Incidence and risk factors of pressure injury via the prone position in patients with spinal surgery
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Abstract
Objective: To explore the incidence and risk factors of pressure injuries associated with the prone position in patients with spinal surgery.
Materials and Methods: This was an observational cross-sectional study conducted among 111 patients undergoing spinal surgery in the prone position at Charoenkrung Pracharak Hospital between June 2024 and March 2025. The participants were selected using purposive sampling. The research instruments included a personal data record form, preoperative factors, intraoperative factors, and a pressure injury assessment form based on the National Pressure Injury Advisory Panel (NPIAP) criteria. The instruments were validated by three experts; the Index of item Objective Congruence (IOC) is 1.00, with good inter-rater reliability. Skin assessments were performed before prone positioning, 30 minutes postoperatively, and followed up at 24 and 48 hours for patients who developed pressure injuries. Data were analyzed using descriptive statistics and multiple logistic regression analysis.
Results: The incidence of pressure injuries for 30 minutes after surgery was 5.4%. All identified pressure injuries were classified as Stage 1. The most common areas of pressure injuries were the face, followed by the chest. Univariable logistic regression analysis demonstrated that intraoperative blood loss greater than 500 mL was significantly associated with the development of pressure injuries (p<0.05). However, multivariable logistic regression analysis showed that none of the studied factors were independently associated with pressure injury occurrence.
Conclusion: Pressure injuries related to prone positioning in spine surgery occurred at a low incidence and were predominantly early-stage injuries. These findings highlight the importance of preoperative risk assessment, appropriate positioning techniques, use of protective devices, and close postoperative skin monitoring to prevent pressure injuries and enhance patient safety during spine surgery.
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