Effectiveness of intraoperative supine repositioning strategies for preventing pressure injuries: a systematic review and meta-analysis protocol

Background: Pressure injuries are a common and preventable postoperative complication among adults undergoing surgery in the supine position. Although various intraoperative repositioning approaches, such as micromovement-based systems and curvilinear repositioning strategies, have been developed to redistribute pressure during surgery, current findings on their effectiveness have not been systematically evaluated. The purpose of this review is to explore the effects of these intraoperative supine repositioning strategies in adult surgical patients and to provide evidence to guide perioperative prevention practices through a meta-analysis of available randomized trials. Methods: A comprehensive literature search (from inception through November 2025) will be conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov to identify randomized controlled trials assessing intraoperative supine repositioning strategies. Additional studies will be retrieved through citation chaining and gray literature searches. We will use Rayyan for study selection and Review Manager (RevMan) for statistical analysis. Eligible studies will include adult surgical patients randomized to repositioning strategies compared with standard positioning or sham controls. The primary outcome will be the incidence of postoperative pressure injuries, while secondary outcomes will include satisfaction rates, changes in skin temperature, effects on interface pressures, and locations of pressure injuries. Results: This study aims to provide the first comprehensive synthesis of the effectiveness of intraoperative supine repositioning strategies for preventing pressure injuries. Findings are expected to clarify which repositioning approaches offer the greatest preventive benefit. Conclusion: Intraoperative supine repositioning strategies have the potential to reduce the development of pressure injuries among adult surgical patients. This systematic review and meta-analysis will synthesize current evidence to inform perioperative practice and guide the selection of optimal repositioning techniques for surgical pressure injury prevention.