The surgical patients' pressure injury incidence (SPPII) study: A cohort study of surgical patients and processes of care

Background Surgical patients are at high risk of developing pressure injuries (Pls) due to anaesthesia-induced immobility as well as risk factors such as length of surgery and co-morbidities. Few Australian studies have investigated the incidence of PIs in surgical patients. This prospective cohort study assessed the incidence of post-surgical PIs and identified gaps in pressure injury prevention (PIP) for elective surgical patients.

Methods Consecutive elective surgery patients at an urban tertiary referral hospital were recruited who had an expected length of stay of >48 hours. Baseline PI risk (measured by the Waterlow scale) and PIP strategies implemented at five time points were collected from medical records. Two prospective outcome assessments were conducted at 24 and 48 hours post-operatively. Data were analysed descriptively.

Results One patient out of 150 (incidence rate 0.7) developed an intra-operative Stage 1 PI. Four patients developed skin tears. PIP strategies were applied inconsistently throughout the patient journey, regardless of risk status.

Conclusions While the incidence of surgically acquired PIs in this study was low, ongoing staff education is needed about the importance of consistent skin and risk assessments and of implementing strategies appropriate for level of PI risk.

What is already known:

• PIs are widely considered to be an adverse event of hospitalisation and are largely preventable.

• Surgical patients are at risk of developing a PI primarily due to immobilisation following anaesthesia, length of surgery and co-morbidities.

• There are few studies on PI incidence and prevention strategies used in the post-operative period.

What this manuscript contributes: Although the incidence of post-surgical PIs among elective surgical patients was low, there are gaps in PIP for this group of patients, including for those deemed at high risk of PI. There is a need for clinicians to improve documentation of risk assessment and strategies implemented to reduce the risk of PIs, throughout the surgical patient journey.