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Pressure ulcer risk factors in patients undergoing surgery


  • Margareta Lindgren PhD RN,

  • Mitra Unosson PhD RN,

  • Ann-Margret Krantz MScN RN,

  • Anna-Christina Ek PhD RN

Margareta Lindgren,
Department of Medicine and Care,
Faculty of Health Sciences,
Linköping University,
SE-581 85 Linköping,


Aim.  This paper reports a study to identify risk factors associated with pressure ulcer development among a mixed group of adult patients undergoing surgery.

Background.  Few studies have been carried out with patients undergoing surgery to assess the risk of pressure ulcer development, and so there is a little knowledge of the risk factors for this group. However, studies among non-surgical patients have shown that nutritional predictors such as low serum albumin level and low body mass index (BMI) are of great importance. An additional predictive factor may be low blood pressure. It is important to study these predictors further among patients undergoing surgery, using techniques such as multiple regression techniques, designed to identify the most important predictors for pressure ulcer development.

Methods.  A prospective comparative study was carried out in 1996–1998 with 286 adult patients undergoing surgical treatment. The data were collected from patient records by Registered Nurses preoperatively, for seven days postoperatively and thereafter once a week for up to 12 weeks. Perioperative data were also collected. The Risk Assessment Pressure Sore Scale was used, and data were collected on general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin.

Results.  Forty-one (14·3%) patients developed pressure ulcers during the observation period. The most common type was non-blanchable erythema. Those who developed pressure ulcers were significantly older, weighed less, and had a lower BMI and serum albumin. More women than men developed pressure ulcers. Risk factors identified in multiple stepwise regression analyses were female gender, American Society of Anaesthesiologists (ASA) status or New York Heart Association (NYHA) status and food-intake.

Conclusion.  Special attention, with regard to risk of pressure ulcer development, should be paid to patients undergoing surgery who have low ASA or NYHA scores, low food intake and/or are women.