face, so it's often difficult to link it to what occurred in the OR. A com-
bination of forensics and an understanding of how deep tissue injuries
develop have led caregivers to take another look at the factors during
surgery that can cause pressure ulcers and have increased awareness
that injuries might not be apparent in the typical locations. For exam-
ple, patients who are in the supine position during surgery can develop
pressure ulcers on the buttocks, not necessarily on the sacrum or coc-
cyx, as is often assumed.
Outpatient procedures are shorter in duration and generally per-
formed on healthier patients who are ambulatory soon after surgery,
so pressure injuries are less likely. However, the risk still exists,
because an increasing number of lengthy, complex procedures are
being performed on acute patients in the same-day setting. Although
the likelihood of pressure ulcers occurring during outpatient proce-
dures might be lower than during inpatient procedures, the risk of
being slapped with a medical malpractice lawsuit might be higher
when injuries occur in ambulatory facilities, where patients often
have less tolerance for error when undergoing elective surgeries. It's
good risk management practice to document the precautions you
have in place.
Recognize red flags
Caregivers have reexamined high-risk cases and found that pressure
ulcers often occur after procedures lasting longer than 3 hours, after
cases in which the patient is placed in the prone position and in frail
elderly patients with fragile skin who don't have natural layers fat to
help pad their bones (see "Pressure Ulcer Risk Factors").
Obesity is a risk factor in unusual ways. Heavier patients might not
fit adequately on the surface of the OR table. That puts additional
strain on the strap that holds them in place, which increases the risk
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