Abstract
Spine surgery performed in the prone position carries the risk of developing pressure injuries (PI). PI can lead to prolonged hospital stay, high medical costs, unwanted cosmetic changes to the face and body, and social and psychological issues. Due to the higher likelihood of skin and soft tissue infections in diabetic patients, these individuals are at a high risk of developing perioperative PI. This study aimed to investigate the effects of spinal surgery performed in the prone position on the development of surgical site infections in patients with diabetes. We conducted a prospective cohort study in diabetic patients over 18 years of age, scheduled for elective spinal surgery in the prone position, with an American Society of Anesthesiologists physical status score of I to IV, and without any preoperative clinical signs of PI on physical examination. All patients received the same anesthesia protocol during induction and maintenance. Patients were divided into 2 groups according to the presence or absence of postoperative PI. Demographic characteristics, perioperative vital signs, laboratory findings, surgical data, intraoperative variables, and postoperative PI findings within the first 24 hours were recorded. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors. A total of 115 patients were analyzed. Compared with the absence-PI group, patients who developed PI had significantly higher body mass index [31.6 (27.5-35) vs 27.7 (26-31.2), P = .019] and insulin usage (20.2% vs 0%, P = .011). PI incidence was significantly higher in patients with anesthesia duration ≥2.5 hours compared with <2.5 hours (56.2% vs 30.8%, P = .040). In multivariate analysis, anesthesia duration ≥2.5 hours (odds ratios = 3.19, 95% confidence interval: 1.19-9.24, P = .025) remained an independent predictor of PI. In patients with diabetes undergoing spinal surgery in the prone position, a significant relationship was found between the development of PI and body mass index, insulin use, anesthesia duration, and HbA1c level. It was concluded that an anesthesia duration of >2.5 hours is an independent risk factor for the development of PI, and the threshold level of HbA1c is ≥7.6%. These findings highlight the role of preoperative risk assessment and surgical duration optimization in minimizing PIs among diabetic patients.