Intra-operative pressure sores

Abstract

As the extent of the pressure sore problem within hospitalized populations has been realized, their costs estimated and changes in the management of the NHS occurred, interest in pressure sores has increased and focused toward prevention. Research has served to underline the complexities of the issues involved and it is now acknowledged that the development of a pressure sore is dependent upon a complicated interplay of many variables, including the intensity and duration of pressure and the tolerance of the skin. The focus of this study was to generate data relating to the research question 'what is the extent of intra-operative pressure damage to the skin within a UK hospital setting?'. However, also pertinent was literature relating to the use of risk assessment tools - their predictive validity and value as descriptors of research patient populations. A quantitative descriptive study design was developed to determine post-operative incidence of pressure sore development and the reliability and predictive validity of the Braden Scale. Patients were recruited to the study according to age (=>55 years), surgery type (elective major general and vascular) and intra-operative position (supine and lithotomy). Descriptive data relating to risk, skin and peri-operative time intervals were recorded. Skin assessments amongst a sample of 26 patients identified a pre-operative prevalence of 36% - an unexpected finding, a post-operative incidence of 12.5% consistent with results from North American research and a period prevalence of 56%. The Braden Scale demonstrated good reliability and the most sensitive and specific Braden Score was determined as 19 not at risk/<19 at risk. A discussion of results identified limitations relating to the methodology adopted and issues, such as, inclusion and exclusion criteria of blanching and non blanching reactive hyperaemia and the application of the definition of incidence which lacked clarity within the literature.