title: Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park-bench position: A prospective observational study.
abstract: Preventing pressure ulcers is important in patients undergoing procedures in the park-bench position. We hypothesized that the microclimate around the skin is a significant risk factor for developing pressure ulcers. This research continuously assessed factors of the microclimate in terms of skin temperature and perspiration as well as the interface pressure in order to determine whether the microclimate is an independent risk factor for the development of park-bench position-related pressure ulcers (PBP-PUs). A prospective observational study was conducted among patients undergoing elective surgery in the park-bench position at a general hospital in the metropolitan area of Japan between April and November 2014. Factors of the microclimate, including skin temperature and perspiration, in addition to the interface pressure were continuously measured throughout surgery. Twenty-nine patients were analyzed (mean age 44.4 ± 13.2 years, male 44.8%). Of these 29 patients, seven (24.1%) developed Category I PBP-PUs. The change in skin temperature from baseline to the end of surgery (2.7 ± 0.3 °C vs. 1.9 ± 0.8 °C) and the average peak pressure (119.1 ± 36.8 mmHg vs. 94.5 ± 23.1 mmHg) were significantly higher in the patients with PBP-PUs than in those without PBP-PUs. There were no significant differences in the amount of perspiration between the two groups. A hierarchical logistic regression analysis showed that the change in skin temperature was significantly related to the development of PBP-PUs (unit = 0.1 °C: odds ratio 1.44, 95% confidential interval 1.09-2.33) when adjusted for the average peak pressure and length of surgery. Our results suggest that a change in skin temperature toward a higher value is an independent risk factor for the development of PBP-PUs. Proper intraoperative management of skin temperature may therefore be a promising candidate as a preventive method against PBP-PU development.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mine
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Iizaka
authors.affiliation: Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mikako
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Uehata
authors.affiliation: Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kohno
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kasuya
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mae
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamasaki
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D000328:Adult; D000368:Aged; D001513:Beds; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008834:Microclimate; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D017592:Skin Care / Q000379:methods*; D012881:Skin Temperature; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors; D014945:Wound Healing
keywords: interface pressure; neurosurgery; perioperative nursing; perspiration; skin temperature