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Abstract
Approximately 25% of all hospital acquired pressure injuries (HAPI) begin in the perioperative area. The study purposes were to identify risk factors in adult surgical patients undergoing orthopedic spine surgery in the prone position and compare three HAPI risk assessment tools in perioperative patients. This was a single center, retrospective study electronic medical record (EMR) data. HAPI incidence was 1.14% (51/4466). Person, nursing, and environmental factors were analyzed using logistic regression. Factors from each domain predicted HAPI development. HAPI was associated with longer length of stay and discharge to home with support or a sub-acute facility (p<.001). Using Receiver-operating characteristic (ROC) analysis, area under the curve (AOC) of the ROC for the Braden Risk Assessment Scale (BRAS) was not different from 0.5 (p<.200). AUC of the ROC for Scott Triggers Tool and Munro PACU Total score were different from 0.5 (p<.001). preoperative BRAS cutoff value of 18 yielded Sensitivity 36% and Specificity 75%. Munro PACU Total cutoff value of 29 yielded Sensitivity 87% and Specificity 42%. Scott Triggers cutoff value of 1 yielded Sensitivity 76% and Specificity 44%. A Munro Preoperative score may be more useful than a preoperative BRAS score to guide nurses in planning and implementing preoperative HAPI interventions. Given the low Specificity, the Munro Risk Assessment Tool requires refinement to improve the psychometrics. Prospective research is needed to test perioperative interventions to decrease HAPI in this specialty population and refine the Munro Tool.
