J. Stevens and colleagues from the National Cancer Institute (NCI) of the National Institutes of Health performed a retrospective study to determine the incidence of, and variables associated with, postoperative pressure sores following renal or adrenal surgery.

They performed chart reviews of patients who were admitted to the urologic oncology service, had undergone at least one major surgery under general anesthesia and had complete medical records. Three hundred eighty two patients met these criteria.

Their results were reported in the August 2004 edition of Urology. A total of 55 (14.4%) patients had postoperative skin breakdown. Of these, 64% had grade I, 33% had grade II, none had grade III, and 1.8% had grade IV breakdown. Patients who were in the lateral position were at greater risk than those in the supine position (estimated odds ration 8.1). Longer operative times were also a risk factor. When the operative times were broken into subgroups of 0-3 hours, 3-6 hours, and 6 hours or more, with the 0-3 hour subgroup being the reference, the relative risk of developing skin breakdown in the groups was 1, 2.7, and 9.6 respectively. Other factors such as use of a Vac Pac or belt, patient sex, estimated blood loss, or diagnosis of von Hippel-Lindau disease did not increase the risk of postoperative pressure sores.

Therefore, in order to minimize the incidence of skin breakdown, the surgeon must pay careful attention to proper positioning and padding when placing the patient in the lateral position or when lengthy operative times are expected.

Urology 2004; 64(2):246-249