![]() ![]() The study enrolled 45 patients who were scheduled for open heart surgery under general anesthesia and were assessed as class III–IV according to the American Society of Anesthesiologists (ASA) physical status classification. Written informed consent was obtained from all patients during the preoperative visit. 017-06-008, Approval July 13, 2018), and was registered in the Clinical Research Information Service (Registration No. This randomized, double-blind, prospective study was conducted from July 2018 to January 2019 after receiving approval from the Institutional Review Board of Ilsan Paik Hospital (IRB no. However, no study using a donut-shaped cushion during surgery has been performed. Placement of the donut-shaped cushion on the sacral region during surgery limits contact of this area from the OR bed, and can reduce the risk for the development of pressure injury by decreasing pressure on this area, which is the most frequent site of postoperative pressure injury (39%). The donut-shaped cushion (width 35 cm, height 6, polystyrene beads filled cushion) is a cushion with a 10 cm diameter circular area open in the center. A self-adherent silicone border foam dressing was tested on patients in the ICU following cardiac surgery, but the results showed that there was no significant reduction in the number of pressure injuries. Despite the risk of developing pressure injuries in the OR, only a few studies on the prevention of postoperative pressure injuries after cardiac surgery have been performed. During cardiac surgery, patients are at risk for developing pressure injuries due to the prolonged period on the OR bed, inappropriate tissue perfusion, temperature fluctuations during surgery, and immobility in the early phase after surgery. In addition, exposure to humidity and contact with blood, irrigations, and disinfectants increase the risk for injuries. A patient on an OR bed is exposed to a high-temperature environment due to warming devices such as warming blankets. An OR bed is in a different environment compared to those of standard beds or mattresses. However, repositioning is difficult for patients in the operating room (OR) under general anesthesia. reported that frequent repositioning of patients in the intensive care unit (ICU) reduces the development of pressure injuries by 25%. By using support surfaces, regularly repositioning the patient, optimizing the patient's nutritional status, and moisturizing the sacral skin, pressure injuries can be avoided especially by those who are prone to develop these injuries, such as the elderly and those with physical impairments. Pressure injuries can lead to prolonged hospital stays, resulting in increased medical costs ($5,000–$40,000), additional surgery, and even death in severe cases. In bed-ridden patients, the primary cause of these injuries is pressure due to compression between a bony prominence and an external surface for a prolonged period. Pressure injuries are characterized by necrosis of skin and deep subcutaneous tissues as a result of impaired capillary circulation due to continuous and repetitive pressure combined with friction and shear force to specific body parts.
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