Risk factors for skin breakdown after renal and adrenal surgery.
OBJECTIVE
To perform a retrospective review in patients undergoing urologic operations during a 10-year period. Patient positioning is important before surgery to avoid pressure sores and other iatrogenic injuries. The reported risk factors have included a long operative time, diabetes, and malignancy. We have noted skin breakdown in patients placed on stabilizing devices and in patients with germline von Hippel-Lindau (VHL) gene mutations (a gene important in angiogenesis).


METHODS
We performed a retrospective review in patients undergoing urologic operations during a 10-year period. Patient sex, age, blood loss, position, use of belt or Vac Pac, and diagnosis of VHL were correlated with skin breakdown.


RESULTS
During a 10-year period, 382 patients underwent primarily renal and adrenal surgery. Fifty-five patients (14.4%) developed skin breakdown after surgery. Ninety-six patients had VHL gene mutations. Patient position and operative time were both significantly related to skin breakdown (both P <0.0001). The odds ratio for the position effect indicated that patients in the lateral position were at much greater risk than patients in the supine position (estimated odds ratio 8.1, P <0.0001). The odds ratio for operative time confirmed that patients experiencing longer operative times were also at increased risk of skin breakdown (estimated odds ratio 3.7 for each doubling of the operative time, P <0.0001). Patient sex, patient age, estimated blood loss, diagnosis of VHL, and use of belt or Vac Pac were not associated with an increased risk of skin breakdown.


CONCLUSIONS
Patients with longer operative times were at greater risk of skin breakdown and required greater care during preoperative positioning. The other factors studied were not significantly associated with skin breakdown.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1502, USA.
Jennifer
J
Stevens
Erika
E
Nichelson
W Marston
WM
Linehan
Nancy
N
Thompson
David
D
Liewehr
David
D
Venzon
McClellan M
MM
Walther
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000235:genetics / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D002648:Child; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000295:instrumentation*; D007432:Intraoperative Period / Q000706:statistics & numerical data; D007680:Kidney Neoplasms / Q000235:genetics / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011187:Posture; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012883:Skin Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016683:Supine Position; D013520:Urologic Surgical Procedures; D006623:von Hippel-Lindau Disease / Q000150:complications / Q000601:surgery