ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
A Retrospective Cohort Study of a PIRFAS-and Ultrasound-Guided Program for Pressure Ulcers in Prone Orthopedic Surgery
Provisionally accepted
Lijie Yuan
Ying Fu*- Harbin Medical University Cancer Hospital, Harbin, China
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Pressure ulcers appreciate as a prevalent intraoperative complication in prone-positioned orthopedic surgery patients. This study aimed to explore the effects of a gradient warning nursing procedure (GWNP) guided by pressure injury risk factor assessment scale (PIRFAS) and ultrasonography on pressure ulcers in prone-positioned orthopedic operation patients.This retrospective cohort study enrolled 126 patients who underwent prone-positioned orthopedic surgery at our hospital between May 2022 and May 2024. The assignment to groups was based on a hospital-wide implementation of a new nursing protocol on June 1, 2023. Accordingly, 60 patients admitted before this date constituted the regular group and received regular care, while 66 patients admitted on or after this date constituted the joint group and received the gradient early warning nursing procedure guided by the Pressure Injury Risk Factor Assessment Scale (PIRFAS) and ultrasonography, in addition to regular care.The results in our study revealed that the incidence (aOR: 0.11, 95% CI: 0.02 – 0.48), number (aMD: -0.82, 95% CI: -1.04 – -0.60), area (aMD: -0.62, 95% CI: -0.83 – -0.41) and grading of pressure ulcers were significantly decreased in the joint group versus the regular group (P < 0.05), indicating the implement of the gradient early warning nursing procedure guided by the PIRFAS and ultrasonography effectively reduced the incidence and the tissue damage severity. There was no statistically significant difference in the comparison of GCQ scores of dimensions prior to nursing in the two groups (P＞0.05), whereas the GCQ scores regarding physiological (aMD: 3.32, 95% CI: 2.45 – 4.19) and psycho-spiritual (aMD: 2.23, 95% CI: 1.38 – 3.08) aspects in the joint group post nursing were evidently higher versus the regular group (P < 0.05), with difference insignificant in environmental and socio-culture scores.The GWNP guided by PIRFAS and ultrasonography could effectively represents an effective bundled intervention for prone-positioned orthopedic surgery. Implementation of this protocol in clinical practice can potentially enhance patient safety by reducing pressure ulcer incidence and severity, while also improving healthcare resource utilization. Future research should focus on validating these findings through multicenter randomized controlled trials.
Keywords: Orthopedic Procedures, Perioperative Nursing, Pressure Ulcer, Prone Position, Ultrasonography
Received: 23 Jul 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Yuan and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ying Fu
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