Instituto de Cardiologia do Rio Grande do Sul - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil.
Arq Bras Cardiol. 2019 Jun;112(6):769-774. doi: 10.5935/abc.20190070. Epub 2019 Apr 8.
Surgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2- to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks.
The objective of this study was to identify SSI risk factors in clean cardiac surgery.
A retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher's exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05.
The results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (OR: 2.575; CI: 1.224-5.416), obesity (OR: 2.068; CI: 1.457-2.936), diabetes mellitus (OR: 1,678; CI: 1.168-2.409), and blood glucose level (OR: 1.004; CI: 1.001-1.007).
This study evidenced that complete adherence to the bundle was not associated with a reduction in the risk of surgical infections. Diabetes mellitus, obesity, and surgical risk index assessment were, however, identified to increase association and consequently risk of SSI in cardiac surgery.
手术部位感染（SSI）是医疗机构中最常见的感染之一，其死亡率从 33%到 77%不等，死亡率风险增加 2 到 11 倍。接受心脏手术的患者更容易发生 SSI，占 SSI 的 3.5%到 21%。这些原因导致的死亡率高达 25%。心脏手术中 SSI 的预防基于一组预防措施，重点关注可改变的风险。
本研究旨在确定清洁心脏手术中 SSI 的危险因素。
回顾性队列研究分析了 1846 例接受清洁心脏手术患者的病历。使用 Fisher 确切检验进行双变量比较，使用 Poisson 回归进行 SSI 风险的独立分析，考虑显著性水平 p < 0.05。
该研究的结果包括多变量分析。与 SSI 诊断相关的变量是：手术风险指数（OR：2.575；CI：1.224-5.416）、肥胖（OR：2.068；CI：1.457-2.936）、糖尿病（OR：1.678；CI：1.168-2.409）和血糖水平（OR：1.004；CI：1.001-1.007）。
本研究表明，完全遵守该措施包并不能降低手术感染的风险。然而，糖尿病、肥胖和手术风险指数评估被确定为增加 SSI 的关联和风险。
