SEED PROJECT: Complications of post-flap surgery in people with spinal cord injury.

About the Project

The full title of this project is: Examining the impact of surgical and post-operative factors contributing to complications of surgical repair of pressure injury in people with spinal cord injury or disease to enhance their inpatient rehabilitation trajectory.

About

Pressure injuries are a common and serious complication for people with spinal cord injury/disease (SCI/D), in some cases requiring complex surgery and long hospital admissions to treat and heal. Complications of this intricate surgery occur in up to 40% of people. Management after flap surgery involves at least 4 weeks of strict bed-rest, then several weeks of gradual return to sitting and usual activities. People with SCI/D describe this as extremely “confining”, resulting in a grief response and poorer mental health. This research aims to improve the processes for people needing pressure injury surgery through the Spinal Injuries Unit (SIU), Princess Alexandra Hospital, resulting in better care, fewer complications and less time in hospital. This will be achieved by reviewing published literature, conducting a retrospective chart review of people who have had flap surgery in SIU in the past 9 years, and talking to expert clinicians and people with lived experience of pressure injury surgery in the SIU.  The results will inform a Clinical Pathway document to guide future care of people undergoing flap surgery.  The results will be made widely available through published scientific papers, conference presentations and an easy-to-read summary of the results.

Aims and objectives

Aims:

1.      To identify factors contributing to complications of post-flap surgery in patients with SCI/D.

2.      To understand post-flap surgery complication rates in the SIU in the context of complication rates reported in the literature.

3.      To gain insights into the lived experience of people with post-flap complications and the clinical experience of health professionals who manage them, to provide a framework for strategy-building to improve outcomes.

4.      To develop a Clinical Pathway to guide future practice in SIU for management of people with SCI/D undergoing flap surgery.

Objectives:

1.      To conduct a scoping review of published and grey literature to determine a comprehensive list of factors that are reported to influence post-flap complication rates.

2.      To conduct a retrospective audit of SIU patient records over the past 9 years (to coincide with the availability of electronic medical records) to identify post-flap surgery complication rates and contributory factors leading to the development of complications, for comparison with complication rates reported in the literature.

3.      To qualitatively explore and analyse: (a) the perceptions and experiences of a purposive sample of recent inpatients with SCI/D regarding their post-flap complications, and (b) the views of treating specialist clinicians on causation, prevention/minimisation and management of complications.

4.      To prepare a draft Clinical Pathway based on the findings from objectives 1-3.

5.      To engage and consult with people with lived experience of SCI/D and flap repair complications and with specialist multidisciplinary clinicians, to review and refine the draft document to produce the finalised Clinical Pathway document.

Expected Outcome

a)      A description of the rate and type of complications experienced by people with SCI/D who undergo flap surgery for management of pressure injury.

b)     A comprehensive description of factors which might contribute to the occurrence of complications post-flap surgery in people with SCI/D.

c)     A Clinical Pathway for the management of people with SCI/D undergoing flap surgery in the SIU. Clinical Pathways translate existing evidence into clinical care processes taking into consideration the local healthcare environment, promote quality and efficiency of care, and assist in educating patients regarding what to expect throughout the admission.

Exptected Impact

The scoping review will be the first to examine the rates of complications post-flap surgery in people with SCI/D as well as contributing factors. The retrospective chart audit will allow for quality improvement in our service by comparing the rates of post-flap complications in SIU to those published in the literature. Furthermore, this will be the first study to attempt to comprehensively explore the broader factors contributing to post-flap complications beyond that of patient demographics and comorbid conditions.

People/organisations involved

The principal investigator is Dr Evgeniya Zakharova-Luneva, a Staff Specialist in the Spinal Injuries Unit at Princess Alexandra Hospital. 

The co-investigators are:

• Dr Darren Allon, a Staff Specialist in the Spinal Injuries Unit at Princess Alexandra Hospital; 
• Ms Rachel Jones, a Clinical Nurse Consultant in the Spinal Injuries Unit at Princess Alexandra Hospital; 
• Ms Joanne Kemp, an Advanced Occupational Therapist in the Spinal Outreach Team at Princess Alexandra Hospital; 
• Prof Timothy Geraghty, Director of The Hopkins Centre and a Senior Staff Specialist in the Spinal Injuries Unit at Princess Alexandra Hospital; 
• Dr Letitia Burridge, a Research Fellow in The Hopkins Centre at Griffith University; 
• Dr Christy Hogan, a Research Fellow in The Hopkins Centre at Griffith University;
• Ms Kylie Rixon, a Senior Research Assistant in the Hopkins Centre at Griffith University; and
• Mr Darren Meyers, a person with lived experience of SCI/D and an accountant.

This research project was funded by The Hopkins Centre – a joint initiative of the Department of Rehabilitation, Metro South Health and Griffith University. The Motor Accident Insurance Commission provided funding to The Hopkins Centre to support and conduct research activities that aim to improve the treatment and rehabilitation of people injured in motor vehicle crashes.

Project status and timeframe

This 12-month project commenced in 2024.

Update September 2024: 

• The project team have obtained Ethics approval, and are now awaiting Governance approval.