Risk assessment for the development of perioperative lesions due to surgical positioning

Oliveira, Haglaia Moira Brito de Sena; Santos, Anizielly Maria de Jesus Ferreira dos; Madeira, Maria Zélia de Araújo; Andrade, Elaine Maria Leite Rangel; Silva, Grazielle Roberta Freitas da

Acessibilidade / Reportar erro

Brasil

Revista Gaúcha de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Gaúcha Enferm. 40 (spe) • 2019 • https://doi.org/10.1590/1983-1447.2019.20180114 copy

Risk assessment for the development of perioperative lesions due to surgical positioning

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE:

To evaluate the risk of developing perioperative lesions due to surgical positioning in patients submitted to elective surgeries.

METHODS:

This is an analytical and longitudinal study carried out with 45 patients in a public hospital of medium and high complexity in the state of Piauí. The following data was used: perioperative evaluation instrument, Numerical Visual Scale, Braden Scale and the Risk Assessment Scale for the Development of Injuries from Surgical Positioning (ELPO).

RESULTS:

Participants aged ≥ 46 years had a higher risk, and there were 33.4% of hypertensives among the 35.6% with comorbidities. The most prevalent position, with 64.5% was supine, with only 2.2% cases of pre-surgical injury. Regarding the risk for positional lesions, 68.9% presented low risk.

CONCLUSIONS:

31.1% of the participants were at high risk for developing positional lesions, related to age and comorbidities.

Keywords:
Perioperative nursing; Patient positioning; Patient safety; Risk assessment

Characteristic	M	SD	n	%
Surgical specialty
Gynecology			25	55.6
Urology			8	17.8
Orthopedics			6	13.3
Cardiology			6	13.3
BMI	25.2	4.6
Comorbidities
Yes			16	35.6
Pre-operative surgical site related pain	5.3	2.3
Yes			3	6.7
Pre-operative surgical site unrelated pain	5.4	2.3
Yes			5	11.1
Pre-operative pressure lesion
Yes			1	2.2
Previous pressure lesion
Yes			3	6.7
Braden Scale Classification
Elevated risk (10 to 12)			1	2.2
Moderate risk (13 to 14)			1	2.2
At risk (15-16, adult; 17-18, elder)			2	4.4
No risk (19 or higher)			41	91.1
Physical limitations
Age-related and other limitations			5	11.1
Paresis			1	2.2
Paralysis			2	4.4
No limitation			37	82.2
Post-operative surgical site related pain	3.5	0.7
Yes			2	4.4
Post-operative surgical site unrelated pain	2.0	-
Yes			1	2.2
Total			45	100.0

ELPO items	Md	IQR	n	%
Surgical Position	1.0	4.0
Supine			29	64.5
Lithotomic			13	28.9
Prone			2	4.4
Lateral			1	2.2
Surgery length	2.0	2.0
Up to one hour			15	33.3
From one to two hours			17	37.9
From two to four hours			11	24.4
From four to six hours			2	4.4
Type of anesthetic	3.0	1.0
Regional			31	68.9
General			9	20.0
General and regional			3	6.7
Local			1	2.2
Sedation			1	2.2
Support surface	4.0	3.0
Foam and cotton cushions			28	62.2
Viscoelastic and viscoelastic cushions			16	35.6
Foam and viscoelastic cushions			1	2.2
Limb position	2.0	3.0
Anatomic position			13	28.9
Lower limbs opened < 90º			10	22.2
Knees raised <90º and lower limbs opened <90º or neck with no mentosternal alignment.			6	13.3
Knees raised >90º or lower limbs opened >90º			16	35.6
Comorbidities	1.0	1.0
No comorbidities			29	64.5
Vascular diseases			10	22.2
Diabetes Mellitus			5	11.1
PL or previously diagnosed neuropathy or DVT			1	2.2
Patient's age (in years)	2.0	1.0
≥18 and ≤39			10	22.2
≥40 and ≤59			23	51.1
≥60 and ≤69			4	8.9
≥70 and ≤79			5	11.1
≥80			3	6.7
Total			45	100.0

Characteristic	ELPO classification
	Highest risk		Lowest risk		p
	n	%	n	%
Gender					0.469^b
Female	12	26.7	23	51.1
Male	2	4.4	8	17.8
Age (years)					0.013^a
≤46	3	6.7	19	42.2
≥46	11	24.4	12	26.7
Profession					0.343^b
Retired/working	10	22.2	17	37.8
Unemployed/household worker	4	8.9	14	31.1
Origin					0.763^a
Teresina (urban and rural)	7	15.6	17	37.8
Other municipalities in Piauí	7	15.6	14	3.1
Surgical specialty					0.525^b
Gynecology	9	20.0	16	35.6
Urology, orthopedics or cardiology	5	11.1	15	33.3
BMI					0.520^b
24 or higher	6	13.3	18	40.0
Lower than 24	8	17.8	13	28.9
Systemic arterial hypertension					0.039^b
Yes	8	17.8	8	17.8
No	6	13.3	23	51.1
SSRP in the preoperative stage					1.000^b
Yes	1	2.2	2	4.4
No	13	28.9	29	64.4
SSUP in the preoperative stage					0.166^b
Yes	3	6.7	2	4.4
No	11	24.4	29	64.4
Pre-operative pressure lesion					0.311^b
Yes	1	2.2	0	0.0
No	13	28.9	31	68.9
Previous pressure lesion					0.224^b
Yes	2	4.4	1	2.2
No	12	26.7	30	66.7
Braden Classification					0.578^b
Some risk	2	4.4	2	4.4
No risk	12	26.7	29	64.4
Physical limitations					0.231^b
Some limitations	4	8.9	4	8.9
No limitation	10	22.2	27	60.0
SSRP					0.530^b
Yes	1	2.2	1	2.2
No	13	28.9	30	66.7
SSUP					0.311^b
Yes	1	2.2	0	0.0
No	13	28.9	31	68.9
Total	14	31.1	31	68.9

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author:
Haglaia Moira Brito de Sena oliveira. haglaiaoliveira@gmail.com