Understanding Surgical Positioning Injuries II: Causes, Risk Factors, & Prevention

Our last post detailed a variety of injuries patients can suffer when positioned or moved incorrectly during surgery. While identifying the problem is of primary importance, the next stage of particular importance to attorneys serving clients is how the problems occurred and what might have caused a particular surgical positioning injury. Therefore, this secondary post will cover some potential answers, as well as contributing risk factors to these injuries and possible prevention methods.


What causes surgical positioning injuries?

            While surgical positioning injuries are exactly what they sound like – injuries caused by incorrect or poor positioning during surgery – they can occur for a variety of reasons. Sometimes, injuries related to the obstruction of the vascular supply to a body part can be caused by undue pressure on a body part, use of stirrups or traction, or other unnatural positioning.[1]Respiration can be impeded by arm pressure or a patient’s gown on the chest or neck.[2]Nerves, also, when not protected from undue pressure caused by improper arm, hand, shoulder, leg, or feet positioning, also face serious injury.[3]

In addition to poor positioning, surgical tables can be the cause of injury if not properly set; injuries can occur if it is not locked and properly padded.[4]Any time a patient is transferred from one surface to another, injuries can also occur.[5]


What are risk factors leading to surgical positioning injuries?

Patients undergoing surgery may face a variety of preexisting risk factors for surgical positioning injuries, some of which are modifiable while others are more difficult to adjust. Here are some of the most important ones to be aware of:[6]

  • Length of procedure. The longer a procedure is, the greater chance of something going wrong, and poor positioning uncorrected has the chance to stay uncorrected longer.
  • Type of procedure. Different procedures require different positioning of the body, of which risk can vary.
  • Anesthesia requirements. Different types of anesthesia and different doses can have different effects and effect patients differently depending on various pre-existing conditions they may have.
  • Patient’s age. Due to lower skin thickness, less muscle bulk, and less subcutaneous fat (fat sitting under the skin) covering pony prominences, the elderly are often thought to be at greater risk of positioning injuries.[7]However, other studies have shown this might not be as big of a concern as it once was.[8]
  • Patient’s body weight. Patients with obesity present a perioperative injury risk, since increased fat mass can compress blood vessels and nervous structures. This can reduce blood circulation in tissue and result in injuries.[9]
  • Patient’s current medication regime.Medications can make patients more susceptible to various conditions on this list and others that might increase their chances of injury during surgery.
  • Nutritional status.Patients who are malnourished or facing difficulties with their nutrition in other ways are likely to have weaker systems, which can put them at risk of being more susceptible to injury during surgery.
  • Chronic illness. Patients who are diabetic or have hypertension, for example, are known to face increased perioperative risks. When bodily systems cannot operate at full capacity, threats like those potentially posed during surgery can be magnified.[10]
  • As mentioned above, various chronic illnesses can have serious effects, and the more that are present, the more dangerous surgery can be.
  • Preexisting pressure ulcers.If a patient already has skin damage from staying too long in one position, the chances of this damage getting worse increases during surgery which exacerbates immobility.


How can surgical positioning injuries be prevented?

            Many of us will experience at least one surgery in our lifetime, and many of us might face several; minimizing surgical positioning injuries doesn’t have to be difficult, and it could have huge repercussions for all of us undergoing surgery at some point. Surgical teams need to pay careful attention to how patients are being placed, moved, and situated both before and during a surgery. Tables should be checked for proper padding and lock settings before a patient is moved. Ask patients if they are comfortable before they are unconscious. Patients should be moved slowly and gently, and assistance should always be asked for when transferring a patient.[11]Thinking about how a patient might assess their comfort level if conscious is an important method for minimizing injury.


Additional prevention techniques include the following:

  1. Identify opportunities for improvement – as in evidence based checklist for patient positioning with time for staff education and team collaboration[12].
  2. Perform skin assessments – as patients are lying down during the pre-operative assessments, anesthesia inductions and PACU recovery, the potential for harm is no limited to actual surgery time itself [13]
  3. Document and Communicate – ensure staff documents the skin condition in pre op area, the OR and the PACU and communicate those results in the handoff from one area to the other [14].


Knowing whether your client was on the other side of a medical error or unjustly accused of one can be aided by better knowledge of how these injuries occur. Now that you know a bit more about surgical positioning injuries, you can be confident in the case you’re making.

[1]“Preventing intraoperative positioning injuries,” Nursing Management, July, 2006, 9.





[6]The following list, unless otherwise cited, is drawn from “Preventing intraoperative positioning injuries”

[7]Menezes, Sonia, Rodrigues, Regina, Tranquada, Raquel, Muller, Sofia, Gama, Karina, & Tania Manso, “Injuries Resulting from Positioning for Surgery: Incidence and Risk Factors,” Acta Med Port, 2013, Jan-Feb 26(1), 15.




[11]“Preventing intraoperative positioning injuries”

[12]Suzy Scott, “Are You Doing Enough to Prevent Pressure Injuries”, Outpatient Surgery Magazine (outpatient surgery.net),2018, August 15, 1-3