Med Sci Monit, 2018, 24:970-976. doi: 10.12659/MSM.906018 URL
[16]	Kim JM, Lee H, Ha T, et al. Perioperative factors associated with pressure ulcer development after major surgery[J]. Korean J Anesthesiol, 2018, 71(1):48. doi: 10.4097/kjae.2018.71.1.48 URL
[17]	Kumta N, Coyer F, David M. Perioperative factors and pressure ulcer development in postoperative ICU patients: A retrospective review[J]. J Wound Care, 2018, 27(8):475-485. doi: 10.12968/jowc.2018.27.8.475 pmid: 30086257
[18]	Lu CX, Chen HL, Shen WQ, et al. A new nomogram score for predicting surgery-related pressure ulcers in cardiovascular surgical patients[J]. Int Wound J, 2017, 14(1):226-232. doi: 10.1111/iwj.2017.14.issue-1 URL
[19]	O'Brien DD, Shanks AM, Talsma A, et al. Intraoperative risk factors associated with postoperative pressure ulcers in critically ill patients: A retrospective observational study[J]. Crit Care Med, 2014, 42(1):40-47. doi: 10.1097/CCM.0b013e318298a849 pmid: 23982023
[20]	Peixoto CA, Ferreira MBG, Felix MMDS, et al. Risk assessment for perioperative pressure injuries[J]. Rev Lat Am Enfermagem, 2019, 27 :e3117. doi: 10.1590/1518-8345.2677-3117 URL
[21]	Primiano M, Friend M, Mcclure C, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures[J]. AORN J, 2011, 94(6):555-566. doi: 10.1016/j.aorn.2011.03.014 pmid: 22118201
[22]	Tschannen D, Bates O, Talsma A, et al. Patient-specific and surgical characteristics in the development of pressure ulcers[J]. Am J Crit Care, 2012, 21(2):116-125. doi: 10.4037/ajcc2012716 pmid: 22381988
[23]	Wright KM, Van Netten Y, Dorrington CA, et al. Pressure injury can occur in patients undergoing prolonged head and neck surgery[J]. J Oral Maxillofac Surg, 2014, 72(10):2060-2065. doi: 10.1016/j.joms.2014.04.018 URL
[24]	陈青. 手术室老年患者术中压疮危险因素及护理人员压疮认知调查[J]. 中国现代医生, 2013, 51(30):15-17.
[25]	陈沅, 吴蓓雯, 钱蒨健, 等. 成人心血管手术压疮高危预测模型的建立与验证[J]. 护理学杂志, 2019, 34(10):52-54.
[26]	陈哲颖, 吴晓蓉, 吴梦媛. 术中获得性压力性损伤发生的影响因素分析[J]. 中国护理管理, 2019, 19(1):43-48.
[27]	胡娟娟, 高兴莲, 杨英, 等. 手术患者手术压疮高危因素的多中心研究[J]. 护理学杂志, 2018, 33(16):11-14.
[28]	蒋琪霞, 瞿小龙, 郭秀君, 等. 手术患者压疮发生率及发生时间和影响因素研究[J]. 中国护理管理, 2013, 13(9):25-28.
[29]	李凤玲, 吴晓燕, 张丽娟. 预测骨折手术患者并发术中压疮风险的列线图模型的建立[J]. 中国实用护理杂志, 2018, 34(4):279-283.
[30]	宋文静, 管晓萍, 李蓉, 等. 成人开颅手术压疮的风险因素研究[J]. 中国全科医学, 2015, 18(11):1270-1273. doi: 10.3969/j.issn.1007-9572.2015.11.010
[31]	童琍琍, 赵梅, 杨玉英, 等. 汉化版Munro成人手术室压疮风险评估表在全身麻醉手术中的应用研究[J]. 重庆医学, 2018, 47(10):1336-1339.
[32]	Liang M, Chen Q, Zhang Y, et al. Impact of diabetes on the risk of bedsore in patients undergoing surgery: An updated quantitative analysis of cohort studies[J]. Oncotarget, 2017, 8(9):14516-14524. doi: 10.18632/oncotarget.v8i9 URL
[33]	Lumbley JL, Ali SA, Tchokouani LS. Retrospective review of predisposing factors for intraoperative pressure ulcer development[J]. J Clin Anesth, 2014, 26(5):368-374. doi: 10.1016/j.jclinane.2014.01.012 pmid: 25113424
[34]	Shafipour V, Ramezanpour E, Gorji MA, et al. Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis[J]. Electron Physician, 2016, 8(11):3170-3176. doi: 10.19082/3170 URL
[35]	Kirkland-Walsh H, Teleten O, Wilson M, et al. Pressure mapping comparison of four or surfaces[J]. AORN J, 2015, 102(1):61.
[36]	Hayes RM, Spear ME, Lee SI, et al. Relationship between time in the operating room and incident pressure ulcers: A matched case-control study[J]. Am J Med Qual, 2015, 30(6):591-597. doi: 10.1177/1062860614545125 URL
[37]	郭月, 余云红, 赵体玉. 手术室患者压疮临床特点的回顾性分析[J]. 护理学杂志, 2014, 29(24):36-39.

纳入研究	发表年份	地区	研究类型	研究对象	样本量(例)			质量评价 (分)
纳入研究	发表年份	地区	研究类型	研究对象	例数	压疮组	非压疮组	质量评价 (分)
Aloweni et al	2019	新加坡	病例对照	-	269	80	189	8
Chen et al	2017	中国	病例对照	肝脏手术	803	159	644	6
Engels et al	2016	美国	病例对照	-	60	15	45	5
Gao et al	2018	中国	队列	神外、骨科、心胸外科等	1 940	48	1 892	7
Gardiner et al	2014	美国	病例对照	-	242 745	6 505	236 280	8
Huang et al	2018	中国	队列	心脏外科	120	60	60	5
Kim et al	2017	韩国	病例对照	外科ICU	129	43	86	6
Kumta et al	2018	澳大利亚	病例对照	外科ICU	3 484	69	3 415	7
Lu et al	2016	中国	病例对照	心脏手术	149	37	112	6
O'Brien et al	2014	美国	病例对照	外科ICU	2 695	288	2 407	8
Peixoto et al	2019	巴西	队列	-	278	157	121	4
Primiano et al	2011	美国	队列	-	258	21	237	6
Shaw et al	2014	中国台湾	队列	心胸外、骨科、普外等	297	44	253	5
Tschannen et al	2012	美国	队列	-	3 225	383	2 842	6
Wright et al	2014	澳大利亚	队列	头颈手术	88	13	75	6
陈青等	2013	中国	病例对照	老年患者	1 193	185	1 008	5
陈沅等	2019	中国	病例对照	心血管手术	1 163	231	932	7
陈哲颖等	2019	中国	队列	-	610	121	489	7
胡娟娟等	2018	中国	队列	-	2 652	202	2 450	5
蒋琪霞等	2013	中国	队列	-	1 074	11	1 063	6
李凤玲等	2018	中国	病例对照	骨折手术	3 796	392	3 404	5
宋文静等	2015	中国	病例对照	神经外科	124	56	68	7

纳入研究	发表年份	地区	研究类型	研究对象	样本量(例)			质量评价 (分)
纳入研究	发表年份	地区	研究类型	研究对象	例数	压疮组	非压疮组	质量评价 (分)
Aloweni et al	2019	新加坡	病例对照	-	269	80	189	8
Chen et al	2017	中国	病例对照	肝脏手术	803	159	644	6
Engels et al	2016	美国	病例对照	-	60	15	45	5
Gao et al	2018	中国	队列	神外、骨科、心胸外科等	1 940	48	1 892	7
Gardiner et al	2014	美国	病例对照	-	242 745	6 505	236 280	8
Huang et al	2018	中国	队列	心脏外科	120	60	60	5
Kim et al	2017	韩国	病例对照	外科ICU	129	43	86	6
Kumta et al	2018	澳大利亚	病例对照	外科ICU	3 484	69	3 415	7
Lu et al	2016	中国	病例对照	心脏手术	149	37	112	6
O'Brien et al	2014	美国	病例对照	外科ICU	2 695	288	2 407	8
Peixoto et al	2019	巴西	队列	-	278	157	121	4
Primiano et al	2011	美国	队列	-	258	21	237	6
Shaw et al	2014	中国台湾	队列	心胸外、骨科、普外等	297	44	253	5
Tschannen et al	2012	美国	队列	-	3 225	383	2 842	6
Wright et al	2014	澳大利亚	队列	头颈手术	88	13	75	6
陈青等	2013	中国	病例对照	老年患者	1 193	185	1 008	5
陈沅等	2019	中国	病例对照	心血管手术	1 163	231	932	7
陈哲颖等	2019	中国	队列	-	610	121	489	7
胡娟娟等	2018	中国	队列	-	2 652	202	2 450	5
蒋琪霞等	2013	中国	队列	-	1 074	11	1 063	6
李凤玲等	2018	中国	病例对照	骨折手术	3 796	392	3 404	5
宋文静等	2015	中国	病例对照	神经外科	124	56	68	7

危险因素	合并文献数(篇)	异质性检验			Meta分析结果
危险因素	合并文献数(篇)	I²(%)	P值	效应模型	OR值	95%CI	P值
自身因素
年龄	10^{[9, 12, 15, 17-20, 23, 25, 29]}	97	<0.05	随机	1.12	1.03~1.23	<0.05
BMI<23 kg/m²	6^{[9, 13-14, 19-20, 24]}	0	0.89	固定	2.85	2.36~3.44	<0.05
性别(女性)	3^{[9, 12, 20]}	32	0.23	固定	1.87	1.21~2.91	<0.05
性别(男性)	4^{[14, 15, 19, 23]}	21	0.28	固定	1.01	0.97~1.07	0.55
术前Braden量表评分	5^{[16, 21-22, 24, 28]}	68	<0.05	随机	0.79	0.67~0.92	<0.05
糖尿病史	5^{[18-19, 22, 29-30]}	59	0.04	随机	1.57	1.21~2.03	<0.05
高血压史	2^{[9, 25]}	0	0.78	固定	2.14	1.99~2.31	<0.05
术中因素
手术时间	8^{[11, 17, 22, 24, 26, 28-30]}	87	<0.05	随机	1.41	1.21~1.64	<0.05
体位(侧卧位)	2^{[13, 27]}	0	0.41	固定	1.78	1.23~2.58	<0.05
体位(俯卧位)	2^{[13, 27]}	0	0.55	固定	2.48	1.68~3.66	<0.05
特殊用药	3^{[18-19, 22]}	8	0.34	固定	1.42	1.14~1.77	<0.05
体外循环	2^{[13, 26]}	48	0.17	固定	3.24	2.14~4.90	<0.05
术中出血	2^{[13, 24]}	0	0.62	固定	1.77	1.61~1.95	<0.05
术中低血压	2^{[10, 17]}	11	0.29	固定	4.91	3.09~7.81	<0.05

危险因素	合并文献数(篇)	异质性检验			Meta分析结果
危险因素	合并文献数(篇)	I²(%)	P值	效应模型	OR值	95%CI	P值
自身因素
年龄	10^{[9, 12, 15, 17-20, 23, 25, 29]}	97	<0.05	随机	1.12	1.03~1.23	<0.05
BMI<23 kg/m²	6^{[9, 13-14, 19-20, 24]}	0	0.89	固定	2.85	2.36~3.44	<0.05
性别(女性)	3^{[9, 12, 20]}	32	0.23	固定	1.87	1.21~2.91	<0.05
性别(男性)	4^{[14, 15, 19, 23]}	21	0.28	固定	1.01	0.97~1.07	0.55
术前Braden量表评分	5^{[16, 21-22, 24, 28]}	68	<0.05	随机	0.79	0.67~0.92	<0.05
糖尿病史	5^{[18-19, 22, 29-30]}	59	0.04	随机	1.57	1.21~2.03	<0.05
高血压史	2^{[9, 25]}	0	0.78	固定	2.14	1.99~2.31	<0.05
术中因素
手术时间	8^{[11, 17, 22, 24, 26, 28-30]}	87	<0.05	随机	1.41	1.21~1.64	<0.05
体位(侧卧位)	2^{[13, 27]}	0	0.41	固定	1.78	1.23~2.58	<0.05
体位(俯卧位)	2^{[13, 27]}	0	0.55	固定	2.48	1.68~3.66	<0.05
特殊用药	3^{[18-19, 22]}	8	0.34	固定	1.42	1.14~1.77	<0.05
体外循环	2^{[13, 26]}	48	0.17	固定	3.24	2.14~4.90	<0.05
术中出血	2^{[13, 24]}	0	0.62	固定	1.77	1.61~1.95	<0.05
术中低血压	2^{[10, 17]}	11	0.29	固定	4.91	3.09~7.81	<0.05

危险因素	I² (%)	固定效应模型合并OR(95%CI)	随机效应模型合并OR(95%CI)
自身因素
年龄	97	1.02(1.01~1.03)	1.20(1.06~1.37)
BMI<23 kg/m²	0	2.94(2.40~3.62)	2.94(2.40~3.62)
术前Braden量表评分	14	0.89(0.86~0.92)	0.87(0.82~0.93)
糖尿病史	0	1.46(1.20~1.77)	1.46(1.20~1.77)
术中因素
手术时间	75	1.09(1.06~1.13)	1.14(1.03~1.27)
特殊用药	0	1.39(1.11~1.73)	1.39(1.11~1.73)