Under Pressure: A Quality Improvement Initiative to Reduce Rhabdomyolysis and Hospital-Acquired Pressure Injuries...

The purpose of this study was to present a retrospective quality improvement analysis assessing the incidence and factors associated with elevated creatine kinase (CK) levels, clinical rhabdomyolysis, and hospital-acquired pressure injuries (HAPIs) after complex retroperitoneal surgeries before and after the implementation of The Pink Pad for intraoperative positioning.

We performed a retrospective analysis of 364 patients who underwent renal or retroperitoneal surgery in the lateral decubitus position between July 2018 and July 2023; 19 patients were excluded. The 2 cohorts-pre-Pink Pad and post-Pink Pad utilization-were analyzed, each with 2.5 years of prospectively maintained data available for analysis.

Three hundred forty-five patients were analyzed, and of those, 153 (44.3%) had flank surgery without and 192 (55.7%) with The Pink Pad. In the whole cohort, patients who developed elevated CK values were younger and had a higher BMI, higher preoperative creatine, and longer operative time (P < .05). HAPIs were more frequent in younger patients, those having right-sided surgery, those with hypertension, and those with longer surgeries (P < .05). The frequency of HAPIs (without Pink Pad = 7 [4.6%] vs with Pink Pad = 2 [1%], P = .041), elevated CK values (without Pink Pad = 18 [11.8%] vs with Pink Pad = 0, P < .001), and clinical rhabdomyolysis (without Pink Pad = 9 [2.6%] vs with Pink Pad = 0, P < .001) was significantly lower in The Pink Pad group.

Implementation of The Pink Pad significantly reduced rates of postoperative CK value elevation and HAPIs caused by lateral decubitus positioning. Further studies should be performed to confirm these findings.