Construction of a Risk Prediction Model for Intraoperative Pressure Injuries: A Prospective, Observational Study.

Abstract

PURPOSE\nTo explore the incidence and risk factors of intraoperatively acquired pressure injuries (IAPIs) in patients transferred to the intensive care unit (ICU) after surgery and establish a risk factor prediction model for IAPIs for guiding clinical intervention.\n\n\nDESIGN\nA prospective, observational study was conducted.\n\n\nMETHODS\nThis study was conducted in the West China Hospital of Sichuan University. A total of 648 patients who were transferred to the ICU after surgery were recruited from May 1, 2019, to October 30, 2020. Data were collected preoperatively, intraoperatively, and postoperatively (3 days after transfer to the ICU). The enrolled patients underwent well-developed preventive measures to prevent IAPIs in the operating room and ICU. A sociodemographic and clinical characteristic questionnaire, the Braden pressure injuries risk assessment scale, the activity of daily living scale, and the Nutrition Risk Screening-2002 were used. Descriptive, bivariate, and logistic regression analyses were conducted.\n\n\nFINDINGS\nThe incidence rate of IAPIs within 3\xa0days was 18.67%. The Braden pressure injuries score, preoperative fasting blood glucose level, emergency surgery, and types of vasoactive drugs in the ICU were significant factors for increased risk. The risk factor prediction model was established using the perioperative Braden pressure injuries score (P\xa0=\xa00.027, odds ratio [OR]\xa0=\xa00.901), preoperative fasting blood glucose level (P\xa0=\xa00.027, OR\xa0=\xa01.111), emergency surgery (P\xa0<\xa00.01, OR\xa0=\xa05.054), types of vasoactive drugs in the ICU (P\xa0=\xa00.038, OR\xa0=\xa01.668), and surgery time (P\xa0=\xa00.021, OR\xa0=\xa02.434). The area under the receiver operating characteristic curve was 0.74; 95% confidence interval was 0.671 to 0.810; sensitivity was 0.635; specificity was 0.860; and the Youden index was 0.495.\n\n\nCONCLUSIONS\nIn patients transferred to the ICU after surgery, high fasting blood glucose level before surgery, emergency surgery, types of vasoactive drugs, and surgery time should be treated as predisposing factors in the prevention and control of IAPIs. However, the predictive effect of the perioperative Braden pressure injuries risk assessment scale on the risk of IAPIs needs to be further verified.