Experiencia del Cirujano como riesgo de infección de sitio quirúrgico
DOI:
https://doi.org/10.35954/SM2005.27.1.4Keywords:
Surgical Block; Surgery; Wound Infection; Infections; Operating Room.Abstract
Introduction: Despite technical advances, greater knowledge of the pathogenesis of wound infection and the use of prophylactic antibiotics, surgical site infection (SSI) continues to be an important morbimortality factor. It is estimated to account for 24% of hospital-acquired infections, ranking second only to urinary tract infections among nosocomial infections (1).
Among the risk factors that have been associated with surgical site infection, surgical technique is considered one of the factors that play a fundamental role in postoperative complications, including infection (1,2,3 ).
The main risk factors are linked to inadequate cleaning of the surgical site, hematoma formation and increased tissue exposure time (duration of surgical time). These factors should be improved as the surgeon's experience increases (4).
The purpose of this study is to determine the importance of the surgeon's experience as a risk factor in the development of surgical site infection in a specific intervention: cholecystectomy by laparotomy.
Methodology: This is a retrospective cohort study of patients who underwent cholecystectomy at the Central Hospital of the Armed Forces between 1999 and 2003.
A sample size was estimated with the epi info 6.0 statcal program.
The main independent variable of the study was the surgeon's experience, which was categorized into two groups, resident and surgeon, and the primary outcome was surgical site infection.
The distribution of patient characteristics between surgeons and residents was analyzed with chi-square.
Univariate and multivariate analysis was used to determine the association between the different variables and the outcome of interest.
Results: A total of 842 cholecystectomized patients were followed and the presence of diabetes OR 5.3 (2.26-12.5), the severity score >2 loop OR 2.41 (1.22-4.75) and the presence of intraoperative accidents OR 3.60 (1.08-11.9) were undoubted independent predictors.
Surgery performed by residents showed a borderline interval OR 1.91 (1.0-3.62).
Conclusion: Surgeon experience shows an incidence in this work and for this population as an independent predictor of surgical site infection.
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References
(1) GLEN MAYHALL, Hospital Epidemiology and Infection Control. WILLIAM WILKINS, Baltimore 1996, Second edition 1999.
(2) RICHARD P. WENZEL, Prevention and Control of Nosocomial Infections. WILLIAM WILKINS, Baltimore Second Edition 1993, Third Edition 1997.
(3) Center for Disease Control and Prevention. Guidelines for Prevention of Surgical Site Infection, 1999.
(4) CRUSE PJ, FOORD R. Epidemiología de las infecciones de heridas. Estudio durante 10 años de 62939 heridas. Clin. Quir. N.A. 1:25, 1980.
(5) Enciclopedia Medico Quirúrgica. Francia 2000.
(6) Text book of Surgery . U.S.A 2000.
(7) SOSA, COL. The importance of surgeon experience for clinical and economics outcomes from thyroidectomy. Ann Surg. Volume 228(3). September 1998. 320-330.
(8) ROTH, COL. Does the success of ureterointestinal implantation in orthotopic bladder substitution depend more on surgeon level of experience or choice of technique. J. Urol, Voluime 157(1). January 1997.56-60.
(9) WITT, COL. The effect of surgeon experience on velopharyngeal functional outcome following palatoplasty: Is there a learning curve? Plast Reconstr Surg 1998; 102(5):1375-1384.
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