Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2026 Aug 28;51(8):1727-1740. doi: 10.11817/j.issn.1672-7347.2026.260198.
ABSTRACT
OBJECTIVES: Surgical patients are required to remain in the same position on the operating table for prolonged periods and are unable to reposition themselves under general anesthesia. International pressure injury guidelines identify surgical patients as a population at high risk of pressure injury. This study aims to investigate risk factors for intraoperatively acquired pressure injury in orthopedic patients by collecting clinical data from hospitalized orthopedic patients and to develop a nomogram prediction model, thereby providing a scientific basis for identifying patients at high risk of pressure injury during orthopedic surgery.
METHODS: A real-world prospective cohort study was conducted among 1 498 patients who underwent orthopedic surgery at Xiangya Hospital, Central South University, from June 2022 to December 2022. Of these, 200 developed intraoperatively acquired pressure injury and 1 298 did not. Exposure variables included baseline characteristics, medical history, preoperative factors, and intraoperative indicators. Univariate and multivariate logistic regression analyses were performed to identify exposure factors associated with intraoperatively acquired pressure injury. A nomogram was constructed, and its predictive performance was evaluated in terms of discrimination, calibration, and internal validation.
RESULTS: Multivariate Logistic regression analysis showed that body mass index (BMI)<18.5 kg/m2 (OR=16.70, 95% CI 9.08 to 31.30; P<0.001), BMI ≥24.0 kg/m2 (OR=1.93, 95% CI 1.18 to 3.19; P=0.009), longer operation duration (OR=2.33, 95% CI 1.91 to 2.89; P<0.001), intraoperative wetness of the pressure-bearing area (OR=3.53, 95% CI 1.38 to 9.57; P=0.010), surgical positioning in supine (OR=5.61, 95% CI 1.31 to 22.90; P=0.018), lateral (OR=3.29, 95% CI 1.17 to 9.08; P=0.022), or beach-chair position (OR=31.70, 95% CI 3.16 to 247.000; P=0.001), and the use of a headrest or head ring during surgery (OR=5.21, 95% CI 1.25 to 20.80; P=0.021) were significantly associated with the occurrence of intraoperatively acquired pressure injury in orthopedic patients. Furthermore, statistically significant variables from the multivariate analysis were used as predictors to develop a nomogram scoring system. The concordance indices of the nomogram for predicting pressure injury probability were 0.857 (95% CI 0.825 to 0.889) in the training set and 0.842 (95% CI 0.788 to 0.895) in the validation set, with mean absolute errors of 0.028 and 0.038, respectively.
CONCLUSIONS: This study identified that BMI <18.5 kg/m2, BMI ≥24.0 kg/m2, longer operation duration, moisture at pressure-bearing sites during surgery, the supine, lateral, and beach-chair positions, and intraoperative use of a headrest or head ring were independently associated with intraoperatively acquired pressure injury in orthopedic patients. The nomogram risk prediction model developed on the basis of the multivariable analysis may help identify patients at high risk of intraoperatively acquired pressure injury.
PMID:42935202 | DOI:10.11817/j.issn.1672-7347.2026.260198