Patient positioning on the operating table and patient safety: A systematic review and meta-analysis

Signe Berit Bentsen; Geir Egil Eide; Siri Wiig; Tone Rustøen; Cathrine Heen; Benedikte Bjøro

doi:10.1111/jan.16049

Patient positioning on the operating table and patient safety: A systematic review and meta-analysis

J Adv Nurs. 2024 Jan 7. doi: 10.1111/jan.16049. Online ahead of print.

Authors

Signe Berit Bentsen^{1

2}, Geir Egil Eide¹, Siri Wiig^{1

3}, Tone Rustøen^{4

5}, Cathrine Heen², Benedikte Bjøro^{5

2}

Affiliations

¹ Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
² Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway.
³ SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
⁴ Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.
⁵ Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.

PMID: 38186052
DOI: 10.1111/jan.16049

Abstract

Aim: To identify occurrence of harmful incidents related to patient positioning on operating table.

Design: Systematic review and meta-analysis.

Data sources: Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information.

Review methods: The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis.

Results: Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]).

Conclusions: Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously.

Impact: This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning.

Patient or public contribution: No patient or public contribution, as this is a review of previous research.

Keywords: adverse events; harmful incidents; operating room; operating room nurse; operating room team; patient positioning; patient safety; systematic review; meta-analysis.

Publication types

Review