The Risk Factors of Postoperative Pressure Ulcer After Liver Resection With Long Surgical Duration

A Retrospective Study

Hong-Lin Chen, MD; Ai-Gui Jiang, MD; Bin Zhu, MD; Ji-Yu Cai, MM; Yi-Ping Song, MM


Wounds. 2019;31(9):242-245. 

In This Article

Abstract and Introduction


Objective: The aim of this study is to investigate the risk factors of postoperative pressure ulcer (PU) development after liver resection with a long surgical duration.

Materials and Methods: A retrospective analysis was performed of patients who underwent a liver resection with a surgical duration greater than 2 hours between January 2015 and December 2016 at a tertiary referral hospital in eastern China. Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors for postoperative PUs.

Results: Of the 128 patients included in the study, 11 (8.6%; 95% confidence interval [CI], 4.4%–14.9%) developed a stage 1 PU. Univariate analysis showed albumin on admission, diabetes mellitus complication, length of surgery, and intraoperative blood loss were all significantly different between the developed PU group (n = 11) and no PU group (n = 117; P < .05). However, multivariate logistic regression showed length of surgery (odds ratio [OR] = 1.026; 95% CI, 1.008–1.146) and intraoperative blood loss (OR = 1.014; 95% CI, 1.009–1.124) as only the independent risk factors for PU development after liver resection with a long surgical duration.

Conclusions: These results showed length of surgery and intraoperative blood loss were independent risk factors for PU after liver resection with a long surgical duration. Use of PU prevention strategies are recommended for patients who undergo liver resection with massive intraoperative blood loss and long surgical duration.


Surgery-related pressure ulcer (PU) is a common type of PU. A previous systematic review showed the incidence of surgery-related PU was 15%, with a 95% confidence interval (CI) of 14% to 16%.[1] These PUs cause significant pain and additional costs. One study[2] showed surgical patients who developed a PU had an extended mean length of hospital stay (28.1 days; up from 10.3 days), increased medical expenditure on antibiotics (risk ratio 2.60; 95% CI, 1.88–3.60), and about 1.83-fold risk (95% CI, 1.54–2.18) of 30-day postoperative mortality compared with a control group. Therefore, it is critical to prevent postoperative PU.

The most common types of surgery associated with PU development are cardiac, general/thoracic, orthopedic, and vascular procedures.[3] However, in clinical practice, the authors also found PUs could develop in patients receiving liver resection, especially in long and complex surgeries. The authors' previous study found length of surgery is an important risk factor for PUs in the cardiovascular surgical patient.[4] Long surgical duration will increase tissue pressure time, allowing a PU to develop. It seems long surgical duration may be a risk factor for PUs in patients who undergo liver resection. However, no study was found assessing this relationship, and other risk factors for PUs in patients with liver resection are unknown.

This study aims to investigate the risk factors of PU following liver resection with long surgical duration.