118. Reduction of facial pressure injuries after prone positioning in spine surgery: a multidisciplinary approach

Abstract

BACKGROUND CONTEXT Spine surgery requiring prone positioning subjects the skin to friction, shear, moisture, and pressure. These factors increase the risk of facial pressure injuries. Prone positioning for thoracolumbar spine surgery allows the surgeon access to the dorsal spine and is the most common positioning method. Facial pressure injury must be carefully considered during prone positioning with pressure sore rates reported between 5%-66%. These injuries may result in longer hospital stays, patient morbidity and increased health care costs. Literature addressing facial pressure injury prevention strategies during prone spinal surgery is limited. PURPOSE The purpose of this study was to assess the efficacy of a multidisciplinary-derived pressure ulcer prevention bundle intended to prevent facial pressure injuries during prone spinal surgery. STUDY DESIGN/SETTING Review of pre- and postintervention consecutive cases. PATIENT SAMPLE Patients undergoing prone spinal surgery between November 2018 and August 2020. OUTCOME MEASURES Total case volume, pre- and postintervention monthly case volumes, total and monthly facial pressure ulcer rates. Methods A multidisciplinary group at a quaternary academic medical center developed a plan to address facial pressure injuries. The group reviewed institutional baseline facial pressure injury data and a literature review was conducted for previously studied prevention techniques. A pressure injury prevention bundle was developed including the following elements: (1) prophylactic placement of silicone foam dressings on the chin and forehead, (2) use of a contoured foam head positioner, and (3) application of a skin barrier wipe prior to securing the endotracheal tube with tape. A preoperative baseline skin assessment was performed. Postoperative pressure injury staging was assessed on our inpatient unit postoperatively. Monthly ulcer rates were calculated by dividing the number of pressure injuries by the monthly case volume. Differences in monthly ulcer rates were evaluated between intervention groups. A cross-tabulation of intervention group versus presence/absence of an ulcer was performed and an odds ratio of ulcer occurrence was calculated. Results Intervention compliance was greater than 90% within 1 week of bundle implementation. There were 22 total months of data reviewed with 2,331 total prone spinal procedures. Mean cases per month for the entire period was 106.0±23 (range 20-127). There were no significant differences in mean cases per month between intervention groups (P>0.05). There were 17 total facial ulcers encountered across all 2,331 cases (0.73%). There were 15/992 (1.50%) total ulcers in the preintervention group and only 2/1339 (0.15%) ulcers in the postintervention group. Monthly ulcer rates were calculated and displayed a non-normal distribution. The median monthly ulcer rate was significantly lower in the postintervention vs the preintervention group (0.000% vs 0.820%, P=0.021). Cross-tabulation of the intervention group vs presence/absence of an ulcer revealed a 10.1x higher odds of sustaining an ulcer in the preintervention group (odds ratio 10.1; 95% confidence interval 2.3-44.2). Conclusions Utilizing a standardized pressure injury prevention bundle during prone spinal surgery reduces the occurrence of facial pressure injuries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.