Incidence rate and risk factors of intraoperative-acquired pressure injury in posterior interbody fusion: A retrospective study of a national inpatient sample database

Abstract

Background

Intraoperative-acquired pressure injuries (IAPIs) are a common complication in posterior intervertebral fusion surgery, leading to adverse outcomes for patients. However, there is a lack of large-scale national database research analyzing the morbidity and associated risk factors of IAPIs in this surgical procedure.

Methods

This retrospective study analyzed data from the National Inpatient Sample (NIS) database from 2010 to 2019. Demographic, hospital, and patient characteristics were examined, including length of stay (LOS), total costs, in-hospital mortality, preoperative comorbidities, and complications.

Result

The overall incidence of IAPIs in posterior intervertebral fusion surgery was 0.2 % from 2010 to 2019. The annual occurrence of interbody fusion demonstrated an M-shaped trend, with rates of 0.2 % in 2010, 0.05 % in 2016, and 0.05 % in 2019. IAPIs were associated with increased preoperative complications, longer LOS, higher total hospitalization costs, and higher in-hospital mortality rates. Risk factors for IAPIs included comorbidities, large hospitals, urban hospitals, deficiency anemia, coagulation disorders, fluid electrolyte disorders, paralysis, and weight loss. Additionally, IAPIs were linked to medical complications such as sepsis, deep vein thrombosis, urinary tract infections, acute renal failure, shock, pneumonia, blood transfusion, and surgical complications such as cerebrospinal fluid leak. Elective admission was found to be a protective factor.

Conclusion

Identifying risk factors for IAPIs in posterior intervertebral fusion surgery can help identify high-risk patients and develop preventive measures. By targeting these risk factors, the incidence of IAPIs can be reduced, leading to improved patient outcomes.