Clinical Decision Support System for Pressure Injury Management Post-Cardiac Surgery

Overview

Pressure injuries (PI) are a significant complication in cardiac surgery patients, with incidences reaching 25% intraoperatively. Current prevention methods lack specificity for cardiac surgery patients, prompting the development of a clinical nursing decision support system (CNDSS) tailored to this population to enable precision care and improve outcomes.

Background

Pressure injuries result from localized tissue damage due to pressure and shear forces, posing a global healthcare challenge with high prevalence and substantial costs. Cardiovascular disease patients undergoing cardiac surgery are at elevated risk for PI due to surgery complexity and perioperative factors. Traditional risk assessment tools like the Braden Scale are insufficiently specific for cardiac surgery patients, and existing CNDSS lack integration of cardiac surgery-specific risk parameters. Thus, there is an urgent need for specialized decision support systems to guide nursing care and prevent PI in this high-risk group.

Data Highlights

A meta-analysis reported that the incidence of intraoperative acquired pressure injuries in open-heart surgical patients can reach 25%. Epidemiological data from 13,254 ICU patients across 90 countries showed an overall ICU stress injury prevalence of 26.6%, with ICU-acquired prevalence at 16.2%. In China, hospital-acquired PI prevalence ranges from 1.67% to 1.79%. The annual cost of hospital-acquired PI is estimated at $26.8 billion, with over half attributed to advanced stage injuries.

Key Findings

• Pressure injuries are common and costly complications in cardiac surgery patients, with incidence rates up to 25% intraoperatively.
• Existing generic PI risk assessment tools, such as the Braden Scale, lack specificity and reliability in cardiac surgery and ICU settings.
• Clinical nursing decision support systems (CNDSS) can enhance nursing decision-making by integrating evidence-based practices and patient data.
• Current CNDSS for PI management do not incorporate cardiac surgery-specific risk factors or provide full-process management including risk prediction, graded intervention, and healing tracking.
• Chinese research has begun developing intelligent, structured PI decision-making platforms, but these are still in early stages and lack comprehensive integration for cardiac surgery patients.

Clinical Implications

Implementing a specialized CNDSS that integrates cardiac surgery-specific risk parameters can improve early identification and prevention of pressure injuries in this vulnerable population. Such systems support nurses by providing real-time alerts and personalized intervention guidelines, potentially reducing PI incidence and improving patient outcomes. Adoption of these tools may also standardize care and enhance nursing quality in cardiac surgery intensive care units.

Conclusion

Pressure injuries remain a significant perioperative complication in cardiac surgery patients, necessitating tailored prevention strategies. Development and implementation of specialized clinical decision support systems offer a promising approach to enable precision nursing care and reduce the burden of PI in this high-risk group.

References

1. Epidemiological survey of ICU stress injuries -- Global prevalence data
2. Meta-analysis on intraoperative pressure injuries in cardiac surgery -- Incidence up to 25%
3. Xia et al., 2020 -- CNDSS for PI staging and monitoring
4. Zhou et al., 2022 -- Intelligent PI decision-making platform