Under Pressure: A Quality Improvement Initiative to Reduce Rhabdomyolysis and Hospital-Acquired Pressure Injuries Following Retroperitoneal Surgery.

Abstract

Introduction: Present a retrospective quality improvement analysis assessing the incidence and factors associated with elevated creatine kinase (CK) levels, clinical rhabdomyolysis, and hospital-acquired pressure injuries (HAPIs) following complex retroperitoneal surgeries before and after the implementation of The Pink Pad for intraoperative positioning.

Methods: We performed a retrospective analysis of 364 patients who underwent renal or retroperitoneal surgery in the lateral decubitus position between July 2018 through July 2023. The 2 cohorts-pre-and post-Pink Pad utilization-were analyzed, each with 2.5 years of prospectively-maintained data available for analysis.

Results: Three hundred forty-five patients were analyzed and of those, 153 (44.3%) had flank surgery without and 192 (55.7%) with The Pink Pad. In the whole cohort, patients who developed elevated CK values were younger, had a higher BMI, higher preoperative Cr, and longer operative time (P < .05). HAPIs were more frequent in younger patients, those having right-sided surgery, those with hypertension, and in patients with longer surgeries (P < .05). The frequency of HAPIs (without Pink Pad = 7 [4.6%] vs with Pink Pad = 2 [1%], P = .041), elevated CK values (without Pink Pad = 18 [11.8%] vs with Pink Pad = 0, P < .001), and clinical rhabdomyolysis (without Pink Pad = 9 [2.6%] vs with Pink Pad = 0, P < .001) was significantly lower in The Pink Pad group.

Conclusions: Implementation of The Pink Pad significantly reduced rates of postoperative CK value elevation and HAPIs caused by lateral decubitus positioning. Further studies should be performed to confirm these findings.