Evaluation of the postoperative risk of deep tissue injury to the lower extremities following surgery in the lithotomy position

Abstract

Abstract Aims The aim of this study was to determine the incidence of deep tissue injury (DTI) and its potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2015 and December 2019 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, of mean age 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male (odds ratio [OR]: 11.43; 95% confidence interval [CI]: 1.15–113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17–1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004–1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity 100%, specificity 64%) and 285 minutes (sensitivity 100%, specificity 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.