Safeguarding Patients: Reducing the Risk of OR Acquired Pressure Injuries

Pressure injuries are a risk to any patient entering the operating room (OR). It’s hard to pinpoint the precise moment when and where it starts, but lengthy surgical procedures can be the culprit. Of the 2.5 million patients who develop pressure injuries a year, 23% of those pressure injuries are acquired in surgeries that last more than three hours. 4,12??

Damage from pressure injuries may not even be visible for hours or days after they form. Meaning, whether a patient develops a pressure injury during surgery or post-op, your OR remains at risk of liability. ?

That’s why it’s imperative to implement proper pressure management procedures for hospital-acquired pressure injuries (HAPI) and cover all your bases because the risks of a HAPI go far beyond just the patient’s suffering, as your entire hospital could be held accountable.??

What is an ORHAPI??

OR hospital-acquired pressure injuries (ORHAPI) are pressure injuries that are acquired in the Operating Room. Research has shown that surgical patients are 2 to 3 times more likely to develop hospital-acquired pressure injuries (HAPIs) than patients outside of the OR. 1 That risk only rises as the time of surgery increases (more on that to come).?

There’s no exact data on the incidence rate of ORHAPIs, as the National Database Nursing Quality Indicators (NDNQI) does not recognize the OR as a survey unit, but all HAPIs are considered a hospital-acquired condition (HAC) and are counted under the PSI-90 safety measure composite. While other HACs have decreased over time, the rates of HAPIs have exclusively increased since 2015, rising 30% in the two years between 2015 and 2017. 8?

The Risk of ORHAPIs?

As discussed, pressure injuries can be just as alarming for the hospitals and care teams involved as they are for the patients. HAPI related incidents leave severe financial burdens for hospitals to navigate. 2.5 million patients per year develop pressure injuries in the United States. 4 A single HAPI incident could cost anywhere from $500 to more than $70,000 in financial responsibility. 9 Moreover, US Centers for Medicare and Medicaid Services (CMS) have recently reduced reimbursement related to hospital‐acquired conditions, increasing the responsibility on the hospital. 11 This is a rising concern when you consider that Medicare beneficiaries are reporting chronic pressure injury care to account for about $22 billion in the US. 9??

These costs don’t even account for the expenses of legal liability if a patient or their family files a medical malpractice lawsuit. HAPIs are the second most frequent hospital lawsuit claim, just behind wrongful death. 3 Even beyond the costs of legal negotiations, settlements can lead to huge hits in a hospital’s profitability, and judgments against the hospital can lead to lasting impact on the hospital's reputation.?

But it’s easy to glean why a patient might seek legal action when you consider the cost from their perspective.?

HAPI Patient Consequences?

Patients’ risk for developing pressure injuries is dependent upon a variety of factors. Geriatric patients, diabetic patients, overweight patients, are all at higher risk of developing a pressure injury during surgery. But these outside factors do not retract liability away from the OR staff or hospital.?

Healthcare-associated pressure injuries cost approximately $10,708 per patient. With 2.5 million cases per year, this totals $26.8 billion annually in direct costs. 9 In 2007, Medicare also estimated that every pressure ulcer added $43,180 in costs to a hospital stay. 3 Which is unfortunate when you consider how much a pressure injury can prolong a hospital stay.?

Data from a retrospective study of 774 older adult patients who had Stage II pressure injuries indicated that the average time to healing was 46 days. 10 Results showed that the larger the pressure injury, the longer it took to heal: 10?

• A pressure injury 1 cm2 or less took 33 days to heal on average?

• A pressure injury > 1 cm2 to 4 cm2 took 53 days on average?

• A pressure injury > 4 cm2 took 73 days on average?

Equally alarming is that this not only represents the impact on the patients who recover from their wounds. Around 60,000 patients are reported to die as a direct result of a pressure ulcer each year. 3 To put that in perspective, that’s just below the 63,600 deaths that were reported from drug overdose, 5 and right above the 44,000 deaths reported from suicide.??

Preparing for High-Risk HAPI Incidents?

Pressure injuries are unpredictable and have arisen in even the most stable of conditions, but it’s still important to take extra measures to protect your patients and protect your organization’s liability.??

Firstly, you want to understand which procedures are more susceptible to OR hospital-acquired injuries. Studies have proven that the length of surgery aligns with the risk of PI development. Incidence rates of PIs for surgeries over five hours range from 9.9% up to 13.2%.2 The national survey reported that the most common surgical procedures related to pressure incidents were cardiac (29.3%), general/thoracic (27.7%), orthopedic (20.6%), and vascular (9.8%). 7??

Some specialties can face additional challenges with pressure injuries. Cardiac surgery patients, for instance, sometimes must use intra-aortic balloon pumps. While in use, patient movement is not allowed, severely limiting the ability to reposition patients throughout surgery.?

Additional risk factors unique to individual patient comorbidities add to the challenges of pressure management.?

There is no one solution to pressure injury abatement. Repositioning is a known solution to reducing risk but not every procedure provides the flexibility required to routinely reposition patients. Gel pad overlays and other surface covers are known to relieve pressure damage, but they don’t always cater to a variety of risks.??

Investing in Protecting Your Patients and Your Staff?

Fortunately, new technology is always arising, and while nothing has cured the surgical field of ORHAPI incidents, there are options that may complement your existing pressure management procedures.??

Mizuho OSI’s Aquari (TM) Immersion Simulation system relies on fluid immersion simulation to protect patients during long, high-risk surgeries. Unlike standard padding and protection, fluid immersion adapts to where the patient is feeling pressure most, conforming to the at-risk areas and maintaining tissue perfusion at a rate 6X more than other OR support surfaces. 6?

Aquari’s technology is up to the challenge. The fluid immersion simulation relieves pressure points even when repositioning opportunities are limited, making it great for procedures where the patient cannot be adjusted during surgery, such as cardiac procedures or transplant cases. The settings on Aquari additionally adapt based on patient weight, helping cater to higher-risk patients.?

If you’re looking to start finding the right solution for pressure injury prevention, then reach out to one of your local account managers today. The experts at Mizuho OSI are always willing to walk you through and demonstrate our lineup of pressure injury abatement solutions.?

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References:?

1. Padula WV, Black JM, Davidson PM, Kang SY, Pronovost PJ. Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions. J Patient Saf. 2020 Jun;16(2):e97-e102. doi: 10.1097/PTS.0000000000000517. PMID: 30110019.?

2. Esra ?lkhan, Gulten Sucu Dag, The incidence and risk factors of pressure injuries in surgical patients, Journal of Tissue Viability, Volume 32, Issue 3, 2023, Pages 383-388, ISSN 0965-206X

3. Are we ready for this change? Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

4. Preventing Pressure Ulcers in Hospitals. Content last reviewed February 2024. Agency for Healthcare Research and Quality, Rockville, MD.?

5. Hedegaard H, Warner M, Mini?o AM. Drug Overdose Deaths in the United States, 199–2016.?NHCS Data Brief. 2017;294:1‐8.???

6. Data on File; Mizuho OSI?

7. Aronovitch SA. Intraoperatively acquired pressure ulcer prevalence: a national study.?J Wound Ostomy Continence Nurs. 1999;26(3):130-136.?

8. Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019:1–7?

9.? Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019;16(3):634-640?

10. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.?

11. Hospital-acquired conditions.?The Centers for Medicare & Medicaid Services

12. Primiano M, Friend M, McClure C, Nardi S, Fix L, Schafer M, Savochka K, McNett M. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011 Dec;94(6):555-66. doi: 10.1016/j.aorn.2011.03.014. PMID: 22118201; PMCID: PMC4467017.?