Pressure ulcers often acquired during surgery

Patients undergoing surgery for more than three hours are at risk for developing pressure ulcers, say medical researchers who gathered recently in Atlanta to discuss the problem.

Each year, more than 1.5 million hospitalized patients develop pressure ulcers, which are responsible for 60,000 deaths and costs approaching $10 billion, according to studies presented at the First Annual symposium on Operating Room-Acquired Pressure Ulcers. Pressure ulcers, although commonly linked to long-term care facilities, also pose a serious risk to otherwise healthy patients undergoing conventional surgical procedures.

Data presented at the conference indicate that up to 25% of all pressure ulcers suffered by hospitalized patients begin in the operating room, and that about one in 12 patients undergoing procedures lasting more than three hours will develop pressure ulcers within four days of their surgery. Coronary artery bypass patients and patients with vascular disease and poor circulation are especially at risk because they often undergo procedures that take up to five hours to perform.

A difficult connection to make

"The lesion may not be apparent immediately following surgery, yet the patient has suffered irreversible tissue damage while in the operating room," says Sharon Aronovitch, PhD, RN, CETN, a consultant for education at Regents College in New York City. "Because pressure ulcers may not develop into serious sores until days after surgery, the connection back to the operating room is difficult to establish. As a result, the occurrence of OR-acquired pressure ulcers is often underreported."

A number of variables have been implicated in the development of OR-acquired pressure ulcers, including patient immobility and unrelieved pressure unique to surgery, age, and pre-existing conditions such as diabetes and vascular disease.

"Most people are not aware of the severity of OR-acquired pressure ulcers and the great need for preventive measures," says James Ramsay, MD, director of critical care service and associate professor of anesthesiology at Emory University Hospital in Atlanta.

Conference proceedings and a closer look at the issue of OR-acquired pressure ulcers will appear in an upcoming issue of Wound Care.