Sezaryen Sonrasi Cerrahi Alan Komplikasyonları: Retrospektif Kohort Çalışma

Yıl 2022, Cilt: 19 Sayı: 2, 1290 - 1294, 01.07.2022

Yusuf Yavuz , Rukiye Ozcelik Tepe

https://doi.org/10.38136/jgon.1111186

Öz

Amaç: Çalışmanın amacı sezaryen sonrası yara komplikasyonları için risk faktörlerini belirlemektir. Ayrıca sekonder amaç cerrahi alan enfeksiyonu olan hastaların kültür sonuçlarını göstermektir.
Materyal ve Metod: Ocak 2019 ile Aralık 2020 tarihleri arasında üçüncü basamak bir merkezde gerçekleştirilen ardışık sezaryen doğumlarının retrospektif bir kohort çalışması gerçekleştirdik. Cerrahi alan enfeksiyonu tanımu, ameliyattan 30 gün sonra meydana gelen cerrahi alandaki enfeksiyonu içeriyordu. Tıbbi kayıtlar gözden geçirildi hasta demografik özellikleri, komorbiditeler, potansiyel risk faktörleri olarak değerlendirildi.
Bulgular: Çalışma süresince sezaryen uygulanan 22627 hastadan 151'inde (%0.6) CAE gelişti. CAE grubunda vücut kitle indeksi kontrol grubuna göre anlamlı şekilde daha yüksekti (28.3±4.3'e karşılık 23.9±4.7; <0.001). Aynı şekilde hipertansif hastalıklar CAE olan grupta kontrol grubuna göre anlamlı şekilde daha sık görüldü (sırasıyla 30'a (%19.8) karşılık 1131 (%4.9); <0.001).
Sonuç: Hipertansiyon ve artan vücut kitle indeksi ile CAE olan hastalar arasında ilişki vardır. Ameliyattan önce yüksek riskli kadınlara daha yüksek CAE oranları ve önleyici tedbirler hakkında bilgi verilmelidir.

Anahtar Kelimeler

cerrahi alan enfeksiyonu, sezaryen, yara yeri enfeksiyonu

Surgical Site Complications After Cesarean Section: A Retrospective Cohort Study

Öz

Aim: The aim of the study is to determine the risk factors for wound complications after cesarean section. In addition, the secondary aim is to show the culture results of patients with surgical site infection.
Materials and Methods: We conducted a retrospective cohort study of consecutive cesarean deliveries performed at a tertiary center between January 2019 and December 2020. The definition of surgical site infection included infection at the surgical site occurring 30 days after surgery. Medical records were reviewed and patient demographics, comorbidities were evaluated as potential risk factors.
Results: SSI developed in 151 (0.6%) out of 22627 patients who underwent cesarean section during the study. Body mass index was significantly higher in the CAE group than in the control group (28.3±4.3 vs. 23.9±4.7; <0.001). Likewise, hypertensive diseases were significantly more common in the group with SSI compared to the control group (30 (19.8%) vs. 1131 (4.9%), respectively; <0.001).
Conclusion: There is a relationship between hypertension and increased body mass index in patients with CAE. High-risk women should be counseled about higher rates of SAE and preventive measures prior to surgery.

Anahtar Kelimeler

surgical site infection, cesarean section, wound infection

Kaynakça

• 1. Saeed KB, Greene RA, Corcoran P, O'Neill SM. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol. BMJ Open. 2017 Jan 11;7(1):e013037. doi: 10.1136/bmjopen-2016-013037. PMID: 28077411; PMCID: PMC.
• 2. Saeed KB, Corcoran P, Greene RA. Incisional surgical site infection following cesarean section: A national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:256-260. doi: 10.1016/j.ejogrb.2019.07.020.
• 3. Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014 Sep;41(3):237-44. doi: 10.1111/birt.12104.
• 4. Appropriate technology for birth. Lancet. 1985 Aug 24;2(8452):436-7.
• 5. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992 Oct;20(5):271-4. doi: 10.1016/s0196-6553(05)8020.
• 6. Martin EK, Beckmann MM, Barnsbee LN, et al. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses. BJOG. 2018 Jul;125(8):956-964.
• 7. Petrou S, Glazener C. The economic costs of alternative modes of delivery during the first two months postpartum: results from a Scottish observational study. BJOG. 2002 Feb;109(2):214-7. doi: 10.1111/j.1471-0528.2002.01032.x.
• 8. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994 Aug;34(4):398-402. doi: 10.1111/j.1479-828x.1994.tb01256.x.
• 9. Bruce J, Russell EM, Mollison J, Krukowski ZH. The measurement and monitoring of surgical adverse events. Health Technol Assess. 2001;5(22):1-194. doi: 10.3310/hta5220.
• 10. Bärwolff S, Sohr D, Geffers C, Brandt C, Vonberg RP, Halle H, Rüden H, Gastmeier P. Reduction of surgical site infections after Caesarean delivery using surveillance. J Hosp Infect. 2006 Oct;64(2):156-61.
• 11. Johnson A, Young D, Reilly J. Caesarean section surgical site infection surveillance. J Hosp Infect. 2006 Sep;64(1):30-5. doi: 10.1016/j.jhin.2006.03.020.
• 12. Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol. 2001 Oct;22(10):613-7. doi: 10.1086/501831.
• 13. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995 Mar;40(3):171-5.
• 14. Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol. 2010 Sep;203(3):271.e1-7. doi: 10.1016/j.ajog.2010.06.049.
• 15. Avila C, Bhangoo R, Figueroa R, Santorelli J, Ogburn P, Desan PH. Association of smoking with wound complications after cesarean delivery. J Matern Fetal Neonatal Med. 2012 Aug;25(8):1250-3. doi: 10.3109/14767058.2011.636462.
• 16. Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol. 2000;8(2):77-82. 17. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005 Jul;90(1):10-5.
• 18. Koigi-Kamau R, Kabare LW, Wanyoike-Gichuhi J. Incidence of wound infection after caesarean delivery in a district hospital in central Kenya. East Afr Med J. 2005 Jul;82(7):357-61.
• 19. https://tuikweb.tuik.gov.tr/UstMenu.do?metod=temelist.
• 20. Salim R, Braverman M, Teitler N, Berkovic I, Suliman A, Shalev E. Risk factors for infection following cesarean delivery: an interventional study. J Matern Fetal Neonatal Med. 2012 Dec;25(12):2708-12. doi: 10.3109/14767058.2012.705394.
• 21. Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med. 2017 Jan;30(1):8-12. doi: 10.3109/14767058.2016.1163540. 22. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008 Jun;29(6):477-84; discussion 485-6. doi: 10.1086/587810.
• 23. Farret TC, Dallé J, Monteiro Vda S, Riche CV, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. 2015 Mar-Apr;19(2):113-7. doi: 10.1016/j.bjid.2014.09.
• 24. Tran TS, Jamulitrat S, Chongsuvivatwong V, Geater A. Risk factors for postcesarean surgical site infection. Obstet Gynecol. 2000 Mar;95(3):367-71. doi: 10.1016/s0029-7844(99)00540-2.
• 25. Smid MC, Kearney MS, Stamilio DM. Extreme Obesity and Postcesarean Wound Complications in the Maternal-Fetal Medicine Unit Cesarean Registry. Am J Perinatol. 2015 Dec;32(14):1336-41. doi: 10.1055/s-0035-1564883.
• 26. Anderson ER, Gates S. Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004663. doi:10.1002/14651858.CD004663.pub2.
• 27. Takoudes TC, Weitzen S, Slocum J, Malee M. Risk of cesarean wound complications in diabetic gestations. Am J Obstet Gynecol. 2004 Sep;191(3):958-63. doi: 10.1016/j.ajog.2004.05.063.
• 28. Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol. 2013 Oct;209(4):294-306. doi: 10.1016/j.ajog.2013.02.043.
• 29. Tuuli MG, Liu J, Stout MJ, Martin S, Cahill AG, Odibo AO, Colditz GA, Macones GA. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery. N Engl J Med. 2016 Feb 18;374(7):647-55. doi: 10.1056/NEJMoa1511048. 30. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014 Oct 28;2014(10):CD007482. doi: 10.1002/14651858.CD007482.pub3.
• 31. Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2011 Mar;117(3):682-690. doi: 10.1097/AOG.0b01.