Association between preoperative cutaneous conditions and incidence of postoperative skin disorders in patients undergoing lateral decubitus surgery under general anesthesia: a prospective cohort study

Abstract Background Pressure ulcers pose significant risks during surgical procedures, particularly in patients undergoing procedures in the lateral decubitus position. This study aimed to explore the relationship between preoperative transepidermal water loss and occurrence of postoperative skin disorders in patients undergoing lateral decubitus surgery under general anesthesia. Methods This single-center prospective observational study included participants aged ≥ 20 years who underwent thoracoscopic pneumonectomy between November 2022 and December 2023. The initial sample size was calculated to be 85 but increased to 106 to accommodate potential discontinuations and exclusions. The primary endpoint was transepidermal water loss, with secondary endpoints including keratin moisture content and skin pH. Measurements were conducted in high-risk areas (i.e., the chest side), immediately after sedation. Statistical analysis included Mann–Whitney U test, Spearman's rank correlation, receiver operating characteristic curve analysis, and multiple regression analysis. Results A significant correlation was observed between elevated preoperative transepidermal water loss and postoperative skin disorders, suggesting transepidermal water loss as a predictive biomarker for such complications, especially in surgeries requiring prolonged immobilization or specific positioning (R2 = 0.545, adjusted R2 = 0.545) (B=-0.094; 95% confidence interval, -0.161 to -0.037). This suggests that integrating transepidermal water loss measurements into routine preoperative evaluations could effectively identify patients at higher risk, enabling targeted preventive strategies. A transepidermal water loss cut-off value of 19.5 g/m2/h was identified, with higher values indicating increased risk of postoperative skin disorders. Conclusion Preoperative transepidermal water loss measurement holds promise as a predictive tool for identifying patients at risk of postoperative skin impairment and pressure ulcers. Early interventions (e.g., enhanced skin care, hydration management, and nutritional supplementation) are necessary for patients with elevated transepidermal water loss. Integrating transepidermal water loss assessment into preoperative evaluations and implementing targeted preventive strategies may mitigate the incidence of postoperative skin disorders in surgical patients. Trial registration: The study and protocol registry for this study is UMIN000053356.