Avaliação da redução do tempo de vigilância pós-alta sobre a incidência das infecções de sítio cirúrgico em pacientes submetidos à craniotomia

• Ano de defesa: 2016
• Autor(a) principal: Torres, Silvana [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Craniotomia; Infecção da ferida operatória; Fatores de risco; Implantes; Alta do paciente
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3701827; http://repositorio.unifesp.br/handle/11600/48309

Introduction: Surgical site infections post-craniotomy are complications that affect directly the prognosis of the patient contributing to the increase in length of hospital stay, morbidity, mortality and reoperation. Objectives: To determine the SSI rates in patients undergoing craniotomy; identify the risk factors for the development of SSI post-craniotomy; compare SSI rates between twelve month postdischarge surveillance versus three-month post-discharge surveillance. Method: A retrospective cohort study involving patients undergoing craniotomy between January 1, 2014 and June 30, 2014 in a University affiliated hospital in São Paulo. A nested case-control was undertaken to evaluate risk factors for SSI. All patients included in the study were evaluated preoperatively, during and after surgery and were followed for a year to analyze the development of SSI. Results: The SSI rates among 173 patients undergoing craniotomy was 11.56%, thirteen (65%) organ / space, four (20%) superficial incisional and three (15%) incisional deep. The most prevalent microorganism isolated in surgical site infections was Staphylococcus aureus, 3 (15%). The average time between the procedure and the diagnosis of surgical site infection was 34 days (SD ± 48.9). The mean age was 51.9 years, 51% were male patients. Independent risk factors for surgical site infection were: duration of surgery greater than 4 hours (OR = 1,49; IC95% = 0,96-2,30; p = 0,076); presence of drain for more than three days (OR = 4.67; CI95% 1.34-16.00; p = 0.015) and number of procedures > 1 (reoperation) (OR = 4.38; CI95% = 1.14-16.74; p = 0.030). When comparing the incidence of SSI between the three periods of post-discharge surveillance, we obtained: 30-day surveillance, 15 (8.67%); 90-day surveillance, 19 (10.98%); 1-year surveillance, 20 (11.56%). Among the patients with implants 30-day surveillance 8 (7.54%); 90-day surveillance, 9 (8.49%); 1-year surveillance, 10 (9.43%). For craniotomy whithout implants, no SSI would be lost after three months of surveillance, however, 3 (30%) SSI would be lost in the period post-discharge surveillance was not performed earlier (31-90 days), reducing SSI rate in 4.48%. In the group of patients who used implants, a greater sensitivity was seen during the 1-year surveillance, period held for one year 100% (PPV = 100%) when compared to 30-day surveillance, 80% (PPV = 100%) and 90-day surveillance, 90% (100%). Conclusion: The study shows that SSI rates post-craniotomy are high. Reducing the duration of postdischarge surveillance period from one year to three months did not cause significant losses in the number of SSI detected. Independent risk factors for surgical site infection were: duration of surgery greater than 4 hours, presence of drain for more than three days and number of procedures > 1.