The Risk Factors of Postoperative Pressure Ulcer After Liver Resection With Long Surgical Duration

A Retrospective Study

Hong-Lin Chen, MD; Ai-Gui Jiang, MD; Bin Zhu, MD; Ji-Yu Cai, MM; Yi-Ping Song, MM


Wounds. 2019;31(9):242-245. 

In This Article


In this study, the postoperative PU incidence in patients who underwent liver resection for longer than 2 hours was 8.6% (95% CI, 4.4%–14.9%). Length of surgery was found to be an independent risk factor for postoperative PU in these patients. The OR value for length of surgery and PU risk was 1.008 (95% CI, 1.002–1.146), which means when length of surgery increased every 1 minute, the PU risk will increase by 1.008 correspondingly. Schoonhoven et al[6] reported the risk of surgery-related PU increased as the length of surgery in minutes increased (OR = 1.0061; 95% CI, 1.0035–1.0087). Their results[6] in mixed surgical samples were similar to the present results of patients with a prolonged liver resection. Long surgical duration increases the amount of time a tissue experiences pressure and shear. Some animal model studies explained the correlation between tissue pressure time and the risk for PU development. In a porcine model, Daniel et al[7] found pressure exceeding 35 mm Hg for 2 hours would cause ischemia, resulting in a PU. In rat models, Linder-Ganz et al[8] reported the magnitude of cell death causing pressure strongly depends on the time of exposure.

The current study also found intraoperative blood loss was an independent risk factor for postoperative PU in patients with prolonged liver resection surgery. The OR for intraoperative blood loss and PU risk was 1.005 (95% CI, 1.001–1.124), which means when intraoperative blood loss increased every 1 milliliter, the PU risk will increase by 1.005 correspondingly. There may be an explanation for the relationship between intraoperative blood loss and PU risk. As massive intraoperative blood loss occurs, the peripheral blood vessels are vasoconstricted, reducing the supply of blood to the tissue. As Stordeur et al[9] reported, hypotensive periods were associated with PU incidence in cardiovascular surgical patients.

The Braden Scale is the most widely used tool for predicting PU risk and has been confirmed with good performance in the clinical setting.[10] A low Braden score is an important risk factor for PU; however, the present study did not use the Braden Scale for PU risk assessment in liver resection patients before the initiation of this retrospective study. Therefore, Braden score data cannot be collected. After this study, the authors prospectively began to use the Braden Scale for patients who underwent a liver resection with a surgical duration greater than 2 hours. Further study is needed to assess whether Braden score is a risk factor for the patient population studied herein.

Previous studies also showed serum Alb[11] and DM status[12] were related to PU incidence. In the univariate analysis of the present study, the authors still found admission Alb and DM status were significantly different between the 2 groups (P < .05), but Alb and DM were not statistically significant in the multivariate logistic regression. This is possibly due to the low sample size of this study. This study only included 128 patients, and other prospective cohorts with larger sample sizes are needed.