Incidence and Risk Factors of Pressure Injury in Patients Undergoing Spinal Surgery in the Prone Position: A Retrospective Cohort Study

Abstract

Purpose: This study was performed to investigate the incidence rate and risk factors associated with pressure injuries (PIs) in patients undergoing spinal surgery in the prone position. Design: A retrospective cohort study. Methods: A total of 590 patients who underwent spinal surgery in the prone position were compared for potential risk factors–related PIs. The preoperative patient characteristics, intraoperative factors, and postoperative outcomes were collected using a patient record form based on existing literature. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for the occurrence of PIs. Findings: The overall incidence rate of PIs was 26.94%. The most commonly affected areas were the face, chest, and anterior superior iliac spine (89.94%, 89.30%, and 77.35%, respectively). Most patients developed stage 1 (89.30%) and stage 2 (11.70%) PIs. Multivariate analysis revealed that anemia (adjusted odds ratio [AOR] = 2.13, 95% confidence interval [CI] = 1.09 to 4.16, P = .026), obesity (AOR = 2.29, 95% CI = 1.26 to 4.97, P = .004), operation time exceeding 6 hours (AOR = 4.49, 95% CI = 2.31 to 8.74, P < .001), and blood loss greater than 750 mL (AOR = 6.45, 95% CI = 2.42 to 25.95, P < .001) were significant risk factors for PI occurrence. In the subgroup analysis, the risk of PIs was evaluated based on the operation time. Anemia significantly increased the risk of PIs in surgeries lasting more than 6 hours (AOR = 2.75, 95% CI = 1.34 to 4.79, P = .004). Obesity was a significant risk factor for both shorter surgeries (AOR = 2.59, 95% CI = 2.06 to 5.97, P = .004) and longer surgeries (AOR = 4.50, 95% CI = 2.75 to 8.44, P = .001). Blood loss greater than 750 mL was a significant risk factor for PI occurrence in both shorter surgeries (AOR = 4.42, 95% CI = 2.42 to 19.95, P < .001) and longer surgeries (AOR = 8.24, 95% CI = 2.98 to 45.86, P < .001). Conclusions: Health care professionals play a crucial role in optimizing patient health before surgery, particularly patients with anemia, obesity, significant blood loss, and prolonged operation times. Intraoperative management strategies should be implemented to prevent PIs during spinal surgeries in the prone position.