Prevention of Pressure Injuries in Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE: Pressure injuries (PIs) are common yet preventable complications in surgical patients, but the effectiveness of prevention strategies remains uncertain. This review systematically evaluates randomized controlled trials to synthesize the available evidence and inform evidence-based prevention strategies in surgical settings. DATA SOURCES: A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and CINAHL for studies published from January 1, 2000, to June 1, 2024. Additional records were identified by hand-searching reference lists of included articles. STUDY SELECTION: Randomized controlled trials evaluating interventions to prevent PIs in surgical patients were included. Of 5242 records screened, 21 studies met the predefined inclusion criteria. DATA EXTRACTION: Two reviewers independently performed study selection and data extraction, with the third reviewer resolving any discrepancies through discussion. Extracted data included study and participant characteristics, type and timing of interventions, control measures, and outcomes. DATA SYNTHESIS: Interventions were classified into 7 categories: support surfaces, position management, prophylactic dressings, localized pressure protection, warming therapy, education intervention, and nutrition support. Meta-analyses indicated that support surfaces, position management, localized pressure protection, and warming therapy significantly reduced PI incidence. The effectiveness of prophylactic dressings was observed only in intraoperative subgroups. Position management did not significantly affect health care staff satisfaction. CONCLUSIONS: Several interventions are effective in reducing PI incidence among surgical patients. Findings underscore the relevance of phase-specific prevention strategies and may inform clinical practice, especially for high-risk procedures and patient populations.