Korean J Anesthesiol.  2018 Feb;71(1):48-56. 10.4097/kjae.2018.71.1.48.

Perioperative factors associated with pressure ulcer development after major surgery

• Kim JM
• Lee H
• Ha T
• Na S

• KMID: 2402913
• DOI: http://doi.org/10.4097/kjae.2018.71.1.48

Abstract

BACKGROUND
Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers.
METHODS
This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities.
RESULTS
The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05-0.82; P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07-2.71; P < 0.05) were independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79-0.97; P < 0.001).
CONCLUSIONS
The present study revealed that preoperative low albumin levels and high lactate levels were significantly associated with pressure ulcer development after surgery.

Keyword

Albumin; Lactate; Perioperative risk factors; Pressure ulcer

MeSH Terms

Case-Control Studies
Comorbidity
Critical Care
Erythrocytes
Humans
Lactic Acid
Logistic Models
Perioperative Care
Pressure Ulcer*
Retrospective Studies
Risk Factors
ROC Curve
Ventilators, Mechanical
Lactic Acid