Perioperative interventions for preventing intraoperatively acquired pressure injuries: a systematic review and Bayesian network meta-analysis

Intraoperatively acquired pressure injury is a common, largely preventable complication of surgery, and its prevention is a core responsibility of perioperative nursing. Although many nursing-led preventive measures are used in the operating room, they have not been compared directly within a single network. We aimed to compare and rank these interventions and to grade the certainty of the evidence. Six databases were searched from inception to 30 April 2026 for randomised and quasi-randomised controlled trials of preventive nursing interventions in adults undergoing surgery. A random-effects Bayesian network meta-analysis estimated odds ratios (OR) with 95% credible intervals (CrI) versus standard care, and interventions were ranked by the surface under the cumulative ranking curve (SUCRA). Combination interventions were estimated by additive component network meta-analysis. Certainty of evidence was assessed with CINeMA. Thirty-one trials (4799 participants, 13 countries) were included, of whom 749 (15.6%) developed a pressure injury. Posterior estimates favoured four interventions over standard care, with their 95% credible intervals entirely below 1: intraoperative repositioning (OR 0.09, 95% CrI 0.03 to 0.31), the prevention care bundle (0.14, 0.03 to 0.54), positioning or offloading devices (0.18, 0.06 to 0.55), and prophylactic silicone foam dressing (0.20, 0.05 to 0.80). Intraoperative repositioning ranked highest among single interventions (SUCRA 0.74). Between-study heterogeneity was substantial. Certainty was moderate at best and very low for most comparisons. Posterior estimates suggest potential benefits from intraoperative repositioning, prevention care bundles, offloading devices and silicone foam dressings, although the certainty of the evidence remains limited. These findings can inform perioperative nursing practice and identify a priority set for confirmatory trials. This systematic review was registered with PROSPERO (CRD420251146802) on 15 September 2025.