Incidência e fatores associados a infecção do sítio cirúrgico em pacientes submetidos a cirurgia do tornozelo e pé: uma coorte de 7 anos

Abstract

Background: Surgical site infections (SSI) represent 31% of all hospital-acquired diseases, are the most common type of nosocomial infection, and have more severe orthopaedic complications. Surgical procedures of the ankle and foot, specifically, have an incidence of SSI ranging from 0.5% to 6.5%. Purpose: This study aimed to evaluate the incidence of superficial and deep SSI in foot and ankle surgery and the associated factors and to identify the most prevalent microorganisms. Methods: This study was a retrospective cohort including 2180 patients who underwent surgery of foot and ankle in a private hospital between 2014 and 2020. All elective and urgent procedures were included if they were considered clean. The outcome variable was SSI (superficial or deep) and the predictor variables were: sex, age, diabetes mellitus, systemic arterial hypertension (SAH), smoking, American Society of Anesthesiologists (ASA) score, and body mass index (BMI). Logistic regression models were used to determine associations between the study variables. Results: The incidence of SSI was 4% (83/2180), representing a incidence rate of 2.8% (57/2180) for superficial SSI and 1.2% (26/2180) for deep SSI. Two factors were identified as independently associated with SSI: smoking (OR 2.8, 95%CI 1.4-5.2) and ASA > 2 (OR 3.0, 95%CI 1.1-6.9). The group of patients with deep infections had higher proportions of smokers (p=0.002), SAH (p=0.018), emergency surgery (p=0.049), and ASA > 2 (p=0.011). The most prevalent organism detected by culture was Staphylococcus aureus in 61.5% of the cases, followed by Pseudomonas aeruginosa in 15.54%. Conclusions: The incidence of infection in this cohort was 4%; urgent surgical procedures, smoking, hypertension, and ASA classification > 2 were independently associated with the development of deep infections. The surgeon should be aware of these risk factors in order to manage the patient’s prophylactic antibiotic regimen.