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(17) Improvement in Patient Postoperative Skin Integrity for Long Duration Robotic Surgery

Allison Kalas


In robotic surgeries exceeding three hours, will releasing each shoulder bolster for five to 10 minutes every two to three hours result in improved postoperative skin integrity? In 2009, an increase in shoulder Stage 1-3 pressure ulcers (PU) was observed postoperatively in robotic surgical patients in steep Trendelenburg position for three hours or greater. One shoulder bolster was released for five to 10 minutes every three hours. The other shoulder bolster was not released. None of the released sites developed a PU while all of the non-released shoulders were assessed with post procedure stage 1-2 PU. After consultation with Ethics and Risk management, study design was modified to allow for bilateral shoulder bolster relief. In four robotic cases, the non-released shoulder revealed Stage 1-2 PU development while no damage was noted on the released shoulder. Seven cases with bilateral release showed no PU development. The PU assessment form for 556 surgical cases from March 30 to August 18, 2010 indicated 26 possible PUs. All but five instances subsided without PU development and none were robotic. This study demonstrated improved postoperative skin condition due to intermittent bolster release. Additional benefits were increased staff awareness of perioperative skin condition and improved interdepartmental communication.Based on these preliminary results, intermittent release of bolsters does improve postoperative skin integrity in long duration robotic surgeries. Intermittent pressure relief during surgery may improve postoperative skin integrity in other patients.

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