title: Prevalence and Predictors of Pressure Injuries From Spine Surgery in the Prone Position: Do Body Morphological Changes During Deformity Correction Increase the Risks?
abstract: MINI: Pressure injuries are prevalent in patients undergoing spine surgery while prone. Multiple risk factors exist and should be addressed. We found that patients undergoing spinal deformity correction surgery are at unique risk (odds ratio 3.31, P = 0.010) due to body morphological changes occurring secondary to intraoperative changes in spinal alignment.
  
  
  METHODS
  Review of data and prospective study.
  
  
  OBJECTIVE
  To investigate the prevalence and predictive factors of pressure injuries in spine surgery performed in the prone position, and to determine whether morphological changes and truncal shifts occurring during deformity correction predispose to this complication.
  
  
  BACKGROUND
  Spine surgery performed in the prone position presents the risk of developing pressure injuries. This risk is potentially increased in deformity correction, because it tends to involve more extensive procedures, with associated longer operating times.
  
  
  METHODS
  Cases of pressure injuries after spine surgery in the prone position were reviewed to ascertain prevalence and determine risk factors. Data including patient factors (age, sex, height, weight, body mass index, American Society of Anesthesiologists grade, comorbidities, Braden scale, neurological status, spinal pathology) and surgical factors (approach, procedure type, number of screws, operated levels, operative time) were collected. Independent risk factors were identified via multivariate analysis. A subsequent prospective analysis of all patients undergoing spinal deformity correction was conducted by performing intraoperative measurements of body morphological changes and shifts in truncal positions. Statistical correlation was performed to determine whether positional shifts cause pressure injuries.
  
  
  RESULTS
  The prevalence of pressure injuries was 23.0%. Previous skin problems (P = 0.034), myelopathy (P = 0.013), operative time >300 minutes (P = 0.005), and more than four operated levels (P = 0.006) were independent predictors of pressure injuries. Being a spinal deformity patient was also an independent risk factor for developing pressure injuries (odds ratio 3.31, P = 0.010). Significant changes in body measurements during deformity correction were predictive of pressure injuries.
  
  
  CONCLUSIONS
  Pressure injuries are prevalent in patients undergoing spine surgery while prone. Future studies should investigate strategies to prevent this complication based on the multiple risk factors identified in the present study. Patients undergoing spinal deformity correction surgery are particularly at risk due to intraoperative body morphological changes. Improved padding methods should be trialed in future studies.
  
  
  METHODS
  3.
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore.
authors.forename: Shuxun
authors.initials: S
authors.lastname: Lin
authors.forename: Hwee Weng Dennis
authors.initials: HWD
authors.lastname: Hey
authors.forename: Eugene Tze Chun
authors.initials: ETC
authors.lastname: Lau
authors.forename: Kimberly-Anne
authors.initials: KA
authors.lastname: Tan
authors.forename: Joseph Shantakumar
authors.initials: JS
authors.lastname: Thambiah
authors.forename: Leok-Lim
authors.initials: LL
authors.lastname: Lau
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Ka-Po Gabriel
authors.initials: KG
authors.lastname: Liu
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D001827:Body Height; D015992:Body Mass Index; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000601:surgery; D061646:Operative Time; D056888:Patient Positioning / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D016684:Prone Position; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology