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Leading Researchers Expose Hidden Risk of Pressure Ulcers in the Operating Room Studies Indicate Up to 25 Percent of 'Bed Sores' Begin in Surgery
ATLANTA, March 9, 1998 — Patients undergoing surgery for more than three hours are at risk for developing potentially fatal pressure ulcers, warn leading medical experts gathered here today to present clinical data on this underreported problem.
Each year more than 1.5 million hospitalized patients develop pressure ulcers (also known as bed sores), resulting in 60,000 deaths at an estimated annual cost approaching $10 billion to the nation's health care system. Although pressure ulcers are a problem commonly linked to nursing homes, they pose a serious risk to an otherwise healthy patient undergoing a conventional surgical procedure, according to the latest studies presented at the First Annual Symposium on Operating Room-Acquired Pressure Ulcers.
Data presented indicate up to 25 percent of all pressure ulcers in hospitalized patients begin in the operating room (OR). Moreover, about one in 12 individuals undergo-ing surgeries lasting more than three hours will develop pressure ulcers within four days of their operation. Coronary artery bypass patients and patients with vascular disease and poor circulation are especially at risk due to surgeries that may take up to five hours to perform.
"The lesion may not be apparent immediately following surgery, yet the patient has suffered irreversible tissue damage while in the operating room," said Sharon Aronovitch, Ph.D., R.N., C.E.T.N., a consultant for education at Regents College, New York. "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."
Surgical patients are subject to prolonged immobility, which results in unrelieved pressure and impaired blood flow to the skin. Because of anesthesia, they are unable to perceive discomfort or reposition themselves. The unrelieved pressure, particularly at bony prominences, can disrupt blood flow and cause irreversible soft-tissue damage.
A number of variables have been implicated in the development of OR-acquired pressure ulcers, from a patient's complete immobility and unrelieved pressure unique to the surgical experience, to factors such as age. Other circumstances include nutritional status and pre-existing conditions such as diabetes or vascular disease, which can impair blood flow in the infected area, leading to tissue breakdown.
James Ramsay, M.D., director of critical care service and associate professor of anesthesiology in the cardiothoracic division, Emory University Hospital in Atlanta, explained that increased recognition of this serious health care problem is necessary to spur an international focus on preventive strategies.
"Most people are not aware of the severity of OR-acquired pressure ulcers and the great need for preventative measures," said Dr. Ramsay, who presented data on pressure ulcer risk factors in the operating room. "These ulcers are not simple bruises. Patients suffer severe physical pain and, for those afflicted with a high degree of tissue damage, these wounds can potentially lead to fatal infections."
Sponsored by the science journal Advances in Wound Care and Versaggi Biocommunications, the symposium on OR-acquired pressure ulcers is providing researchers with a forum to introduce new findings on the cause, prevention, and treatment of this little known problem.
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