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Obstetrik ve Jinekolojik Operasyonlarda Cerrahi Alan Enfeksiyonları İle İlgili Risk Faktörlerinin Değerlendirilmesi

Yıl 2020, Cilt: 5 Sayı: 1, 41 - 48, 31.03.2020
https://doi.org/10.26453/otjhs.600815

Öz

Amaç: Cerrahi alan enfeksiyonları, cerrahi sonrası 30 gün içeri-sinde insizyon yerinde ortaya çıkan enfeksiyonlardır. Jinekolojik cerrahi sonrası en sık görülen komplikasyon cerrahi alan enfeksi-yonudur. Cerrahi alan enfeksiyonlarının gelişmesinde risk faktörle-ri değiştirilebilir ve değiştirilemez faktörler olarak ikiye ayrılır. Değiştirilebilir risk faktörleri arasında preoperatif anemi, diyabetes mellitus, hipertansiyon, malnütrisyon, sigara kullanımı; değiştiri-lemeyen risk faktörleri arasında yaş, obezite, malignite gibi faktör-ler bulunmaktadır. Bu çalışmada jinekolojik ve obstetrik cerrahi sonrası cerrahi alan enfeksiyonu gelişen olgularda risk faktörleri değerlendirildi.
Materyal Metot: Retrospektif olgu-kontrol çalışmasında Ocak-Aralık 2017 yılı içerisinde jinekolojik ve obstetrik cerrahi geçirmiş; operasyon sonrası cerrahi alan enfeksiyonu gelişen 65 ve enfeksi-yon gelişmeyen 52 hastanın demografik (yaş, kilo, beden kitle indeksi, kronik hastalık varlığı), preoperatif dönemde transfüzyon geçmişi, sigara kullanımı, tıbbi ve operasyon verileri karşılaştırıldı.
Bulgular: Cerrahi alan enfeksiyonu geçiren olguların yaş ve beden kitle indeksi enfeksiyon gelişmeyen olgulara göre daha fazla bu-lundu. Cerrahi alan enfeksiyonu gelişenlerde diyabet, hipertansi-yon, malignite daha fazla oranda mevcuttu.
Sonuç: Cerrahi alan enfeksiyonları hasta morbiditesini artırmakta-dır. Risk faktörleri arasında yaş, obezite, malignite, diyabet, hiper-tansiyon gibi faktörler bulunmaktadır. Risk faktörlerinin cerrahi öncesi belirlenmesi ve cerrahi alan enfeksiyonunu önlemeye yöne-lik tedbirler alınması önemlidir.

Proje Numarası

71522473/050.01.04/05

Kaynakça

  • Kaynaklar1. T. C. Horan, R. P. Gaynes, W. J. Martone, W. R. Jarvis, T. G. Emori, “CDC de nitions of nosocomial surgical site infections, 1992: a modification of CDC de nitions of surgical wound infections,” Infection Control and Hospital Epidemiology, vol. 13, no. 10, pp. 606–608, 1992.
  • 2. Antibiotic Prophylaxis for Gynecologic Procedures, “Practice bulletin No. 104. American College of Obstetricians and Gynecologists,” Obstetrics & Gynecology, vol. 113, no. 5, pp. 1180–1189, 2009.
  • 3. Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol. 2013;209(5):490.e1-9. doi: 10.1016/j.ajog.2013.06.018.
  • 4. Hodges KR, Davis BR, Swaim LS. Prevention and management of hysterectomy complications. Clin Obstet Gynecol. 2014 Mar;57(1):43-57.
  • 5. Lachiewicz MP, Moulton LJ, Jaiyeoba O. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy. JSLS. 2015;19(3). doi: 10.4293/JSLS.2015.00065. Review. 6. Matthews KJ, Brock E, Cohen SA, Chelmow D. Hysterectomy in obese patients: special considerations. Clin Obstet Gynecol. 2014 Mar;57(1):106-14.
  • 7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96.
  • 8. Najjar PA, Smink DS. Prophylactic antibiotics and prevention of surgical site infections. Surg Clin North Am. 2015;95(2):269-83.
  • 9. Kore S, Vyavaharkar M, Akolekar R, Toke A, Ambive V. Comparison of closure of subcu- taneous tissue versus non-closure in relation to wound disruption after abdominal hysterectomy in obese patients. J Postgrad Med 2000;46: 26-8.
  • 10. Allaire AD, Fisch J, McMahon MJ. Subcutaneous drain versus suture in obese women undergoing cesarean delivery, a prospective, randomized trial. J Reprod Med 2000;45:327-31. 29.
  • 11. Ramsey PS, White AM, Guinn DA, et al. Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women un- dergoing cesarean delivery. Obstet Gynecol 2005;105:967-73.
  • 12. Hellum EK, Lin MG, Ramsey PS. Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery—a metaanalysis. Am J Obstet Gynecol 2007;197: 229-35.
  • 13. Inotsume-Kojima Y, Uchida T, Abe M, Doi T, Kanayama N. A combination of subcuticular sutures and a drain for skin closure reduces wound complications in obese women under- going surgery using vertical incisions. J Hosp Infect 2011;77:162-5.
  • 14. Ahmed F. Infectious complications following abdominal hysterectomy in Karachi, Pakistan. Int J Gynecol Obstet 2000;73:27-34.
  • 15. Walsh C, Scaife C, Hopf H. Prevention and management of surgical site infections in morbidly obese women. Obstet Gynecol 2009;113:411-5.
  • 16. Morgan-Ortiz F, et al. Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy. Int J Gynaecol Obstet. 2012;120:61–64.
  • 17. Hourigan JS. Impact of obesity on surgical site infection in colon and rectal surgery. Clin Colon Rectal Surg. 2011;24:283–290.
  • 18. Eddib A, Danakas A, Hughes S, et al. Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery. J Gynecol Surg. 2014;30(2):81–86. doi:10.1089/gyn.2012.0142
  • 19. Mahdi H, Gojayev A, Buechel M, Knight J, SanMarco J, Lockhart D, Michener C, Moslemi-Kebria M. Surgical site infection in women undergoing surgery for gynecologic cancer. Int J Gynecol Cancer. 2014;24(4):779-86.
  • 20. Savage MW, Pottinger JM, Chiang HY, Yohnke KR, Bowdler NC, Herwaldt LA. Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 2013;209(2):108.e1-10.
  • 21. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99.
  • 22. Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med. 2017;30(1):8-12.
  • 23. Kadija S, Stefanovic A, Jeremic K, Tavcar J, Argirovic R, Pantovic S. Malignant disease as a risk factor for surgical site infection. Clin Exp Obstet Gynecol. 2012;39:53–6.
  • 24. Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS ONE. 2013;8:e83743.
  • 25. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9(2):196–203.

Evaluation of Risk Factors Related to Surgical Site Infections in Obstetric and Gynecologic Operations

Yıl 2020, Cilt: 5 Sayı: 1, 41 - 48, 31.03.2020
https://doi.org/10.26453/otjhs.600815

Öz

Objective: Surgical site infections(SSI) are those that occur at the incision site within 30 days after surgery. They are the most com-mon complications after gynecological surgery. For the develop-ment of SSI, risk factors are divided into two as modifiable and non-modifiable factors. Modifiable risk factors include preoperati-ve anemia, diabetes mellitus, hypertension, malnutrition and smo-king, whereas non-modifiable risk factors include age, obesity, malignancy, etc. This study evaluated the risk factors in patients who developed SSI after gynecological-obstetric surgery. Materials and Methods: This retrospective case-control study compared data including age, weight, body mass index(BMI) and presence of a chronic disease, history of preoperative transfusion, smoking and medical-operative data between 65 patients who underwent surgery and developed postoperative SSI and 52 pati-ents who did not develop SSI from January to December 2017.
Results: Patients with SSI had higher age, weight and BMI than those without infection. The incidence of diabetes, hypertension and malignancy was higher in patients with SSI.
Conclusion: Surgical site infections increase morbidity rates. Risk factors for SSI include age, obesity, malignancy, diabetes and hypertension. It is important to determine the risk factors before surgery and to take precautions to prevent SSI.

Proje Numarası

71522473/050.01.04/05

Kaynakça

  • Kaynaklar1. T. C. Horan, R. P. Gaynes, W. J. Martone, W. R. Jarvis, T. G. Emori, “CDC de nitions of nosocomial surgical site infections, 1992: a modification of CDC de nitions of surgical wound infections,” Infection Control and Hospital Epidemiology, vol. 13, no. 10, pp. 606–608, 1992.
  • 2. Antibiotic Prophylaxis for Gynecologic Procedures, “Practice bulletin No. 104. American College of Obstetricians and Gynecologists,” Obstetrics & Gynecology, vol. 113, no. 5, pp. 1180–1189, 2009.
  • 3. Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol. 2013;209(5):490.e1-9. doi: 10.1016/j.ajog.2013.06.018.
  • 4. Hodges KR, Davis BR, Swaim LS. Prevention and management of hysterectomy complications. Clin Obstet Gynecol. 2014 Mar;57(1):43-57.
  • 5. Lachiewicz MP, Moulton LJ, Jaiyeoba O. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy. JSLS. 2015;19(3). doi: 10.4293/JSLS.2015.00065. Review. 6. Matthews KJ, Brock E, Cohen SA, Chelmow D. Hysterectomy in obese patients: special considerations. Clin Obstet Gynecol. 2014 Mar;57(1):106-14.
  • 7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96.
  • 8. Najjar PA, Smink DS. Prophylactic antibiotics and prevention of surgical site infections. Surg Clin North Am. 2015;95(2):269-83.
  • 9. Kore S, Vyavaharkar M, Akolekar R, Toke A, Ambive V. Comparison of closure of subcu- taneous tissue versus non-closure in relation to wound disruption after abdominal hysterectomy in obese patients. J Postgrad Med 2000;46: 26-8.
  • 10. Allaire AD, Fisch J, McMahon MJ. Subcutaneous drain versus suture in obese women undergoing cesarean delivery, a prospective, randomized trial. J Reprod Med 2000;45:327-31. 29.
  • 11. Ramsey PS, White AM, Guinn DA, et al. Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women un- dergoing cesarean delivery. Obstet Gynecol 2005;105:967-73.
  • 12. Hellum EK, Lin MG, Ramsey PS. Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery—a metaanalysis. Am J Obstet Gynecol 2007;197: 229-35.
  • 13. Inotsume-Kojima Y, Uchida T, Abe M, Doi T, Kanayama N. A combination of subcuticular sutures and a drain for skin closure reduces wound complications in obese women under- going surgery using vertical incisions. J Hosp Infect 2011;77:162-5.
  • 14. Ahmed F. Infectious complications following abdominal hysterectomy in Karachi, Pakistan. Int J Gynecol Obstet 2000;73:27-34.
  • 15. Walsh C, Scaife C, Hopf H. Prevention and management of surgical site infections in morbidly obese women. Obstet Gynecol 2009;113:411-5.
  • 16. Morgan-Ortiz F, et al. Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy. Int J Gynaecol Obstet. 2012;120:61–64.
  • 17. Hourigan JS. Impact of obesity on surgical site infection in colon and rectal surgery. Clin Colon Rectal Surg. 2011;24:283–290.
  • 18. Eddib A, Danakas A, Hughes S, et al. Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery. J Gynecol Surg. 2014;30(2):81–86. doi:10.1089/gyn.2012.0142
  • 19. Mahdi H, Gojayev A, Buechel M, Knight J, SanMarco J, Lockhart D, Michener C, Moslemi-Kebria M. Surgical site infection in women undergoing surgery for gynecologic cancer. Int J Gynecol Cancer. 2014;24(4):779-86.
  • 20. Savage MW, Pottinger JM, Chiang HY, Yohnke KR, Bowdler NC, Herwaldt LA. Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 2013;209(2):108.e1-10.
  • 21. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99.
  • 22. Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med. 2017;30(1):8-12.
  • 23. Kadija S, Stefanovic A, Jeremic K, Tavcar J, Argirovic R, Pantovic S. Malignant disease as a risk factor for surgical site infection. Clin Exp Obstet Gynecol. 2012;39:53–6.
  • 24. Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS ONE. 2013;8:e83743.
  • 25. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9(2):196–203.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Hilal Uslu Yuvacı 0000-0001-8067-3165

Mehmet Musa Aslan 0000-0002-7830-5002

Elif Köse 0000-0002-2232-4538

Merve Keskin Paker 0000-0003-4796-0909

Arif Serhan Cevrioğlu 0000-0002-3810-6519

Proje Numarası 71522473/050.01.04/05
Yayımlanma Tarihi 31 Mart 2020
Gönderilme Tarihi 2 Ağustos 2019
Kabul Tarihi 26 Kasım 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 5 Sayı: 1

Kaynak Göster

AMA Uslu Yuvacı H, Aslan MM, Köse E, Keskin Paker M, Cevrioğlu AS. Obstetrik ve Jinekolojik Operasyonlarda Cerrahi Alan Enfeksiyonları İle İlgili Risk Faktörlerinin Değerlendirilmesi. OTSBD. Mart 2020;5(1):41-48. doi:10.26453/otjhs.600815

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