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Faktori rizika značajni za nastanak dehiscencije staplerskih anastomoza kod pacijenata operisanih zbog karcinoma rektuma / Risk factors significant for development of dehiscence of stapler anastomosis in patients with rectal cancer removedLalović Nenad 26 September 2016 (has links)
<p>UVOD: Kolorektalna anastomoza koja se formira u dubini karlice radi uspostavljanja kontinuiteta gastrointestinalnog trakta nakon resekcije dijela crijeva ima svoje specifičnosti u toku formiranja, zarastanja, kao i kada se jave komplikacije. Na sam proces zarastanja kolorektalnih anastomoza utiču sistemski, lokalni i tehnički faktori. Bilo kakav kompromis po pitanju ovih principa nosi povećan rizik od komplikacija! Najteža komplikacija na anastomozi je dehiscencija. „Samo neučinjena anastomoza neće dehiscirati“. Ova stara hirurška poslovica je važeća i danas, a što je anastomoza distalnija, mogućnost dehiscencije je veća, posebno kod niskih subperitonealnih anastomoza sa rektumom ili anusom. Učestalost dehiscencija ovih anastomoza u literaturi varira od 0,5 - 69 %, što može ukazivati na kvalitet hirurškog rada, korišćenje definicije dehiscencije, način dijagnostike, itd. Međunarodna grupa za karcinom rektuma definisala je dehiscenciju anastomoze kao defekt crijevnog zida, uključujući šavnu ili staplersku liniju neorektalnog rezervoara, što dovodi do komunikacije između intra i ekstra luminalnog prostora. CILJEVI: Osnovni cilj ove studije je bio da se utvrde preoperativni i perioperativni faktori rizika značajni za nastanak dehiscencija kolorektalnih anastomoza, kao i značaj prokalcitonina i C-reaktivnog proteina u detekciji dehiscencija kolorektalnih anastomoza u subkliničkoj fazi bolesti. MATERIJAL I METODOLOGIJA: Istraživanjem je obuhvaćeno 100 pacijenata operisanih u elektivnom programu, kod kojih je urađena radikalna operacija karcinoma rektuma uz kreiranje dvostruke staplerske kolorektalne anastomoze. Svi pacijenti uključeni u istraživanje, odabrani metodom slučajnog izbora, bili su podijeljeni u dvije grupe. Grupa A: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma i kreirana primarna staplerska kolorektalna anastomoza. Grupa B: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma Hartmanovom procedurom u prvom aktu, a rekonstrukcija kontinuiteta gastrointestinalnog trakta uspostavljena u drugom aktu kreiranjem sekundarne staplerske kolorektalne anastomoze. Primjenom statističkih testova analizirani su preoperativni (pol, godine života, komorbiditeti, ASA skor, indeks tjelesne mase preoperativna primjena hemoradioterapije, laboratorijske analize) i perioperativni (vrijeme trajanja operacije, udaljenost anastomoze od anokutane linije, veličina tumora u cm, intraoperativna primjena krvi) faktori rizika za nastanak dehiscencije anastomoze kod obje grupe. Kod svih pacijenata drugog i četvrtog postoperativnog dana kontrolisane su vrijednosti C reaktivnog proteina i prokalcitonina u serumu, bez obzira da li su postojali ili ne klinički manifestni znaci dehiscencije anastomoze. Takođe, primjenom ROC krive analizirana je senzitivnost, specifičnost i dijagnostička tačnost C reaktivnog proteina i prokalcitonina drugog i četvrtog postoperativnog dana u detekciji dehiscencije kolorektalne anastomoze. REZULTATI: Nema statistički značajne razlike u pojavi dehiscencije anastomoze između primarnih i sekundarnih dvostrukih staplerskih anastomoza. Incidencija dehiscencija anastomoza je bila 11% u ukupnom uzorku. Osam pacijenata je reoperisano, dok su tri pacijenta tretirana konzervativno. Kod tri pacijenta, kod kojih je nastala dehiscencija i koji su reoperisani, zbog posljedice sepse i septičnog šoka nastupio je smrtni ishod. Pol, godine života, komorbiditeti, stadijum bolesti, dužina trajanja operacije, intraoperativna primjena krvi, nisu statistički značajni faktori rizika (p>0,05) za nastanak dehiscencije primarnih i sekundarnih dvostrukih staplerskih kolorektalnih anastomoza. Udaljenost anastomoze od anokutane linije (<7cm), veličina tumora preko 5 cm su statistički značajni faktori rizika za nastanak dehiscencije anastomoze. Postoji visoko statistički značajna razlika (p<0,001) vrijednosti CRP-a i PCT-a četvrtog postoperativnog dana kod bolesnika sa i bez prisutne dehiscenecije kolorektalne anastomoze. Na osnovu ROC analize CRP–a za četvrti postoperativni dan, za graničnu vrijednost od 130 mg/l senzitivnost iznosi 82%, specifičnost 96% i dijagnostička tačnost 94%. Za graničnu vrijednost PCT-a od 0,78 ng/ml za četvrti postoperativni dan primjenom ROC krive utvrđena je sezitivnost 91%, specifičnost 92%, dok je dijagnostička tačnost bila 86%. Četvrti postoperativni dan CRP ima veću dijagnostičku tačnost i specifičnost u detekciji dehiscencije kolorektalne anastomoze u odnosu na PCT. ZAKLJUČAK: I pored velikog tehnološkog napretka, usavršavanja hirurških tehnika, boljeg razumijevanja prirode maligne bolesti, unapređivanja intraoperativnog i postoperativnog kontinuiranog praćenja bolesnika, uvođenja novih antimikrobnih lijekova, problem u liječenju i pojava dehiscencija kolorektalnih anastomoza su i dalje značajno prisutni. Otkrivanjem dehiscencija kolorektalnih anastomoza u subkliničkoj fazi, identifikovanje preoperativnih i perioperativnih faktora rizika značajnih za nastanak dehiscencija, omogućilo bi da se dehiscencija ranije uoči i efikasnije riješi.</p> / <p>INTRODUCTION: Colorectal anastomosis, which is formed deep in the pelvis because of establishment of continuity of gastrointestinal tract after resection of the part of intestines, has got its specifities during forming and healing process and when complications occur. Systemic, local and technical factors influence the healing process of anastomosis itself. Any kind of compromise in terms of these principles causes higher risk of complications! The most serious complication of anastomosis is dehiscence. “Only anastomosis which is not carried out will not dehisce.” This old surgical saying is still true, and the more distal anastomosis is, the possibility of development of dehiscence is higher, especially in lower subperitoneal anastomosis with rectum and anus. Incidence of dehiscence of these anastomosis in literature varies from 0,5 to 69 %, which may indicate the quality of surgical work, use of definition of dehiscence, kind of diagnostics etc. International group for rectal cancer defined dehiscence of anastomosis as a defect of intestinal wall, including suturing or stapler line of neorectal reservoir, which leads to communication between intra and extra luminal space. AIMS: Basic aim of this study was to determine preoperative and postoperative risk factors significant for the development of dehiscence of colorectal anastomosis, as well as significance of procalcitonin and C-reactive protein in detection of dehiscence of colorectal anastomosis at the subclinical stage of the disease. MATERIAL AND METHODOLOGY: The study included 100 patients operated on in the elective programme, on which radical operation of the rectal cancer was carried out with creation of double stapler colorectal anastomosis. All patients included in the study were randomly chosen and divided into two groups. Group A: the patients on which radical operation of the rectal cancer was carried out and primary stapler colorectal anastomosis created. Group B: the patients on which radical operation of the rectal cancer was carried out using Hartman's procedure in the first act, and reconstruction of the continuity of gastrointestinal tract was established in the second act by creation of secondary stapler colorectal anastomosis. By application of statistical tests preoperative (sex, age, comorbidities, ASA score, body mass index, preoperative application of haemoradiotherapy, laboratory analyses) and perioperative (duration of operation, distance of anastomosis from anocutaneous line, size of tumor in cm, intraoperative application of blood) risk factors for development of dehiscence of anastomosis in both groups were analysed. In all patients on the second and fourth postoperative day values of C-reactive protein and procalcitonin in the serum were analysed, regardless of the existence of clinically or non-clinically manifested signs of dehiscence of anastomosis. Also, sensitivity, specifity and diagnostically accurate C-reactive protein and procalcitonin on the second and fourth postoperative day in detection of dehiscence of colorectal anastomosis were analysed by application of ROC curve. RESULTS: There is no statistically significant difference in the development of dehiscence of anastomosis between primary and secondary double stapler anastomosis. Incidence of dehiscence of anastomosis was 11% in all samples. Eight patients were reoperated on, whereas three patients were treated conservatively. In three patients who developed dehiscence and were reoperated on, the death occurred due to sepsis and septic shock. Sex, age, comorbidities, stage of the disease, duration of operation, intraoperative application of blood were not statistically significant risk factors (p>0,05) for the development of dehiscence of primary and secondary double stapler colorectal anastomosis. Distance of anastomosis from anocutaneous line (<7cm), size of tumor over 5 cm were statistically significant risk factors for the development of dehiscence of anastomosis. There is highly statistically significant difference (p<0,001) values of CRP and PCT on the fourth postoperative day in patients with and without dehiscence of colorectal anastomosis. On the basis of ROC analysis of CRP for the fourth postoperative day, for the bordering value of 130 mg/l sensitivity is 82%, specificity 96% and diagnostic accuracy 94%. For bordering value of PCT of 0,78 ng/ml for the fourth postoperative day, by application of ROC curve, the following values were determined: sensitivity 91%, specificity 92% and diagnostic accuracy 86%. CRP for the fourth postoperative day has got higher diagnostic accuracy and specificity in detection of dehiscence of colorectal anastomosis in relation to PCT. CONCLUSION: In spite of huge technological advance, improvement of surgical techniques, better understanding of the nature of malignant diseases, improvement of intraoperative and postoperative continuous follow up of the patient, introduction of new antimicrobial medicines, the problem in treating and development of dehiscence of colorectal anastomosis is still significantly present. Detection of dehiscence of colorectal anastomosis at the subclinical stage, identification of preoperative and perioperative risk factors significant for the development of dehiscence would help in early detection of dehiscence and contribute to more effective operations.</p>
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Značaj intraoperativnog mehaničkog ispiranja u prevenciji kontaminacije kalema kod rekonstrukcije prednje ukrštene veze kolena / Importance of intraoperative mechanical irrigation in prevention of graft contamination in anterior cruciate ligament reconstructionRašović Predrag 26 September 2016 (has links)
<p>Intraoperativna kontaminacija autokalema tokom rekonstrukcije prednjeg ukrštenog ligamenta je i dalje tema koja je predmet stalne debate među ortpedskim hirurzima, a koja se preteţno odnosi na potrebu i način njenog tretmana. Ona nastaje kao posledica naseljavanja uzročnika kontaminacije iz vazduha, sa koţe i sluznica kako pacijenata tako i osoblja, kao i preko nesterilisanih ili nedovoljno sterilisanih instrumenata. Patogeni koji je izazivaju su identični uzročnicima koji izazivaju septični arthritis, pa se smatra jednim od faktora rizika za njegov nastanak. Septični arthritis predstavlja najčešću komplikaciju u artroskopskoj hirurgiji uopšte, a njegove posledice mogu bitno uticati na funkcionalni i mentalni status pacijenata. Zbog toga se smatra da je tretman intraoperativne kontaminacije autokalema tokom rekonstrukcije prednjeg ukrštenog ligamenta kolena mandatoran. Najčešće primenjivani agensi u tretmanu intraoperativne kontaminacije alokalema predstavljaju različite vrste antiseptičnih i antibiotskih solucija. I pored toga što intraoperativna irigacija fiziološkim rastvorom predstavlja jednu od najčešče primenjivanih procedura tokom hirurških operacija, u savremenoj literaturi je objavljen mali broj radova na temu primene ove procedure u tretmanu intraoperativne kontamninacije. Cilj ove studije je bio da pokaţe da se dekontaminacija autoklema tokom rekonstrukcije prednjeg ukrštenog ligamenta kolena moţe uspešno tretirati intraoperativnom mehaničkom irigacijom čistim fiziološkim rastvorom, kao i da odredi koja je količina fiziološkog rastvora dovoljna da izvrši potpunu dekontaminaciju autokalema. Jedan od ciljeva se odnosio na utvrđivanje uticaja faktora okruţenja na pojavu intraoperativne kontaminacije. Studija se sastojala iz dva dela- eksperimentalnog i kliničkog. Eksperimentalni deo studije je bio sproveden na Odeljenju za kliničku bakteriologiju Centra za mikrobiologiju Instituta za javno zdravlje Vojvodine i sastojao se iz pravljenja eksperimentalnog modela koji je imao za cilj da u in vitro uslovima obezbedi iste ili pribliţno iste uslove kao i operacionoj sali. On se sastojao od pedeset ispreparisanih i sterilisanih svinjskih tetiva dubokih pregibača prstiju koje su po svojim dimenzijama pribliţno odgovarale humanom prednjem ukrštenom ligamentu kolena. Tetive su potom bile kontaminirane unapred određenom koncetracijom najčešćeg uzročnika kontaminacije, a to je koagulaza negativan stafilokok ( ATCC 12228 Staphylococcus epidermidis). One su se potom mehanički ispirale sa 500 ml, 1000 ml, i 1500 ml fiziološkog rastvora, a nakon svakog ispiranja uzimao se bris. Brisevi su nakon toga bili zasejavani na krvni agar, a nakon 24h inkubacije su očitavane vrednosti brojanjem kolonija uzročnika. Rezultati eksperimentalnog dela pokazuju da je količina od 1500 ml fiziološkog rastvora dovoljna da izazove potpunu dekontaminaciju tetive. Rezultati eksperimentalnog dela su potom bili primenjivani u kliničkom delu studije koji je obuhvatao 200 ispitanika starosne dobi između 15-50 godina i koje je je bilo sprovedeno na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine. Kontrolnu grupu su činili onih 100 pacijenata kod kojih je mehaničko intraoperativno ispiranje autokalema neposredno pred njegovu implantaciju vršeno pomoću 500 ml fiziološkog rastvora, a ispitivanu grupu su činili drugih sto pacijenata kod kojih je isto to ispiranje izvršeno sa 1500 ml fiziološkog rastvora. Rezultati kliničkog dela studije jasno ukazuju da je količina od 1500 ml fiziološkog rastvora kojim se vrši intraoperativna mehanička irigacija dovoljna da izvrši potpunu dekonaminaciju autokalema kao i da stepen kontaminacije autokalema raste sa povećanjem vremena koje kalem provodi na vazduhu tokom obrade, što je u direktnoj vezi sa vremenskim trajanjem operacije i vrstom kalema koji se koristi za rekonstrukciju. Rezultati pokazuju da je rizik za nastanak kontaminacije autokalema u direktnoj vezi sa faktorima okruţenja, odnosno da se porastom broja ljudi u operacionoj sali, kao i redosledom operativnih procedura u toku jednog operativnog dana u smislu da operacije koje počinju kasnije na operativnom programu, povećava i procenat kontaminacije. Intraoperativna mehanička irigacija kontaminiranog autokalema se pokazala kao metoda koja se uspešno moţe koristiti u intaoperativnoj dekontaminaciji autokalema tokom rekonstrukcije prednje ukrštene veze kolena. Rezultati ove studije se mogu se primeniti i na druge asetne hirurgije i mogu posluţiti i daljim kliničkim istraţivanjima.</p> / <p>Intraoperative contamination of autograft during anterior cruciate ligament reconstruction still remains a topic for debate among orthopaedic surgeons mainly concerning the need and the way of its treatment. Graft contamination arises after pathogen settlement from the surrounding air, from skin and mucoses of patient and staff, as well as not enough sterilized instruments. Pathogens found in graft contamination are the same ones who are causes of septic arthritis, which is the most common complication in arthroscopic surgery in general. Consequences of septic arthritis usually leave a huge impact on patient’s mental and physical status. In modern surgery, it is mandatory to prevent potential auto-graft contamination by irrigation (during anterior cruciate ligament reconstruction in knee). Most commonly used agents for intraoperative auto-graft irrigation are variety of antiseptic and antibiotic solutions. Even though intraoperative irrigation with saline solution presents one of the most commonly used procedures during different surgical interventions in general, little is said in literature about its usage in auto-graft contamination. The aim of this study was to show that decontamination of auto-graft during anterior cruciate ligament reconstruction of the knee can be successfully done by mechanical irrigation with saline (0,9%) solution and also to define a precise quantity of saline for complete decontamination. Furthermore, effects of different factors in surroundings were inspected. The study consisted of two parts: experimental and clinical. Experimental part was conducted at the Department for clinical bacteriology, at Microbiology Centre at the Institute for public health of Vojvodina. It consisted in making the experimental model with in vitro conditions similar to or as the same as in the operating theatre. Experimental model was made of 50 preparated and sterilized pig tendons of deep finger flexors, which are similar dimensions as human anterior cruciate ligament of the knee. Then, the tendons were contaminated with previously defined concentration of most common cause of contamination which is coagulase negative staphylococcus (ATCC 12228 Staphylococcus epidermidis). Contaminated tendons were mechanicaly irrigated with 500ml, 1000ml and 1500ml saline solution. After each irrigation a swab was taken and put in blood agar to grow. Following 24h of incubation, bacterial colonies were counted. Results of experimental model show that 1500ml of saline solution is required for decontamination of tendon. Results of experimental model were used in clinical part of the study which was conducted at the Clinic for orthopaedic surgery and traumatology in Clinical Centre of Vojvodina. It comprised of 200 patients, who were 15-50 years old. Patients were divided in two equal groups: tested and control group. In control group mechanical irrigation of auto-graft was done prior to its implementation with 500ml saline solution, while in tested group 1500ml of saline was used for irrigation. Results of clinical part of the study show that intraoperative irrigation with 1500ml of saline solution is enough for complete decontamination of auto-graft. Furthermore, degree of auto-graft contamination rises with prolonged exposure time on surrounding air, with incrised number of people in the operating theatre and also with number and sequence of operations during the day. Intraoperative mechanical irrigation proved to be a sufficient method that can be used in intraoperative autograft decontamination during anterior cruciate ligament reconstruction. The results of this study can be applied to other aspects of the surgery and could be used and further clinical<br />studies.</p>
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Indicadores de processo para a prevenção da infecção do sítio cirúrgico em um hospital universitário do centro-oeste brasileiro / Process indicators for the prevention of surgical site infections in a teaching hospital in central-western Brazil.Gebrim, Cyanéa Ferreira Lima 26 March 2013 (has links)
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Previous issue date: 2013-03-26 / INTRODUCTION: Evidence shows that out of every ten people in the world, one has
been the victim of medical errors or preventable adverse events. These statistics are
further evidence that of the 234 million patients undergoing surgeries, seven million
suffer postoperative complications, increasing mortality rates by around 0.4 to 10%.
A surgical site infection is considered the second highest incidence of major impact
to the morbidity and mortality of patients, and may cause irreparable physical and
emotional harm, as well as increase the cost of therapy for institutions. This reality
drove the Safe Surgery Saves Lives program, which is the second Global Challenge
for the World Alliance for Patient Safety program, launched by the World Health
Organization in 2004. Studies organized by the National Health Surveillance Agency
of Brazil, derived from these campaigns, cataloged nine process indicators to prevent
these infections, which were the subject of this investigation.
OBJECTIVE: To examine the process indicators for the prevention of surgical site
infection in the perioperative period in patients undergoing clean surgery in a
teaching hospital in central-western Brazil. METHODS: Retrospective analytical
cohort study, conducted in 700 records of patients aged 18 years or older undergoing
clean surgical procedures from January 2008 to December 2010. We used a
structured form, previously evaluated according to national guidelines. Data were
entered into SPSS version 15 for Windows. The analysis was descriptive and
multivariate, and used chi-square tests, Fisher, and odds ratio (OR) as measures of
association for variables with p <0.10. Statistically significant associations with p
<0.05 were considered. RESULTS: Regarding the socio-demographic profile of the
patients, 57.1% were female, aged between 18 and 101 years, 39.3% had
comorbidities, 74.5% with ASA ≤ II. Regarding surgical specialty, 29.9% were
orthopedic and 19.9% were vascular. Nonconforming indicators were found in
64.6%. Aspects such as the time of preoperative hospitalization, the method used for
hair removal, the duration of antimicrobial prophylaxis, glycemic control in diabetics,
as well as the thermal controls and inspection records of the surgical cases were not
considered appropriate. The predictors for surgical site infection in the univariate
analysis were male gender, carriers of chronic disease, alcoholism and smoking,
infections already present on admission, a length of preoperative hospital stay of
greater than 5 days, ASA ≥ III, shaving and antimicrobial prophylaxis; the
independent factors were: being a carrier of a chronic disease, infections already
present on admission and shaving with a razor blade. The estimated rate of infection
was 10%. The surgical specialty with the highest rate of infection was vascular, with
25.9%. The methicillin-resistant Staphylococcus aureus was the most evident
causative agent. CONCLUSION: We conclude that the service partially meets the
process indicators for the prevention of surgical site infection in the perioperative
period of clean surgeries, incongruent with the principles of the Safe Surgery Saves
Lives program. / INTRODUÇÃO: Evidências apontam que, de cada dez pessoas no mundo, uma tem sido
vítima de erros ou eventos adversos evitáveis. As estatísticas reforçam que, dos 234
milhões de pacientes submetidos a procedimentos cirúrgicos, sete milhões sofrem
complicações pós-operatórias, elevando as taxas de mortalidade em torno de 0,4 a 10%. A
infecção do sítio cirúrgico é considerada como o segundo incidente de maior impacto para a
morbimortalidade dos pacientes, podendo gerar prejuízos físicos e emocionais irreparáveis,
além de onerar os custos com a terapêutica para as instituições. Essa realidade impulsionou
o programa Cirurgias Seguras Salvam Vidas, o qual representa o segundo Desafio Global
da Aliança Mundial para a Segurança do Paciente, lançado pela Organização Mundial da
Saúde, em 2004. Estudo organizado pela Agência Nacional de Vigilância Sanitária do Brasil,
proveniente dessa campanha, catalogou nove indicadores de processo para prevenção
dessas infecções, os quais foram objeto dessa investigação. OBJETIVO: analisar os
indicadores de processo para a prevenção da infecção do sítio cirúrgico no perioperatório de
pacientes submetidos à cirurgia limpa em um hospital universitário do Centro-Oeste
brasileiro. MÉTODO: Estudo de coorte retrospectiva do tipo analítico, realizado por meio de
700 prontuários de pacientes, maiores ou igual a 18 anos, submetidos a procedimento
cirúrgico limpo, de janeiro de 2008 a dezembro de 2010. Foi utilizado um formulário
estruturado e previamente avaliado segundo as diretrizes nacionais. Os dados foram
inseridos no Statistical Package For The Social Science versão 15 for Windows. A análise foi
descritiva e multivariada, com testes qui-quadrado, Fisher e OR (odds ratio) como medidas
de associação em variáveis com p<0,10. Foram consideradas estatisticamente significantes
as associações com p<0,05. RESULTADOS: Quanto ao perfil sociodemográfico dos
pacientes, 57,1% eram do sexo feminino, com idade entre 18 e 101 anos; 39,3%
apresentavam comorbidades; 74,5%, com ASA ≤II. Quanto à especialidade cirúrgica, 29,9%
ortopédica e 19,9% vascular. Inconformidades nos indicadores foram encontradas em
64,6%. Aspectos como o tempo de internação pré-operatória, o método usado para
tricotomia, a duração da profilaxia antimicrobiana, o controle glicêmico em diabéticos, o
controle térmico e o registro de inspeção das caixas cirúrgicas foram considerados não
adequados. Os preditores para infecção do sítio cirúrgico pela análise univariada foram:
sexo masculino, portador de doença crônica, etilismo e tabagismo, infecção à distância,
tempo de internação pré-operatória > 5 dias, ASA ≥ III, tricotomia e a profilaxia
antimicrobiana; os fatores independentes foram: ser portador de doença crônica, infecção à
distância e tricotomia com lâmina de barbear. A taxa de infecção foi de 10%. A
especialidade cirúrgica que apresentou maior índice de infecção foi a vascular, com 25,9%.
O Staphylococcus aureus resistente à meticilina foi o agente etiológico de maior evidência.
CONCLUSÃO: Concluiu-se que o serviço atende, parcialmente, os indicadores de processo
para a prevenção da infecção do sítio cirúrgico no perioperatório de cirurgias limpas, em
conformidade com os princípios do programa Cirurgias Seguras Salvam Vidas.
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Riscos e complicações associadas à Infecção do Sitio Cirúrgico : um estudo de coorteCarvalho, Thialla Andrade 15 December 2016 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Purpose: to identify the occurrence of cross infection, the associated risks and its correlation with hospital stay and mortality in patients attended at a teaching hospital located in the northeastern region of Brazil. Methods: prospective cohort study, with information collected in medical records and kept on adverse event surveillance forms during the year 2015. The data were entered and analyzed in Epi-Info7 software. The variables studied were related to patients, procedures and outcomes. Results: A total of 752 adverse events surveillance forms were evaluated, with an overall incidence of 4,52% for Surgical Site Infection (SSI). A statistically significant association was found in the univariate analysis of SSI and the variables studied: contaminated surgeries, surgeries without laparoscopic techniques, patients with severe systemic alteration, patients with functional limitation, Nosocomial Infections Surveillance (NNIS) Risk Index (IRIC) ≥1 and in procedures that did not use Microbial prophylaxis in accordance to standardized Hospital Infection Control Service (HICS). The independent association with SSI was observed for NNIS and non-specified intra-abdominal surgery elsewhere. It was also demonstrated a significant association between the diagnosis of SSI and increased mortality and hospital stay.Conclusion: This study demonstrates the significant impact of risk factors for the occurrence of SSI and allows the establishment of strategies that improve the quality of patient care and safety. / Objetivo: Identificar a ocorrência de Infecção do Sítio Cirúrgico (ISC), os riscos associados e a sua correlação com permanência e mortalidade hospitalar em pacientes atendidos em um hospital de ensino localizado na região nordeste do Brasil. Método: estudo de coorte prospectivo, com coleta de informações contidas em prontuários e registradas em formulários de vigilância de eventos adversos durante o ano de 2015. Esses dados foram digitados e analisados em software Epi-Info7. As variáveis estudadas foram relacionadas aos pacientes, aos procedimentos e aos desfechos. Resultados: Foram avaliadas 752 fichas de vigilância de eventos adversos com uma incidência global de 4,52% de ISC. Foi encontrada uma associação estatisticamente significativa na análise univariada entre ISC e as variáveis: cirurgias contaminadas, cirurgias que não utilizaram técnicas videolaparoscópicas, pacientes com alteração sistêmica grave e com limitação funcional, Índice de Risco Cirúrgico (IRIC) ≥1 e nos procedimentos que não usaram a profilaxia microbiana conforme padronização do Serviço de Controle de Infecção Relacionadas à Assistência (SCIRA) da instituição. A associação independente com a ISC foi observada para IRIC e para cirurgia intra-abdominal não especificada em outro local (IAB). Demonstrou-se ainda, associação significativa entre o diagnóstico de ISC e o aumento da mortalidade e da permanência hospitalar. Conclusão: Este estudo demonstra o significativo impacto dos fatores de risco para ocorrência de ISC e permite o estabelecimento de estratégias que melhorem a qualidade da assistência e a segurança do paciente.
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