Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors
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Data de Publicação: | 2013 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006 |
Resumo: | Introduction: The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors. Materials and Methods: Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS ≥ 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury. Results: Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS ≥ 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn’t found a statistically significant relationship. Conclusion: The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance. Keywords: Intraoperative Complications; Posture; Surgical Procedures, Operative; Wounds and Injuries/etiology. |
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Injuries Resulting from Positioning for Surgery: Incidence and Risk FactorsLesões Decorrentes do Posicionamento para Cirurgia: Incidência e Fatores de RiscoIntroduction: The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors. Materials and Methods: Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS ≥ 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury. Results: Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS ≥ 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn’t found a statistically significant relationship. Conclusion: The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance. Keywords: Intraoperative Complications; Posture; Surgical Procedures, Operative; Wounds and Injuries/etiology.Introdução: O posicionamento cirúrgico adequado é um passo essencial que é muitas vezes subestimado, no entanto há que considerar que pode levar a lesões graves, mas evitáveis. O objetivo deste estudo é avaliar a incidência de lesão decorrente do posicionamento cirúrgico, bem como tentar identificar os seus fatores de risco. Material e Métodos: Estudo prospetivo que decorreu durante um ano e incluiu doentes de diferentes especialidades cirúrgicas propostos para cirurgia eletiva. Os doentes foram avaliados previamente à intervenção cirúrgica, sendo considerados critérios de exclusão: idade menos de 18 anos, classificação da American Society of Anesthesiologists ASA > III, neuropatia ou doenças neuromusculares documentadas. Consideraram-se lesões decorrentes do posicionamento: eritema não reversível sob digitopressão e/ou persistente > 30 minutos; dor severa em pontos de pressão e não relacionada com o local cirúrgico (Escala analógica visual - VAS ≥ 7) e lesão de nervo periférico. Avaliaram-se as variáveis: sexo, idade, Índice Massa Corporal, classificação ASA, técnica anestésica, tipo de posicionamento, duração da cirurgia e a sua relação com o aparecimento de lesão pós-operatória. Resultados: Dos 172 doentes incluídos no estudo, foram identificadas lesões perioperatórias em 12,2%, sendo que cinco destes doentes apresentaram mais do que uma lesão (dor em ponto de pressão + neuropatia). Destes, 9,9% queixou-se de dor severa (Escala analógica visual - VAS ≥ 7) em pontos de pressão, 4,7% apresentou neuropatia periférica e 0,6% apresentou eritema que não cedia à digitopressão. No grupo que desenvolveu lesão, não houve diferença significativa no que diz respeito à idade, sexo, técnica anestésica, duração da cirurgia e posicionamento. No que diz respeito à classificação ASA, verificou-se que os doentes ASA II e III apresentaram uma maior incidência de lesão (90,5%) quando comparados com os doentes ASA I (9,5%), p < 0,05. O Índice Massa Corporal > 30 Kg / m2 mostrou também estar associado ao desenvolvimento de lesão perioperatória, p < 0,001. Na análise isolada de lesão neuropática constatou-se que o Índice de Massa Corporal > 30 Kg / m2 estava relacionado com a ocorrência de neuropatia, p < 0,05. No que se refere às restantes variáveis e sua relação com neuropatia pós-operatória, não se verificou uma relação estatisticamente significativa. Conclusão: A evidência científica para a prevenção das lesões no peri operatório, nomeadamente das neuropatias, é limitada. A avaliação pós-operatória dos doentes é também essencial pois permite o reconhecimento precoce das lesões e a sua documentação e orientação.Ordem dos Médicos2013-04-24info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006oai:ojs.www.actamedicaportuguesa.com:article/4006Acta Médica Portuguesa; Vol. 26 No. 1 (2013): January-February; 12-16Acta Médica Portuguesa; Vol. 26 N.º 1 (2013): Janeiro-Fevereiro; 12-161646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006/3204https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006/4127Menezes, SóniaRodrigues, ReginaTranquada, RaquelMüller, SofiaGama, KarinaManso, Tâniainfo:eu-repo/semantics/openAccess2022-12-20T11:03:11Zoai:ojs.www.actamedicaportuguesa.com:article/4006Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:18:40.253078Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors Lesões Decorrentes do Posicionamento para Cirurgia: Incidência e Fatores de Risco |
title |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
spellingShingle |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors Menezes, Sónia |
title_short |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
title_full |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
title_fullStr |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
title_full_unstemmed |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
title_sort |
Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors |
author |
Menezes, Sónia |
author_facet |
Menezes, Sónia Rodrigues, Regina Tranquada, Raquel Müller, Sofia Gama, Karina Manso, Tânia |
author_role |
author |
author2 |
Rodrigues, Regina Tranquada, Raquel Müller, Sofia Gama, Karina Manso, Tânia |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Menezes, Sónia Rodrigues, Regina Tranquada, Raquel Müller, Sofia Gama, Karina Manso, Tânia |
description |
Introduction: The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors. Materials and Methods: Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS ≥ 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury. Results: Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS ≥ 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn’t found a statistically significant relationship. Conclusion: The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance. Keywords: Intraoperative Complications; Posture; Surgical Procedures, Operative; Wounds and Injuries/etiology. |
publishDate |
2013 |
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2013-04-24 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006/3204 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4006/4127 |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 26 No. 1 (2013): January-February; 12-16 Acta Médica Portuguesa; Vol. 26 N.º 1 (2013): Janeiro-Fevereiro; 12-16 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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