Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the Border Operating room Spinal Surgery (BOSS) trial in Japan

Abstract

Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton-Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane film dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P = 0·027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of <50 mmHg (P = 0·025, OR 3·74, 95% confidence interval [CI] 1·18-13·08) and the length of surgery (by 1 hour: P = 0·038, OR 1·61, 95% CI 1·03-2·64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P = 0·019, OR 0·23, 95% CI 0·05-0·79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients.

Keywords: Intraoperatively acquired pressure ulcers; Perioperative nursing; Pressure ulcer prevention; Soft silicone foam dressings; spinal surgery.

© 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

Figure 1

Relton‐Hall frame. The Relton‐Hall frame is a device that supports the trunk at four points, thereby avoiding excessive pressure on the abdomen. Additionally, the pads of the Relton‐Hall frame tilt medially in order to increase the stable fixation.

Figure 2

Interface pressure mapping in the prone position using a Relton‐Hall frame for the preliminary test. The interface pressure of the left side and right side showed a high degree of similarity. The chest pressures on both the left and right sides were higher than the pressures of the iliac crest.

Figure 3

Dressing application. Soft silicone foam dressings was applied on left side of the chest and the iliac crest. Polyurethane film dressings was applied on right side of the chest and the iliac crest.

Figure 4

Positioning methods on the Relton‐Hall frame. The cut urethane foam mattresses were placed on the Relton‐Hall frame pads, and the patient was placed in the prone position on the urethane foam mattresses. Both arms were fixed on external arm boards. The entirety of the lower limbs was placed on a pressure‐distributing mattress over the operating table mattress, which was fixed in accordance with the physiological curvature. The face was held by a Protective Helmet System made of urethane foam cushion.

Figure 5

Flow of the participants throughout the study. About 113 patients were assessed for eligibility during the study period. Excluding 13 patients, we analysed the data of the remaining 100 patients.