Risk factors related to pressure injury after spinal surgery in the prone position in patients with diabetes mellitus

Introduction: Spinal surgeries performed in the prone position carry a risk of developing pressure injuries (PI), particularly during prolonged procedures. The occurrence of PI can lead to extended hospital stays, increased medical costs, permanent cosmetic deformities on the face and body, and subsequently, social and psychological complications. Diabetes mellitus is a chronic condition that predisposes patients to skin and soft tissue infections due to impaired tissue perfusion and delayed wound healing. Therefore, diabetic patients are considered at higher risk for perioperative PI development. This study aims to evaluate the impact of prone-position spinal surgery on the development of PI in diabetic patients. Materials and Methods: This study included 115 diabetic patients who underwent elective spinal surgery. The same anesthesia protocol was applied to all patients during both induction and maintenance of anesthesia. Demographic data, perioperative vital signs, laboratory findings, surgical information, and intraoperative parameters were recorded prospectively. The location and stages of PI were assessed at the end of the surgery and on postoperative day 1. The stages of PIs were evaluated using the staging system of the National Pressure Injury Advisory Panel (NPIAP). Results: A total of 115 patients were included in the data analysis, consisting of 89 patients with PI and 26 patients without PI (control group). Compared to the control group, the PI group had a significantly higher body mass index (BMI) and a higher rate of insulin use (respectively, p=0,019 and p=0,011). The incidence of PI was significantly higher in procedures with anesthesia duration ≥2.5 hours (p=0,04). The optimal cutoff value of HbA1c for predicting PI development was determined as 7.6% (sensitivity: 36 [26,1–46,8], specificity: 100 [86,8–100], PPV: 100 [89,1–100], NPV: 31,3 [21,6-42,4]). In univariable regression analysis, the presence of comorbidities, BMI, anesthesia duration, and HbA1c levels were significantly associated with PI. In multivariable logistic regression analysis, PI development was independently associated only with anesthesia duration (OR: 3,19; 95% CI: 1,19–9.24; p=0,025). Discussion and Conclusion: In diabetic patients undergoing spinal surgery in the prone position, a persistent association was identified between the development of PI and BMI, insulin use, anesthesia duration, and HbA1c level. In particular, anesthesia duration ≥2.5 hours was found to be an independent risk factor for PI development, and the threshold HbA1c level was determined as ≥7.6%. Key Words: Diabetes Mellitus, Pressure İnjury, Prone Position, Spinal Surgery