Hepatobilier cerrahide cerrahi alan enfeksiyonuna etkili risk faktörleri
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Date
2010
Authors
Işık, Özgen
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Cerrahi alan enfeksiyonu (CAE) ile ilgili pek çok çalışma yapılmış ve çeşitli risk faktörleri tanımlanmıştır. Ancak hepatobilier (HPB) cerrahide CAE'na etkili risk faktörlerine yönelik çalışma sayısı yok denecek kadar azdır. Bu çalışmamızda hepatobilier cerrahi için risk faktörlerini saptamayı amaçladık. Ocak 2005 ile Aralık 2009 arasında hepatobilier sistem cerrahisi geçiren 14818 hasta çalışmaya dahil edildi. Demografik veriler, hasta ve operatif süreçle ilişkili risk faktörleri, laboratuar parametreleri retrospektif olarak incelendi.HPB cerrahide CAE insidansı %3.94'tü. Tek değişkenli analizde uygulanan cerrahi prosedür, uygunsuz antimikrobiyal profilaksi (AMP), insizyon yeri, yara sınıfı, preoperatif hastanede kalış süresi, operasyon süresi, preoperatif hemoglobin düzeyi, total ve direkt bilirubin düzeyleri, bilier drenaj kateteri, acil cerrahi girişim, obezite, malignite, cilt kolonizasyonu , KOAH, DM, dren, cilt sütürü, kan transfüzyonu (p<0.0001), ASA skoru, ALT düzeyi (p=0.002), cerrah (p=0.016), preoperatif cilt traşı (p=0.036), AST düzeyi (p=0.04) ve malnutrisyon (p=0.041) CAE ile anlamlı olarak ilişkili bulundu. Ancak çok değişkenli analizde kan transfüzyonu (OR:20.9), dren varlığı (OR:10.7), 8 günden fazla preoperatif yatış süresi (OR8.1), DM (OR:6.2), KOAH (OR:6.1), uygunsuz AMP (OR:6), obezite (OR:3.2) preoperatif eksternal-internal bilier drenaj katateri varlığı (OR:2), preoperatif direkt bilirubin düzeyinin 15mg/dl'nin üzerinde olması (OR:1.4) bağımsız risk faktörleri olarak saptandı. E.Coli ve Enterococcus spp. en sık izole edilen patojen mikroorganizmalardı. Hepatobilier cerrahide etkili birçok bağımsız risk faktörü diğer abdominal genel cerrahi prosedürler için tanımlananlara benzerdir. Preoperatif bilier drenaj (özellikle eksternal-internal bilier drenaj) ve direkt bilirubin seviyesinin 15mg/dl'nin üzerinde olması hepatobilier cerrahiye özgü risk faktörleri olarak belirlenmiştir.
There are plenty of studies about risk factors effecting on surgical site infection (SSI). But there are not enough studies focused on the risk factors effecting on SSI in hepatobiliary (HPB) surgery. In this study we aimed to determine risk factors related to HPB surgery. Totaly 1418 patients were included in this study who were undergone hepatobiliary system surgery in a five years period between January 2005 to December 2009. Demographical data, patient and operation related risk factors and laboratory parametres analyzed retrospectively. The overall incidence of SSI was %3.94 in HPB surgery. In univariate analysis the type of surgery, inappropriate antimicrobial prophylaxis (AMP), incision type, wound classification (p<0.0001), preoperative hospital stay, duration of operation, preoperative hemoglobin level, total and direct bilirubin levels, biliary drainage catheterisation, emergency surgery, obesity, malignancy, skin colonization, chronic obstructive pulmonary disease (COPD), DM, drains, skin sutures, blood transfusion (p<0.0001), ASA score, ALT level (p=0.002), surgeons experience (p=0.016), preoperative hair removal (p=0.036), AST level (p=0.04) and malnutrition (p=0.041) were found to be significantly related with SSI. In multivariate analysis; blood transfusion (OR:20.9), presence of surgical drains (OR:10.7), preoperative hospital stay more than 8 days (OR8.1), DM (OR:6.2), COPD (OR:6.127), inappropriate AMP (OR:6.), obesity (OR:3.2), presence of external-internal biliary drainage catheter (OR:2), direct bilirubin level over than 15mg/dl (OR:1.4) were determined as independent risk factors. E.Coli and Enterococcus spp. were most common isolated pathogene microorganisms in SSI?s.It seems that most of indepent risk factors for HPB system surgery are similar to the other abdominal general surgical procedures. But the presence of external-internal biliary drainage catheter and direct bilirubin levels over than 15mg/dl were found to be spesific risk factors for HPB surgery.
There are plenty of studies about risk factors effecting on surgical site infection (SSI). But there are not enough studies focused on the risk factors effecting on SSI in hepatobiliary (HPB) surgery. In this study we aimed to determine risk factors related to HPB surgery. Totaly 1418 patients were included in this study who were undergone hepatobiliary system surgery in a five years period between January 2005 to December 2009. Demographical data, patient and operation related risk factors and laboratory parametres analyzed retrospectively. The overall incidence of SSI was %3.94 in HPB surgery. In univariate analysis the type of surgery, inappropriate antimicrobial prophylaxis (AMP), incision type, wound classification (p<0.0001), preoperative hospital stay, duration of operation, preoperative hemoglobin level, total and direct bilirubin levels, biliary drainage catheterisation, emergency surgery, obesity, malignancy, skin colonization, chronic obstructive pulmonary disease (COPD), DM, drains, skin sutures, blood transfusion (p<0.0001), ASA score, ALT level (p=0.002), surgeons experience (p=0.016), preoperative hair removal (p=0.036), AST level (p=0.04) and malnutrition (p=0.041) were found to be significantly related with SSI. In multivariate analysis; blood transfusion (OR:20.9), presence of surgical drains (OR:10.7), preoperative hospital stay more than 8 days (OR8.1), DM (OR:6.2), COPD (OR:6.127), inappropriate AMP (OR:6.), obesity (OR:3.2), presence of external-internal biliary drainage catheter (OR:2), direct bilirubin level over than 15mg/dl (OR:1.4) were determined as independent risk factors. E.Coli and Enterococcus spp. were most common isolated pathogene microorganisms in SSI?s.It seems that most of indepent risk factors for HPB system surgery are similar to the other abdominal general surgical procedures. But the presence of external-internal biliary drainage catheter and direct bilirubin levels over than 15mg/dl were found to be spesific risk factors for HPB surgery.
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Keywords
Cerrahi alan enfeksiyonu, Hepatobilier cerrahi, Risk faktörü, Surgical site infection, Hepatobiliary surgery, Risk factor
Citation
Işık, Ö. (2010). Hepatobilier cerrahide cerrahi alan enfeksiyonuna etkili risk faktörleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.