Repositioning During Surgery Tops Nursing Measures for Preventing Pressure Injuries, Bayesian Network Meta-Analysis Finds

Intraoperatively acquired pressure injuries remain one of the most common and largely preventable complications of surgery, and a new systematic review has now compared the nursing-led preventive measures used in operating rooms against each other within a single statistical network. The analysis, published in BMC Nursing, pooled data from randomised and quasi-randomised controlled trials of preventive interventions in adults undergoing surgery, using a Bayesian network meta-analysis to estimate odds ratios against standard care and to rank interventions by the surface under the cumulative ranking curve, known as SUCRA.

The evidence base comprised thirty-one trials involving 4799 participants across thirteen countries. Of these participants, 749, or 15.6 per cent, developed a pressure injury during surgery. The reviewers searched six databases from inception to 30 April 2026 and registered the review prospectively with PROSPERO on 15 September 2025 under registration number CRD420251146802. To handle interventions that combine several components, the team applied additive component network meta-analysis, allowing combination strategies to be estimated from the individual parts.

The headline result is that four interventions showed posterior estimates favouring them over standard care, with 95 per cent credible intervals lying entirely below one. Intraoperative repositioning led the field with an odds ratio of 0.09 and a credible interval of 0.03 to 0.31. The prevention care bundle followed at 0.14, with an interval of 0.03 to 0.54. Positioning or offloading devices yielded an odds ratio of 0.18, with an interval of 0.06 to 0.55, and prophylactic silicone foam dressing came in at 0.20, with an interval of 0.05 to 0.80. Because the entire credible interval sits below one, the posterior distribution indicates a reduced likelihood of pressure injury relative to standard care for each of these measures.

Among single interventions, intraoperative repositioning ranked highest on the SUCRA scale, achieving a value of 0.74. This ranking metric summarises each treatment’s probable position across the network, so a SUCRA of 0.74 places repositioning well ahead of the other nursing measures evaluated. The prevention care bundle, offloading devices and silicone foam dressings also emerged as a priority set, and the authors suggest these findings can inform perioperative nursing practice while identifying candidates for confirmatory trials.

The statistical machinery behind these estimates deserves attention. A random-effects Bayesian network meta-analysis does not simply average results; it combines direct comparisons between interventions and indirect comparisons through common comparators, producing posterior distributions for each odds ratio. The credible intervals reported here are Bayesian analogues of confidence intervals, describing the range within which the true effect is estimated to lie given the data and the model. Combination interventions were estimated by adding the effects of their components, an approach that borrows strength across the network when trials of full combinations are sparse.

Important caveats temper the enthusiasm. Between-study heterogeneity was substantial, meaning the trials varied considerably in their populations, surgical settings and how the interventions were delivered. Certainty of evidence, assessed with the CINeMA framework, was moderate at best and very low for most comparisons. The authors are explicit that the posterior estimates suggest potential benefits from repositioning, care bundles, offloading devices and silicone foam dressings, although the certainty of the evidence remains limited. In practical terms, the direction of the estimates is encouraging, but the precision and consistency of the underlying trials do not yet support firm conclusions about the magnitude of any benefit.

For perioperative nurses, the review offers something that has been missing until now: a direct comparison of the measures they already deploy. Preventive nursing interventions in the operating room have proliferated, but they had not been compared within a single network, leaving clinicians without a clear sense of which measure, or which combination, might perform best. The new analysis places intraoperative repositioning at the top of the single-intervention hierarchy, while the care bundle, offloading devices and silicone foam dressings form a cluster of promising alternatives that also cleared the statistical threshold.

The review also clarifies the scale of the problem it addresses. With 15.6 per cent of nearly 4800 surgical participants developing an intraoperatively acquired pressure injury, the burden is far from trivial. Pressure injuries acquired during surgery are considered a core responsibility of perioperative nursing, and the authors frame their work as a step toward evidence-based prioritisation rather than a final verdict. By grading certainty with CINeMA and ranking interventions with SUCRA, the review gives trial designers a map of where new randomised evidence would be most valuable.

What happens next depends on confirmatory research. The authors identify the four interventions as a priority set for future trials, and the very low certainty attached to most comparisons signals that the network’s estimates rest on limited and heterogeneous data. Until such trials report, the review stands as a rigorous synthesis of what the existing literature can and cannot say: four nursing-led measures show posterior estimates favouring them over standard care, repositioning ranks highest among single interventions, and the certainty behind those estimates remains moderate at best.

Subject of Research: Perioperative nursing interventions for preventing intraoperatively acquired pressure injuries

Article Title: Perioperative interventions for preventing intraoperatively acquired pressure injuries: a systematic review and Bayesian network meta-analysis

Article References: Chen, X., Wang, Y., & Yu, Y. (2026). Perioperative interventions for preventing intraoperatively acquired pressure injuries: a systematic review and Bayesian network meta-analysis. BMC Nursing. https://doi.org/10.1186/s12912-026-05612-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05612-w

Keywords: pressure injuries, perioperative nursing, network meta-analysis, intraoperative repositioning, care bundles, offloading devices, silicone foam dressing, SUCRA, systematic review, surgical complications, CINeMA, Bayesian analysis