The importance of repeated risk assessment for pressure sores in cardiovascular surgery.

BACKGROUND: Patients undergoing cardiovascular surgery are at high risk for sores because of impaired perfusion, the time spent on the operating room table, and restricted mobility in the immediate postoperative period. OBJECTIVE: To identify risk factors for sores. METHODS: In a 900-bed teaching hospital, 163 patients who underwent cardiovascular interventions were enrolled. Risk measurement included skin assessment, Braden and Norton scales, physic and biologic data and specific risk factors. The development of the most severe stages of pressure sores was followed (Stages II and III). RESULTS: Forty-eight (29.5%) patients totalized 75 pressure sores. In univariate analyses, Norton and Braden scores, hemoglobin concentration, presence of ulcers at admission, use of antihypertensive drugs, systemic use of corticosteroids, nosocomial infection, re-intervention and readmission in intensive care units were associated with sores. In a logistic regression model, hemoglobin concentration at admission (p=0.0007), postoperative Braden score (p=0.0002), and postoperative steroid therapy (p=0.020) were the only predictors of sores. Total length of stay was 6 days higher (p=0.03) for patients with pressure sores. CONCLUSIONS: The detection of risks is recommended during the entire stay. Identification of patients at risk is required to provide preventive resources appropriately, which can lessen the incidence of pressure sores and reduce patient discomfort, length and costs of hospital stay.