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More than 50% of older surgical patients are thought to have malnutrition that is associated with increased postoperative complications, prolonged length of hospitalization and increased health care cost.

The surgical patient is at a nutrition and fluid disadvantage right off the bat due to the “Nothing by Mouth” order.  The patients are getting ready to “run” the big surgical race with a fuel tank on empty! The tank needs to be filled during the preoperative, optimization time by implementing a nutritional plan that is right for the individual patient.

The lateral surgical position is one of the most labor-intensive surgical positions that depends on brute force and team strength.  The lateral position is not only physically taxing on the staff, but also can be as hard on the patient; therefore, it is important to have an experienced clinical team member leading the way.  The surgeries that rely on the lateral surgical position vary by specialty and include lateral hip, thoracotomy, spine surgery, or kidney surgery. Many times, the lateral position is preferred over prone when possible for obese patients because the bulk of the patients panniculus can be displaced off the abdomen.  To help improve patient outcomes, this blog will discuss the risk and interventions that are involved with placing a patient in the lateral position.

As we partner with colleagues across the nation in preparation for NPIAP’s World Wide Pressure Injury Prevention day on November 19^th, we are presented with an opportunity to reflect and evaluate the changes we have made to improve our patients’ pressure injury outcomes.  The hard work that has been done and the great outcomes that have been achieved, are triumphs that deserve to be celebrated and shared.  Whereas, the poor outcomes need to be evaluated and opportunities identified to implement evidence-based changes for improvement.

The supine position is the most common surgical position with the patient lying on their back with the head, neck and spine in a neutral position.   This position is not without pressure injury risk as there is increased pressure and shear forces to the scapula, occiput, elbows, sacrum, coccyx, and heels. Today we are going to look at ways to mitigate the risk for pressure injuries (PI) to the heel, related to the supine position. When a patient lies supine, all the pressure of their lower legs and feet rest on the heel.  Heel PI represents approximately one third of pressure injuries acquired, and can result in increased morbidity and mortality. In some cases, heel pressure injuries can lead to amputation of the affected limb.

The National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance reports that hospital-acquired pressure injury prevalence in acute care settings to be approximately 10%; their effects on both patients and hospitals is significant. In the previous blogs, we have discussed what can be done to mitigate risk in the preoperative and intraoperative phases of care.  Today, we will discuss the importance of continued risk assessment and interventions in the postoperative phases of care.