Backside first in head and neck surgery?: preventing pressure ulcers in extended length surgeries.
BACKGROUND
The operating room (OR) presents a high-risk environment for pressure injury. We designed a project to improve performance in the prevention of intraoperative pressure ulcers in extended length head and neck surgeries for malignancies (ELS) using a fluid mattress (RIK) intraoperatively.


METHODS
A descriptive design was used to monitor performance improvement in this underrecognized aspect of patient care. A fluid, pressure-reducing OR mattress (RIK) was compared with the use of a standard foam OR mattress (Skytron). A convenience group of 36 consecutive patients, undergoing ELS, was included in the project. Patients were evaluated for presence or absence of a pressure ulcer immediately and 72 hours postoperatively.


RESULTS
Patient groups were demographically and surgically comparable at a clinical level. Pressure ulcer incidence before intervention was 21% (4 of 19). This declined to 0% after intervention.


CONCLUSIONS
Intraoperative pressure ulcers are a costly complication. Presence of a pressure ulcer extends time in the sick role and disrupts desired aesthetic outcomes. Use of a pressure-reducing device achieved the performance improvement objective. Implications for future research and current care are discussed.
Chalian
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Department of Otorhinolaryngology/Head and Neck Surgery, School of Medicine, University of Pennsylvania, Philadelphia 19104-4283, USA. chaliana@mail.med.upenn.edu
Kagan
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SH
D000368:Aged; D001513:Beds; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D003668:Pressure Ulcer / Q000517:prevention & control*