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

Area of Science:

• Surgical Quality Improvement
• Patient Safety in Surgery
• Orthopedic Positioning Devices

Background:

• Complex retroperitoneal surgeries often involve positioning that can lead to complications.
• Elevated creatine kinase (CK) levels, rhabdomyolysis, and hospital-acquired pressure injuries (HAPIs) are potential adverse events.
• The Pink Pad® is a device designed to improve intraoperative patient positioning.

Purpose of the Study:

• To assess the incidence of elevated CK levels, clinical rhabdomyolysis, and HAPIs after retroperitoneal surgery.
• To evaluate the impact of The Pink Pad® on these adverse events compared to traditional positioning methods.

Main Methods:

• A retrospective quality improvement analysis was conducted.
• 364 patients undergoing renal or retroperitoneal surgery in the lateral decubitus position were analyzed.
• Data from July 2018 to July 2023 were compared between pre- and post-Pink Pad® implementation cohorts.

Main Results:

• The Pink Pad® group showed significantly lower rates of HAPIs (1% vs. 4.6%), elevated CK values (0% vs. 11.8%), and clinical rhabdomyolysis (0% vs. 2.6%).
• Factors associated with adverse events included younger age, higher BMI, longer operative time, and specific surgical sides.
• The Pink Pad® group had zero instances of elevated CK or rhabdomyolysis.

Conclusions:

• Implementation of The Pink Pad® significantly reduced postoperative CK elevation and HAPIs.
• The device enhances patient safety during lateral decubitus positioning for retroperitoneal surgeries.
• Further research is recommended to validate these findings.