Lomber Enstrümantasyon Cerrahisinde Yara Yeri Enfeksiyonu ile İlişkili Faktörlerin Değerlendirilmesi
Öz
Amaç: Lomber enstrümantasyon cerrahisini takiben yara iyileşmesi süreci ile ilişkili birçok faktör vardır. Bunların başında beyin omurilik sıvısı fistülü, ameliyat süresi, kanama miktarı, diyabet, obezite, sigara kullanımı, hemoglobin düşüklüğü, steroid kullanılması, eşlik eden malignite varlığı gelmektedir. Bu çalışmada hastaya ait risk faktörlerinden bağımsız olarak, operasyon süresi ve ortaya çıkan eritrosit süspansiyonu transfüzyon ihtiyacının yara iyileşmesine olan etkisinin incelenmesi araştırılmıştır. Yöntem: 2020-2022 yılları arasında 4 seviye ve altında lomber enstrümantasyon cerrahisi uygulanan 490 hasta çalışmaya dahil edilmiştir. Hastaların 362’si kadın 128’i erkektir. Ortalama cerrahi süre ve eritrosit süspansiyon ihtiyacı parametrelerinin cerrahi alan enfeksiyonu gelişmesi üzerine olan etkisi araştırılmıştır. Bulgular: 14 hastada (%2,8) kesi yeri enfeksiyonu görülmüştür. Kesi yeri enfeksiyonu gelişen 14 hastanın 12'sini ES verilmiş olan hastalar oluşturmaktadır. Kesi yeri enfeksiyonu gelişen 14 hastanın operasyon süresi ortalaması 120 dakika olarak bulunmuş iken, kesi yeri enfeksiyonu olmayan grupta ortalama ameliyat süresi 90 dakika olarak bulunmuştur. Kesi yeri enfeksiyonu ile eritrosit süspansiyonu transfüzyonu arasında anlamlı ilişki vardır ve eritrosit transfüzyonu verilmiş olanlarda kesi yeri enfeksiyonu ile karşılaşılması oranı daha yüksektir (p<0,001). Kesi yeri enfeksiyonu gelişmesi ile operasyon süresi uzaması açısından bakıldığında ise görülmektedir ki enfeksiyon gelişenlerde ortalama ameliyat süresi daha uzundur. (p=0,001) Sonuç: Hastaya bağlı risk faktörlerinden bağımsız olarak bakıldığında; cerrahi süresinin kısa olması ve eritrosit süspansiyonu transfüzyon ihtiyacı gerekmemesi yara yeri enfeksiyonunu azaltmaktadır.
Anahtar Kelimeler
Kaynakça
- Liu C, Qian ZG, Sun QC. [Analysis of risk factors of postoperative wound infection in lumbar spondylolisthesis]. Zhongguo Gu Shang. 2019;32(10):882-5.
- Meng F, Cao J, Meng X. Risk factors for surgical site infections following spinal surgery. J Clin Neurosci. 2015;22(12):1862-6.
- Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: incidence, management, and complications. A retrospective review. Injury. 2012;43(4):397-401.
- Kato S, Chikuda H, Ohya J, Oichi T, Matsui H, Fushimi K, et al. Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score-matched analysis. Spine J. 2016;16(1):55-60.
- Kim B, Moon SH, Moon ES, Kim HS, Park JO, Cho IJ, et al. Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols. Asian Spine J. 2010;4(2):71-6.
- Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of Surgical Site Infection After Spine Surgery: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976). 2020;45(3):208-16.
- Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, et al. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2013;22(3):605-15.
- 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.
- Hijas-Gomez AI, Egea-Gamez RM, Martinez-Martin J, Gonzalez-Diaz R, Losada-Vinas JI, Rodriguez-Caravaca G. Surgical Wound Infection Rates and Risk Factors in Spinal Fusion in a University Teaching Hospital in Madrid, Spain. Spine (Phila Pa 1976). 2017;42(10):748-54.
- Kim BD, Hsu WK, De Oliveira GS, Jr., Saha S, Kim JY. Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4588 surgical cases. Spine (Phila Pa 1976). 2014;39(6):510-20.
- Woods BI, Rosario BL, Chen A, Waters JH, Donaldson W, 3rd, Kang J, et al. The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. J Bone Joint Surg Am. 2013;95(23):2105-10.
- Janssen SJ, Braun Y, Wood KB, Cha TD, Schwab JH. Allogeneic blood transfusions and postoperative infections after lumbar spine surgery. Spine J. 2015;15(5):901-9.
Öz
Aim: Many factors are related to wound healing after lumbar instrumentation surgery. These include cerebrospinal fluid fistula, duration of surgery, amount of bleeding, diabetes, obesity, being a smoker, low haemoglobin levels, steroid administration, and accompanying malignancy. This study aims to investigate the effect of surgery duration and the need for erythrocyte suspension transfusion on wound healing, regardless of the patient's risk factors. Methods: 490 patients who underwent lumbar instrumentation surgery at four levels or below by a single surgeon between 2020 and 2022 were included in the study. 362 of 492 patients were female, and 128 were male. The relationship between the average surgical duration, erythrocyte suspension requirement parameters, and surgical wound infection rates was investigated. Results: Surgical wound infection was observed in 14 patients (2.8%). Of these 14 patients, 12 had a history of erythrocyte suspension transfusion. The average surgical duration for the 14 patients with surgical wound infection was 120 minutes, while 90 minutes for the group without surgical wound infection. There is a correlation between erythrocyte suspension transfusion and surgical wound infection, with a higher infection rate observed in patients with an erythrocyte transfusion history (p<0.001). Additionally, there is a correlation between the development of surgical wound infection and prolonged surgical duration, as patients who experience an infection tend to have longer surgical durations (p=0.001). Conclusion: Considered independently of patient-related risk factors, short surgical time and no need for erythrocyte suspension transfusion reduce wound infection.
Anahtar Kelimeler
Surgical duration Erythrocyte suspension surgical wound infection
Kaynakça
- Liu C, Qian ZG, Sun QC. [Analysis of risk factors of postoperative wound infection in lumbar spondylolisthesis]. Zhongguo Gu Shang. 2019;32(10):882-5.
- Meng F, Cao J, Meng X. Risk factors for surgical site infections following spinal surgery. J Clin Neurosci. 2015;22(12):1862-6.
- Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: incidence, management, and complications. A retrospective review. Injury. 2012;43(4):397-401.
- Kato S, Chikuda H, Ohya J, Oichi T, Matsui H, Fushimi K, et al. Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score-matched analysis. Spine J. 2016;16(1):55-60.
- Kim B, Moon SH, Moon ES, Kim HS, Park JO, Cho IJ, et al. Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols. Asian Spine J. 2010;4(2):71-6.
- Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of Surgical Site Infection After Spine Surgery: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976). 2020;45(3):208-16.
- Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, et al. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2013;22(3):605-15.
- 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.
- Hijas-Gomez AI, Egea-Gamez RM, Martinez-Martin J, Gonzalez-Diaz R, Losada-Vinas JI, Rodriguez-Caravaca G. Surgical Wound Infection Rates and Risk Factors in Spinal Fusion in a University Teaching Hospital in Madrid, Spain. Spine (Phila Pa 1976). 2017;42(10):748-54.
- Kim BD, Hsu WK, De Oliveira GS, Jr., Saha S, Kim JY. Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4588 surgical cases. Spine (Phila Pa 1976). 2014;39(6):510-20.
- Woods BI, Rosario BL, Chen A, Waters JH, Donaldson W, 3rd, Kang J, et al. The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. J Bone Joint Surg Am. 2013;95(23):2105-10.
- Janssen SJ, Braun Y, Wood KB, Cha TD, Schwab JH. Allogeneic blood transfusions and postoperative infections after lumbar spine surgery. Spine J. 2015;15(5):901-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Haziran 2023 |
| Gönderilme Tarihi | 6 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 6 Sayı: 2 |
