Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Yohei Yukizawa; Emi Kamono; Shu Takagawa; Kunihito Hirotomi; Shota Higashihira; Hyonmin Choe; Yutaka Inaba; Naomi Kobayashi

doi:10.7759/cureus.57413

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Cureus. 2024 Apr 1;16(4):e57413. doi: 10.7759/cureus.57413. eCollection 2024 Apr.

Authors

Yohei Yukizawa¹, Emi Kamono¹, Shu Takagawa¹, Kunihito Hirotomi¹, Shota Higashihira¹, Hyonmin Choe², Yutaka Inaba², Naomi Kobayashi¹

Affiliations

¹ Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN.
² Orthopaedic Surgery, Yokohama City University, Yokohama, JPN.

Abstract

Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m² (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.

Keywords: compartment syndrome; deep tissue injury (dti); laparoscopic surgery; lithotomy position; rhabdomyolysis; well-leg compartment syndrome (wlcs).