The Hidden Cost of a Long Surgery
If a loved one has ever been through a six-hour cancer operation on the face, jaw, or throat, you probably remember the small details that mattered most. The way their lips looked dry when they came out of the operating room. The bruising on the hand where the IV had been. A nose rubbed raw and red where a breathing tube had rested for hours.
That raw nose is more than a cosmetic problem. It's a pressure injury — essentially a bedsore on the nostril — and it hurts.
Many complex head and neck surgeries require a breathing tube to go through the nose instead of the mouth. Surgeons call this nasotracheal intubation. It gives them an unobstructed view of the mouth and jaw, which is critical when they're working on tumors, removing tissue, or rebuilding structures.
But here's the trade-off. Hours of steady pressure from a plastic tube on a soft, curved part of the face can leave real wounds. They range from mild redness to deep sores. They add pain during recovery. They extend hospital stays. They drive up treatment costs. And they delay the rest of the healing a patient is already working on.
Surgeries are getting longer and more complex — especially for cancer cases. That means the risk of this kind of injury has been climbing, not falling.
The Old Way and the New Twist
For a long time, the answer to nasal pressure injuries was the same as it was for bedsores anywhere else: notice them when they happen, treat them after the fact. Nurses did their best with gentle pads and careful positioning, but there was no standard playbook. Prevention was scattered.
That's what a team at one hospital in China decided to fix.
They built something called a multidisciplinary bundle — a fancy term for a simple idea. Instead of one nurse guessing about risk, an entire team worked together. A surgeon, an anesthesiologist, a team of nurses, and a quality improvement specialist all sat down and built a step-by-step prevention plan.
Think of the old approach as a single lifeguard watching an entire pool. The new approach is a lifeguard at every section, plus a coordinator on shore tracking who's been swimming too long. Before surgery, every patient got a formal risk assessment — age, nutrition, how long the surgery was expected to take, the kind of tube being used. During surgery, the plan told nurses exactly how often to check the nose and what to do at each stage.
After surgery, the monitoring didn't stop. Follow-up checks looked for early warning signs in the first days of recovery, when damage is still reversible. The bundle also included a modified scoring tool — basically a checklist that turns judgment into numbers, so everyone on the team is looking at the same thing.
The Study Behind the Numbers
The researchers compared two groups of patients. The first 221 had their surgery before the new bundle was in place. The next 294 had surgery after. Both groups were similar in age, health, and the kinds of operations they had — that's important, because it means the comparison is reasonably fair.
The results stand out. The rate of nasal pressure injuries fell from 7.24% in the old group to 2.38% in the new group. That's a relative drop of about two-thirds. In simple terms: for every 21 patients treated under the new protocol, one who would have ended up with a nasal wound did not.
No one in either group had a severe, deep injury.
But mid-grade injuries — the ones that actually break the skin and take weeks to heal — were eliminated entirely in the new group. Three patients had them in the old group. Zero in the new. For a young patient recovering from cancer surgery, that difference is real.
If you or someone you love is scheduled for a long head or neck surgery, this research has a practical takeaway. Ask the care team what their nasal pressure injury prevention plan looks like. Not every hospital has a formal bundle yet, but most are aware of the risk and will talk through what they do. A good answer includes a risk assessment before surgery, planned checks during the operation, and attention to the nose during the first days of recovery.
Small things to ask about: how the tube is secured, whether soft padding is used at pressure points, and how often nurses reposition during long cases.
This was a historical comparison at one hospital — not a randomized trial. That means other things besides the bundle may have changed between the two time periods, like staffing or surgical techniques. The researchers did their best to match the groups, but some uncertainty remains. And it's a single-center study, so the exact numbers may look different somewhere else.
What this study adds is evidence that a simple, team-based approach works. The next step is seeing whether other hospitals can reproduce the same kind of reduction when they adopt a similar bundle. Quality improvement work isn't glamorous, but small wins like this add up across a hospital's thousands of surgeries each year.
