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Intraoperative Ultrasound in Spinal Surgery

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Lithotomy Position and Intraoperative-acquired Pressure Injury: A Prospective Observational Study.

Mehtap Karaca¹, Aliye Okgün Alcan²

¹Operating Room, Izmir Bakircay University Cigli Education and Research Hospital, Izmir, Turkey.

Advances in Skin & Wound Care

|June 24, 2026

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Intraoperative-acquired pressure injuries (IAPIs) occurred in 26.1% of patients undergoing surgery in the lithotomy position. Supporting the posterior leg region is recommended to prevent these injuries.

Area of Science:

Urology
Surgical Patient Safety
Dermatology

Background:

Intraoperative-acquired pressure injuries (IAPIs) are a concern in surgical settings.
The lithotomy position is frequently used in urological procedures.
Factors contributing to IAPI development require further investigation.

Purpose of the Study:

To determine the incidence of IAPIs in patients undergoing urological surgery in the lithotomy position.
To identify patient-related and surgery-related factors associated with IAPI development.

Main Methods:

Prospective observational study of 218 adult patients undergoing urological surgery in the lithotomy position.
Skin assessments for IAPI were conducted at multiple time points: pre-operatively, end of surgery, and 24, 48, and 72 hours post-operatively.

Keywords:

lithotomy position nursing care operating room pressure injury risk factor urological surgery

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Statistical analysis was performed to identify associated risk factors.

Main Results:

The incidence of IAPI at the end of surgery was 26.1% (57 out of 218 patients).
All identified IAPIs were Stage 1, with 27% located on the posterior right leg and 27% on the posterior left leg.
Factors associated with IAPI development included age, alcohol use, comorbidities, diagnosis, and type of surgery. Age and alcohol consumption were significant in multivariable analysis.

Conclusions:

The incidence of IAPI in this patient sample was high.
The posterior region of the legs is a common site for IAPIs in the lithotomy position.
Recommendations include providing support to the posterior leg region during surgery in the lithotomy position.