Predictors of Intraoperative Pressure Injury in Patients Undergoing Major Hepatobiliary Surgery

PURPOSE: The purpose of this study was to identify risk factors associated with pressure injury (PI) development in patients undergoing major hepatobiliary surgery requiring general anesthesia. DESIGN: Retrospective medical review and analysis. SUBJECTS AND SETTING: Medical records from 803 patients undergoing hepatobiliary surgery from October 2015 to October 2016 were reviewed. The study setting was a 3400-bed military academic medical center in the northeast region of China. METHODS: Demographic variables, comorbid conditions, preoperative Braden Scale for Pressure Sore Risk scores, preoperative serum hemoglobin and albumin levels, type of surgery, positioning, surgical time, hypotensive episodes, blood loss, body temperature, and other potential risk factors for PI development were collected. Pressure injury occurrences during a 48-hour period after surgery were recorded along with stage. Data were analyzed using univariate analyses and multivariate logistic regression analysis to build a predictive model for factors associated with PI occurrences. RESULTS: The prevalence of PIs in major hepatobiliary surgery patients was 19.8%, 4.9%, and 4.1% in the immediate postoperative period, on the first day and the second day after surgery, respectively. Pancreaticoduodenectomy surgery (odds ratio [OR]: 3.957, 95% confidence interval [CI]: 2.145-7.302, P <.001), open surgery (OR: 2.917, 95% CI: 1.558-5.463, P =.001), surgical time (cutoff point at 197 minutes for increased risk of PI, OR: 1.004, 95% CI: 1.002-1.006, P =.001), and intraoperative hypotensive episodes (OR: 1.022, 95% CI: 1.005-1.039, P =.010) were associated with an increased likelihood of PI development. CONCLUSION: Among patients undergoing major hepatobiliary surgery such as pancreaticoduodenectomy, prolonged surgical time, open surgery, and intraoperative hypotension were found to be associated with an increased likelihood of developing a PI. Maintaining hemodynamic stability and taking more effective measures for skin care during these procedures may reduce the risk of PI in this vulnerable population.