Preoperative Cutaneous Conditions and Postoperative Skin Injuries in Patients Undergoing Surgery in the Lateral Decubitus Position: A Prospective Cohort Study

Pressure injuries are a known complication during surgery, especially in patients positioned laterally under general anesthesia. This study investigated the relationship between preoperative transepidermal water loss (TEWL) and postoperative skin injuries in patients undergoing thoracoscopic pneumonectomy. A prospective observational study was conducted in 86 patients aged 20 years or older. Preoperative assessments included TEWL; stratum corneum hydration; and skin temperature, moisture, and pH at high-risk sites. Logistic regression and receiver operating characteristic analyses were used to evaluate predictive factors. Preoperative TEWL was significantly associated with postoperative skin injuries (R² = 0.545, B = -0.094; 95% confidence interval, -0.161 to -0.037; P < .001). Receiver operating characteristic analysis identified a TEWL cut-off of 19.5 g/m²/h, with sensitivity of 0.500 and specificity of 0.903. These findings suggest that TEWL may indicate patients at risk for postoperative skin injuries, and early preventive strategies may reduce the incidence of these injuries in high-risk patients.