Infecção do sítio cirúrgico em pacientes submetidos a cirurgias neurológicas e ortopédicas
Resumo
Objetivo: analisar a incidência das infecções de sítio cirúrgico (ISC) em pacientes submetidos a cirurgias neurológicas e ortopédicas e seus determinantes em um hospital público. Método: estudo de coorte retrospectivo, conduzido entre pacientes submetidos a cirurgias neurológicas e ortopédicas, de janeiro de 2015 a dezembro de 2020. Resultados: dos 3.029 procedimentos cirúrgicos realizados, 1.327 (43,8%) foram neurocirúrgicos; e 1.702 (56,2%), ortopédicos. A incidência da ISC foi 6,7% (89) em neurocirurgias e 3,3% (56) em ortopedias. A taxa global e de óbitos foi 4,8% e 12,4%, respectivamente. Na análise univariada, os fatores de risco associados às ISC em neurocirurgiasenvolveram tempo cirúrgico (>231 minutos), pontuação da American Society of Anesthesiologistsmaior que doise cirurgias emergenciais; para os procedimentos ortopédicos: cirurgias emergenciais, tempo de internação pré-operatório (>quatro dias) e cirúrgico (>149 minutos). Na análise multivariada, permaneceram cirurgias emergenciais e maior tempo cirúrgico como fatores de risco de ISC para ambas as especialidades;e, para as cirurgias ortopédicas e neurológicas, tempo de internação pré-operatório e classificação ASA, respectivamente. Conclusão: a taxa de incidência das ISC e de mortalidade bem como os fatores de risco identificados neste estudo devem ser considerados para elaborar estratégias destinadas a prevenir e controlar essas infecções.
Downloads
Referências
Agência Nacional de Vigilância Sanitária (BR). Medidas de prevenção de infecção relacionada à assistência à saúde [Internet]. Brasília: ANVISA; 2017 [acesso em: 29 nov. 2022].Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf/view
World Health Organization. Protocol for surgical site infection surveillance with a focus on settings with limited resources[Internet]. Geneva: WHO; 2018 [acesso em: 29 nov. 2022].Available from: https://www.who.int/publications/i/item/protocol-for-surgical-site-infection-surveillance-with-a-focus-on-settings-with-limited-resources
Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244-52. DOI: https://doi.org/10.1001/jama.2022.24075
Centers for Disease Control and Prevention, National Healthcare Safety Network. Patient safety component manual [Internet]. Atlanta: CDC’s National Healthcare Safety Network; 2022 [cited 2022 Feb 08]. p. 9/1-9/41. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K. Risk factors for surgical site infections in neurosurgery. Ann R Coll Surg Engl. 2019;101(3):220-5. DOI: https://doi.org/10.1308/rcsann.2019.0001
Suranigi SM, Ramya SR, Sheela Devi C, Kanungo R, Najimudeen S. Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery. Iran J Microbiol. 2021;13(2):171-7. DOI:https://doi.org/10.18502/ijm.v13i2.5976
Pennington Z, Sundar SJ, Lubelski D, Alvin MD, Benzel EC, Mroz TE. Cost and quality of life outcome analysis of postoperative infections after posterior lumbar decompression and fusion. J Clin Neurosci. 2019;68:105-110. DOI: https://doi.org/10.1016/j.jocn.2019.07.025
Edmiston Jr CE, Spencer M, Gunja NJ, Holy CE, Ruppenkamp JW, Leaper DJ. Longitudinal rates, risk factors, and costs of superficial and deep incisional surgical-site infection (SSI) after primary and revision total knee arthroplasty: A US retrospective claims database analysis. Infect Control Hosp Epidemiol. 2023 Feb 2:1-9. DOI: https://doi.org/10.1017/ice.2023.10
Jiménez-Martínez E, Cuervo G, Carratalà J, Hornero A, Ciercoles P, Gabarrós A, et al. Economic impact of a care bundle to prevent surgical site infection after craniotomy: a cost-analysis study. Antimicrob Resist Infect Control. 2021;10(1):146. DOI: https://doi.org/10.1186/s13756-021-01016-4
Wałaszek MZ, Słowik R, Domański A, Wałaszek MJ, Różańska A, Kołpa M. Five-Year Analysis of Surgical Site Infections in Three Orthopaedics and Trauma Wards under HAI-Net from the South of Poland in 2014-2018 Considering the Standardized Infection Ratio. Medicina (Kaunas). 2022;58(5):682. DOI: https://doi.org/10.3390/medicina58050682
Jiménez-Martínez E, Cuervo G, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, et al. Risk factors for surgical site infection after craniotomy: a prospective cohort study. Antimicrob Resist Infect Control. 2019 May 2; 8:69. DOI: https://doi.org/10.1186/s13756-019-0525-3
Ying H, Luo ZW, Peng AF, Yang QK, Wu X, Chen XY, et al. Incidences and reasons of postoperative surgical site infection after lumbar spinal surgery: a large population study. Eur Spine J. 2022;31(2):482-8. DOI: https://doi.org/10.1007/s00586-021-06967-1
Agência Nacional de Vigilância Sanitária (BR). Boletim Segurança do Paciente e Qualidade em Serviços de Saúde nº 28: Avaliação Nacional dos indicadores de IRAS e Resistência Microbiana (RM), ano 2021 [Internet]. Brasília: ANVISA; 2022 [acesso em: 29 nov. 2022].Available from: https://app.powerbi.com/view?r=eyJrIjoiZDIwZjYyMzUtMmYxZS00MTRjLTk0NWMtZWE2ZDUzOGRjOTVjIiwidCI6ImI2N2FmMjNmLWMzZjMtNGQzNS04MGM3LWI3MDg1ZjVlZGQ4MSJ9
Deng H, Chan AK, Ammanuel S, Chan AY, Oh T, Skrehot HC, et al. Risk factors for deep surgical site infection following thoracolumbar spinal surgery. J Neurosurg Spine. 2019;32(2):292-301. DOI: https://doi.org/10.3171/2019.8.spine19479
Fang C, Zhu T, Zhang P, Xia L, Sun C. Risk factors of neurosurgical site infection after craniotomy: A systematic review and meta-analysis. Am J Infect Control. 2017;45(11):123-34. DOI: https://doi.org/10.1016/j.ajic.2017.06.009
Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical site infection in spine surgery: Who is at risk? Global Spine J. 2018;8(4Suppl):5S-30S. DOI:https://doi.org/10.1177/2192568218799056
AlGamdi SS, Alawi M, Bokhari R, Bajunaid K, Mukhtar A, Baeesa SS. Risk factors for surgical site infection following spinal surgery in Saudi Arabia: A retrospective case-control study. Medicine (Baltimore). 2021;100(17):255-67. DOI: https://doi.org/10.1097/md.0000000000025567
Bischoff P, Kramer TS, Schröder C, Behnke M, Schwab F, Geffers C, et al. Age as a risk factor for surgical site infections: German surveillance data on total hip replacement and total knee replacement procedures 2009 to 2018. Euro Surveill.2023;28(9):2200535.DOI: https://doi.org/10.2807/1560-7917.es.2023.28.9.2200535
Zhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: A meta-analysis. Medicine (Baltimore). 2022;101(8):e28836. DOI:https://doi.org/10.1097/md.0000000000028836
Liang Z, Rong K, Gu W, et al. Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors. Int Wound J. 2019;16: 773-80. DOI: https://doi.org/10.1111/iwj.13096
American Society of Anesthesiologists. ASA Physical Status Classification System [Internett]. Washington D. C.: American Society of Anesthesiologists; 2020 [acesso em: 29 nov. 2022]. Available from: http://www.asahq.org/quality-and-practice-management/standards-guidelinesand-related-resources/asa-physical-status-classification-system
Pawłowska I, Ziółkowski G, Wójkowska-Mach J, Bielecki T. Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study. Int Orthop. 2019;43(9):2009-16. DOI: https://doi.org/10.1007/s00264-019-04298-x.
Oliveira DB, Barcelos VA, Guimarães RPM, Oliveira KAS, Ramos Filho RL, Appelt AL,et al. Análise da taxa de mortalidade em cirurgias de artroplastia total de joelho primária e de revisão no sistema único de saúde, de 2009 a 2018. BJHR. 2021;4(5):22498-505. DOI: https://doi.org/10.34119/bjhrv4n5-343
Costa AC, Santa-Cruz F, Ferraz AAB. What’s new in infection on surgical site and antibioticoprophylaxis in surgery? ABCD Arq Bras Cir Dig. 2020;33(4):e1558. DOI: https://doi.org/10.1590/0102-672020200004e1558
Albuquerque NMQ, Castelo Branco AL, Pimentel MRAR, Silva FVC, Assad LG, Santos MA. Process of hospitalization at surgical-clinic unit at a public university hospital.Rev. enferm. UERJ. 2020; 28:e48849.DOI: https://doi.org/10.12957/reuerj.2020.48849
Alcantara C, Dellaroza MSG, Ribeiro RP, Carvalho CJA. Femoral fracture in the elderly: surgery waiting time and hospitalization outcome. Cienc Cuid Saúde. 2021;20:e54726. DOI:https://doi.org/10.4025/ciencuidsaude.v20i0.54726
Yamamoto EA, Mazur-Hart DJ, Yoo J, Orina JN. Surgical site infection in thoracic and lumbar fractures: incidence and risk factors in 11,401 patients from a nationwide administrative database. Spine J. 2023;23(2):281-6. DOI: https://doi.org/10.1016/j.spinee.2022.10.007
Stefani L, Borges PKO, Gaspar MDR. Infecções de sítio cirúrgico: reabordagem cirúrgica e infecção em cirurgias limpas e potencialmente contaminada. Rev Enferm UFSM. 2022;12: e12.DOI: https://doi.org/10.5902/2179769267474.
Copyright (c) 2023 Ciência, Cuidado e Saúde
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
