Risk factors for pressure ulcer development among adults undergoing surgery: a systematic review

OBJECTIVE: To examine risk factors for pressure ulcer (PU) development among adults undergoing surgery. METHOD: A total of five electronic databases were searched from inception to March 2024. Study selection, data extraction and quality appraisal were performed by two independent reviewers, using the Crowe Critical Appraisal Tool (CCAT v1.4; Michael Crowe, James Cook University, Australia), with scores ≥75% indicating high methodological quality. Results were categorised and reported as preoperative, intraoperative and postoperative risk factors, with percentages representing the proportion of studies assessing each risk factor in which it was statistically significant. Due to methodological heterogeneity, findings were synthesised narratively. RESULTS: A total of 41 studies were included, 20 (48.8%) of which had retrospective designs. Among the preoperative risk factors, Braden score was statistically significant in 11 (68.8%) of the 16 studies assessing this factor, age in 19 (61.3%) of 31 studies, and diabetes in 11 (61.1%) of 18 studies. Among intraoperative risk factors, duration of surgery was statistically significant in 15 (53.6%) of 28 studies assessing this factor, patient positioning in nine (60.0%) of 15 studies, and type of surgery in nine (60.0%) of 15 studies. Postoperatively, Braden Scale score was statistically significant in five (83.3%) of six studies, while sepsis and pneumonia were each statistically significant in all three (100%) studies assessing these factors. The mean methodological quality score was 82±9.7%. CONCLUSION: This systematic review identified several risk factors for PU development across the included studies during the preoperative, intraoperative, and postoperative surgical period. Due to the complex interplay between competing factors that impact PU development during surgery, the development of a core outcome set of risk factor variables for inclusion in future studies may enhance homogeneity and support risk stratification alongside optimisation of modifiable exposure factors.