Risk of pressure ulcer development in surgical patients: a review of the literature.

OBJECTIVE: The purpose of this paper is to review the scientific knowledge about risk factors for pressure ulcer development in the surgical population. DATA SOURCE: A literature review was conducted from 1960 to present using MEDLINE and the key words pressure ulcer, decubitus ulcer, surgery, surgical patient, research, clinical research, and human. All sources were English. STUDY SELECTION: Included were articles that specifically addressed the risk of pressure ulcers in the surgical population and had ulcer formation as an outcome measure. DATA EXTRACTION: All data were reviewed and extracted by the author. DATA SYNTHESIS: The development of pressure ulcers has been explored in only a small proportion of surgical patients. Few groups of surgical patients have been addressed. Major surgical populations potentially at risk because of their immobility, debility, and therapy have not been studied. A portion of the literature is quite old and one issue is whether the older studies are relevant, considering the rate of change in treatment. Pressure relief, seen as the single most important factor in pressure ulcer prevention, is underrepresented in the analysis of factors leading to pressure ulcer development.
CONCLUSION: There is limited information about pressure ulcer risk in the preoperative, intraoperative, and postoperative periods. Because the surgical period is defined temporally, and more so than pressure ulcers in the chronically ill, this paradigm must be examined using a time-based evaluation. The Agency for Health Care Policy and Research guideline for pressure ulcer prevention needs to be tested in surgical patients.