Related Experiment Video
Updated: Sep 26, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Risk factors for position-related injuries in adult surgical patients: a systematic review and meta-analysis
Veronica Ramirez Johansson1,2, Oili Dahl2,3,4, Ann-Charlotte Falk4
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Background:
Correct patient positioning is a vital responsibility of the operating team to ensure patient safety. By identifying risk factors associated with position-related injuries in surgical patients, perioperative nurses can develop effective strategies to prevent these iatrogenic injuries.
Objective:
To identify and synthesise intrinsic and extrinsic risk factors for position-related pressure injuries and peripheral nerve injuries.
Information Sources:
Searches were conducted in Medline, Web of Science, CINAHL, Embase, and the Cochrane Library (January 1990 - September 2025).
Methods:
Observational studies examining intrinsic and extrinsic risk factors for new pressure injuries or peripheral nerve injuries in adult surgical patients were included. The risk of bias was assessed using the Research Triangle Institute item bank framework. Meta-analyses were performed using random-effects models, with sensitivity analyses regarding study design and risk of bias.
Results:
In total, 16 382 records were screened, and 161 full-text articles were assessed for eligibility. Of these, 41 studies were included (33 on pressure injuries comprising 26 074 patients and 8 on peripheral nerve injuries comprising 1 338 592 patients), assessing 101 potential risk factors. Four factors were found to be statistically significant in association with pressure injuries: diabetes (OR 1.89; 95% CI 1.25-2.86), high body mass index (MD 1.80; 95% CI 0.38 to 3.22), low preoperative serum albumin (MD -3.04; 95% CI - 4.99 to -1.09), and intraoperative use of circulatory agents (OR 2.11; 95% CI 1.13 to 3.92). Biological sex (OR 1.10; 95% CI 0.94-1.30), age (MD 0.69; 95% CI -1.65 to 3.03), hypertension (OR 1.37; 95% CI 0.93-2.01), low haemoglobin (MD -7.64; 95% CI -16.90 to 1.62), and surgery duration (MD 42.54; 95% CI -9.03 to 94.11) were not associated with injury risk. For peripheral nerve injuries, the available evidence on risk factors was too limited and heterogenous to permit meta-analysis.
Conclusions:
Surgical patients are at risk of position-related injuries, particularly in the presence of factors such as diabetes, high body mass index, low serum albumin, and use of circulatory agents. Preoperative optimisation and thorough postoperative assessment are essential to reduce these iatrogenic injuries.
Registration:
www.crd.york.ac.uk/prospero/ PROSPERO CRD42023401329, registered 21/02/2023.
