Risk Factors for Facial Pressure Ulcers in Patients Who Underwent Prolonged Prone Orthopedic Spine Surgery

Mini This study evaluated incidence and risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position. A total of 300 cases were studied. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. Hypotension, higher temperature, prolonged operation time, and much crystalloid therapy were the independent risk factors Study Design. Retroprospective study. Objectives. The aim of this study was to identify the incidence and the risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position for at least 3 hours. Summary of Background Data. FPU is a serious complication that can occur after prolonged surgery in the prone position. Methods. A total of 300 cases were studied (160 retrospective cases and 140 prospective cases). Preoperative, intraoperative, and postoperative data were collected using a structured record form. Patients were divided into FPU group and normal group. A univariate and multivariate logistic regression was used to determine the association of predictor variables. Results. FPU occurred in 82 patients (27.3%), 129 zones, and 151 lesions. The average age was 61.9 years (11–89), the average operating time was 3.8 hours (3–8.3). The locations of FPU were the forehead, maxillary, and chin zone (33.3%, 34.1%, and 32.5%, respectively). The severity was mostly stage I or II except one patient who developed stage III on the entire face. Patients in the FPU group had significant difference in: operation time (4.4 vs. 3.6 hours), anesthetic time (5.2 vs. 4.0 hours), hypotension (79% vs. 56%), lowest blood pressure, total blood loss, total crystalloid, colloid and blood replacement, highest temperature (36.5 C° vs. 36.2 C°) compared to the normal group (P < 0.05). Factors related to FPU were hypotension odds ratio (OR) 2.75 (95% confidence interval [CI] 1.4–5.2, P = 0.002), highest temperature OR 1.95 (95% CI 1.1–3.3, P = 0.013), operation time OR 1.44 (95% CI 1.0–1.9, P = 0.014), and total crystalloid therapy OR 1.07 (95% CI 1.0–1.1, P = 0.042). Conclusion. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. The risk factors of developing FPU included: hypotension, higher temperature, prolonged operation time, and much crystalloid therapy. Level of Evidence: 4