A retrospective cohort study of a PIRFAS- and ultrasound-guided program for pressure ulcers in prone orthopedic
1Department of Orthopedic, The Affiliated Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Insights
A new nursing protocol significantly reduced pressure ulcer incidence and severity in orthopedic surgery patients. This intervention also decreased hospitalization duration and costs, improving patient safety and resource use.
Area of Science:
- Orthopedic Surgery
- Patient Safety
- Nursing Interventions
Background:
- Pressure ulcers are a common complication in patients undergoing orthopedic surgery in the prone position.
- Existing nursing care may not adequately prevent intraoperative pressure injuries.
Purpose of the Study:
- To evaluate the effectiveness of a gradient warning nursing procedure (GWNP) combined with the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography.
- To assess the impact of this protocol on pressure ulcer incidence, severity, patient comfort, and healthcare resource utilization in prone-positioned orthopedic surgery patients.
Main Methods:
- A retrospective cohort study involving 126 patients undergoing prone-positioned orthopedic surgery.
- Comparison between a regular care group (n=60) and a group receiving the GWNP protocol (n=66).
- Data collected included pressure ulcer incidence, grading, number, area, comfort scores, hospitalization duration, and costs; statistical analyses were performed using SPSS.
Main Results:
- The GWNP group showed significantly reduced pressure ulcer incidence (aOR: 0.11), number (aMD: -0.82), area (aMD: -0.62), and grading compared to the regular group (p<0.05).
- Post-intervention, the GWNP group reported higher physiological and psycho-spiritual comfort scores (p<0.05).
- Hospitalization duration (aMD: -4.50 days) and costs (aMD: -2.00 ten thousand yuan) were significantly lower in the GWNP group (p<0.05).
Conclusions:
- The GWNP, guided by PIRFAS and ultrasonography, is an effective bundled intervention for reducing pressure ulcers in prone-positioned orthopedic surgery.
- This protocol enhances patient safety and improves healthcare resource utilization.
- Further validation through multicenter randomized controlled trials is recommended.
Objective:
Pressure ulcers are recognized as a prevalent intraoperative complication in prone-positioned orthopedic surgery patients. This study aimed to explore the effects of a gradient warning nursing procedure (GWNP) guided by the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography on pressure ulcers in prone-positioned orthopedic operation patients.
Methods:
This retrospective cohort study enrolled 126 patients who underwent prone-positioned orthopedic surgery at our hospital between May 2022 and May 2024. The assignment to groups was based on a hospital-wide implementation of a new nursing protocol on 1 June 2023. Accordingly, 60 patients admitted before this date constituted the regular group and received regular care, while 66 patients admitted on or after this date constituted the joint group and received the gradient early warning nursing procedure guided by the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography, in addition to regular care. The incidence of pressure ulcers, pressure ulcer grading, number and area of injury, simplified comfort status scale (GCQ) pre- and post-care, hospitalization duration, and costs were collected and compared between the two groups. Statistical analyses were performed using SPSS 25.0, with the χ 2 test, independent samples t-test, Mann-Whitney U-test, and multivariate regression analysis being employed as appropriate for data types and comparison purposes.
Results:
The results in our study revealed that the incidence (adjusted odds ratio [aOR: 0.11], 95% CI: 0.02-0.48), number (adjusted mean difference [aMD: -0.82], 95% confidence interval [CI]: -1.04 - -0.60), area (aMD: -0.62, 95% CI: -0.83 - -0.41), and grading of pressure ulcers were significantly decreased in the joint group versus the regular group (p < 0.05), indicating the implementation of the gradient early warning nursing procedure guided by the PIRFAS and ultrasonography effectively reduced the incidence and tissue damage severity. There was no statistically significant difference in the comparison of GCQ scores of dimensions prior to nursing in the two groups (p>0.05), whereas the GCQ scores regarding physiological (aMD: 3.32, 95% CI: 2.45-4.19) and psycho-spiritual (aMD: 2.23, 95% CI: 1.38-3.08) aspects in the joint group post nursing were evidently higher versus the regular group (p < 0.05), with the difference insignificant in environmental and socio-cultural scores. The hospitalization duration (aMD: -4.50 days, 95% CI: -6.12 - -2.88) and costs (aMD: -2.00 ten thousand yuan, 95% CI: -2.45 - -1.55) of the joint group were prominently decreased versus the regular group, with statistical significance (p < 0.05).
Conclusion:
The GWNP guided by the PIRFAS and ultrasonography could effectively represent an effective bundled intervention for prone-positioned orthopedic surgery. Implementation of this protocol in clinical practice can potentially enhance patient safety by reducing pressure ulcer incidence and severity while also improving healthcare resource utilization. Future research should focus on validating these findings through multicenter randomized controlled trials.
