Stage 4 involves full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone. Stage 3 involves full-thickness skin loss with adipose tissue that is visible in the ulcer, and granulation tissue and epibole are often present. Stage 2 involves partial-thickness skin loss with exposed dermis in a red or irritated area, and can involve a blister or open sore. Therefore, the initial management of stage 1 pressure ulcers only involves a protective dressing with observation, and stage 1 pressure ulcers are not routinely treated by a wound care nurse. Because of their immobilization, patients commonly experience a stage 1 pressure ulcer at weight-bearing sites immediately after surgery. Stage 1 involves intact skin with a localized area of non-blanchable erythema, which may appear different in darkly pigmented skin and is usually temporary and reversible. In this staging system, the degree of tissue damage increases at higher stages. Based on the pressure ulcer staging guidelines of the National Pressure Ulcer Advisory Panel, 43 patients were found to have developed pressure ulcers of stage 2 or higher (stage 2: 28 patients, stage 3: 12 patients, deep tissue injury: 1 patient, unstageable ulcers: 2 patients). New-onset postoperative pressure ulcers (within one month after surgery) were identified based on nursing notes in the patients' electronic medical records. The potentially eligible population included 2,498 patients who were discharged from the surgical intensive care unit (ICU) after surgery. Therefore, the present study aimed to identify perioperative factors that could identify patients who were at risk of developing postoperative pressure ulcers and to develop a model for predicting pressure ulcer development after surgery. In addition, there is a validated scoring system that is commonly used in the critical care setting to identify patients with a high risk of developing pressure ulcers, although the score may not be updated to reflect the patient's altered mobility after surgery. These findings highlight the possibility that pressure ulcer development is not related to distinct intraoperative factors, although that study did not consider the association of the patients' pre-existing conditions (e.g., nutritional status) with pressure ulcer occurrence. No significant associations were observed for operation length, hypotension, or vasopressor use. have recently investigated intraoperative risk factors for postoperative pressure ulcers, and found that only the intraoperative use of blood products was independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97 P < 0.001). In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio : 0.21, 95% CI: 0.05–0.82 P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07–2.71 P < 0.05) were independently associated with pressure ulcer development. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell ( pRBC) units.
The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group.
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