복위 척추 수술 환자의 의료기기 관련 욕창 발생 위험요인

Abstract

Purpose This study examined the incidence of medical device-related pressure injuries (MDRPIs) and the risk factors for onset of MDRPIs in patients with spinal surgery in the prone position.

Method The study design was prospective, observational with medical record review. Participants who underwent spinal surgery in the prone position were at an orthopedic hospital located in Busan, Korea. The inclusion criteria stipulated that participants 1) had never undergone previous spinal surgery, 2) had no pressure injuries before admission to the operating room, and 3) completed the consent form for study participation. Data of 6 points under the medical devices (Bispectroal index, face foam positioners, blood pressure cuff, Wilson spine frame, taping areas on face, and endotracheal tube) in 147 patients were analysed. Descriptive analysis, t-test, chi-square test, point biserial correlations, Spearman's rank correlations, and multiple logistic regressions were performed.

Result Three points under Bispectral index, Wilson spine frame, and endotracheal tube had MDRPIs. The highest incidence of MDRPIs occurred under Wilson spine frame (56.5%), the mean size was 38.19*5.63cm. Incidence of MDRPI caused by Bispectral index was correlated with age (ρ=.291, p<.001), sex (rpb=.213, p=.010), operation time (ρ=.492, p<.001), American Society of Anesthesiologists classification (ASA) (rpb=.339, p<.001), and serum albumin (ρ=-.165, p=.046). There was a significant relationship between incidence of MDRPI under Wilson spine frame with operation time (ρ=.534, p<.001), ASA (rpb=.251, p=.002), and protein level (ρ=.171, p=.038). MDRPI caused by endotracheal tube was associated with operation time (ρ=.171, p=.038) and ASA (rpb=.171, p=.038). The common risk factors of MDRPIs in patients with spinal surgery in the prone position were operation time. In the MDRPI under Wilson spine frame, lower BMI (Odds Ratio; 46.57, 95% Confidence Interval: 6.37∼340.25) was a critical risk factor for incidence of MDRPI.

Conclusion Based on the results of this study, the most important risk factors for incidence of MDRPIs in patients with spinal surgery in the prone position were operating time. Therefore, appropriate MDRPIs preventive strategies considering these factors should be provided.