Backside first in head and neck surgery?: preventing pressure ulcers in extended length surgeries.

BACKGROUND: The operating room (OR) presents a high-risk environment for pressure injury. We designed a project to improve performance in the prevention of intraoperative pressure ulcers in extended length head and neck surgeries for malignancies (ELS) using a fluid mattress (RIK(R)) intraoperatively. METHODS: A descriptive design was used to monitor performance improvement in this underrecognized aspect of patient care. A fluid, pressure-reducing OR mattress (RIK) was compared with the use of a standard foam OR mattress (Skytron(R)). A convenience group of 36 consecutive patients, undergoing ELS, was included in the project. Patients were evaluated for presence or absence of a pressure ulcer immediately and 72 hours postoperatively. RESULTS: Patient groups were demographically and surgically comparable at a clinical level. Pressure ulcer incidence before intervention was 21% (4 of 19). This declined to 0% after intervention. CONCLUSIONS: Intraoperative pressure ulcers are a costly complication. Presence of a pressure ulcer extends time in the sick role and disrupts desired aesthetic outcomes. Use of a pressure-reducing device achieved the performance improvement objective. Implications for future research and current care are discussed. Copyright 2000 John Wiley & Sons, Inc. Head Neck 23: 25-28, 2001.