Epidemiologia da infecção pós-operatória em pacientes com mielomeningocele, tratados para correção de deformidades da coluna vertebral

Abstract

RESUMOObjetivo: As cirurgias de coluna realizadas em pacientes com mielomeningocele, apresentam maior risco de infecção pós-operatória. Fizemos um levantamento epidemiológico dessas infecções e fatores possivelmente associados para estabelecer fatores de risco. Mé-todos: Levantamento retrospectivo de dados de cirurgias de coluna realizadas em pacientes com mielomeningocele, na Associação de Assistência à Criança Deficiente -AACD/Hospital Abreu Sodré. A comparação para possíveis fatores de risco avaliados foi feita através do teste exato de Fisher. Foram considerados significativos os resultados com p < 0,05. Resultados: Avaliamos 27 procedimentos cirúrgicos com um total de sete casos de infecção pós-operatória do sítio cirúrgico (25,92%). Cinco destes pacientes com infecção do sítio cirúrgico apresentaram infecção concomitante do trato urinário (ITU), com p = 0,004. Não encontramos significância estatística para os demais fatores avaliados: via de acesso, tipo de procedimento e linfócitos séricos totais. Conclusão: a ITU está relacionada à infecção do sítio cirúrgico, mas é necessário um estudo prospectivo com maior número de casos para elucidar esse fator de risco com um possível fator de confusão: estado nutricional e imunológico.

Epidemiological Profile and Outcomes in Postoperative Neuromuscular Escoliosis

“…The incidence of surgical site infection seems to have some relationship with the underlying diagnosis of the patient. In our study, which had a diverse set of underlying diagnoses, the incidence of infection was 12%, while in the study by Jaccard et al, 13 whose sample was comprised only of patients with myelomeningocele, surgical site infection was present in more than double the number of cases (25%) in our study. However, we cannot infer anything from this finding, since there are no studies that stratify outcomes by underlying diagnosis.…”

“…However, we cannot infer anything from this finding, since there are no studies that stratify outcomes by underlying diagnosis. 13,18 Immobility, although with a small overall percentage (2%) in this study, was reported as a complication because it is a factor that can impact hospital outcomes. 19,20 The 1 st postoperative was the day of least adherence to the proposed mobility goals (24%) and this should be a point of attention to be managed in the institutions, in conjunction with patient education and the active participation of the patient and family in postoperative planning, including information about daily goals.…”

“…As in other studies, it was noted that the presence of curves with high angular values and the need for surgical intervention did not seem to be related to sex. 13,14 Regarding the age of the individuals on the date of surgical intervention, we observed greater variability in the sample. The mean age found in our study was 13.9 years, similar to the data published in the study by Jaccard, 13 who reported a mean age of 11 years.…”

“…13,14 Regarding the age of the individuals on the date of surgical intervention, we observed greater variability in the sample. The mean age found in our study was 13.9 years, similar to the data published in the study by Jaccard, 13 who reported a mean age of 11 years. In the study by Dahe, 14 the mean age of the operated population was 16.4 years.…”

“…In this study, the Cobb angle, which is an important factor when analyzing outcomes related to surgical time, for example, was not documented. 13,18 Most studies only report complications related to the intraoperative period or the most serious postoperative ones, such as infection of the surgical site and respiratory infection. In this sense, the complication rate percentages found in the literature are lower than the values observed in our study.…”