Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers: a meta-analysis 

Pressure-redistribution surfaces are generally recommended to prevent pressure ulcers (PUs) in high-risk patients, but their use in surgery-related PU prevention remains controversial. A meta-analysis was conducted to assess the relative preventive impact of pressure-redistribution surfaces versus standard hospital mattresses (usually a hospital-issue, foam-based mattress) on the incidence of surgery-related PUs. Systematic literature searches were performed using the terms pressure ulcer, operation, surgery, mattress, foam, polymer, pad, overlay, surface, and interface. Country, race, language, and publication year of articles was not restricted; randomized or quasi-randomized controlled trials were eligible for analysis. Odds ratio (OR) with 95% confidence intervals (CIs) for surgery-related PU incidence in patients using support surfaces versus standard mattress were calculated by random-effects model. Of the 316 studies identified, 10 involving a total of 1,895 patients were eligible for inclusion in the meta-analysis. Seven studies were randomized, controlled and three were quasi-randomized controlled trials. Patients who were provided a support surface had a significantly decreased incidence of surgery-related PUs (OR 0.31 [95% CI 0.17-0.59]) compared to patients using a standard mattress. Subgroup analysis showed pressure-redistribution surfaces used intra-operatively did not decrease the incidence of surgery-related PUs (OR 0.59, [95% CI 0.34-1.01]), but PU incidence decreased with postoperative (OR 0.07 [95% CI 0.01-0.49]) as well as with intra-operative and postoperative use (OR 0.20 [95% CI 0.06-0.73]). Funnel plot diagrams suggest a minimal risk of bias. Sensitivity analysis did not materially change the result of the main metaanalysis. Postoperative use of pressure-redistribution surfaces can effectively decrease the incidence of surgery-related PUs, but evidence to substantiate intra-operative use is insufficient. Patients at high risk for surgery-related PUs should be placed on a pressure-redistribution surface during the postoperative period, but intra-operative use can remain prudent until more well-designed, adequately powered, urgently needed studies are performed.