Fatores de risco para infecção do sítio cirúrgico, hemotransfusão e mortalidade em pacientes submetidos a tratamento cirúrgico de fraturas em membros inferiores

Abstract

The interest in identifying risk factors for blood transfusion and infections in surgical patients with fractures in the lower limbs has increased in recent years, due to the increase in the hospitalization period, the costs of care and the patient's suffering.Surgical site infections (SSI) are generally related to the energy of the trauma and the surgical approach, but blood transfusion is also considered in isolation as a risk factor for infection, even considering that it is associated with more severe trauma. prospective, identified the risk factors for SSI and blood transfusion, treated surgically in the period between February 2017 and May 2019 at two referral hospitals in urgency and emergency in the city of Belo Horizonte. Data were collected regarding patient characteristics, surgical procedures and blood transfusion strategy, seeking to compare groups and their relationship with surgical infections. The characterization of patients was performed by calculating the absolute and relative frequencies of categorical variables and by calculating the mean, median, minimum, maximum value, standard deviation and coefficient of variation for quantitative variables. The incidence of surgical site infection, the risk of postoperative death in the hospital and the total length of hospital stay were calculated using point estimates and 95% confidence intervals identified through statistical tests of bilateral hypotheses, considering the level of significance of 5%. In the last stage of the work, a multivariate analysis (logistic regression) was performed.243 patients were included in this study. The SSI rate was 14% and the risk factors for surgical infection were:use of ASA (OR = 13.5), use of amitriptyline (OR = 17.6), being run over or a car accident (OR = 4, 4), intraoperative transfusion (OR = 4.7), need for a complementary dose of ATB intraoperatively (increase) (OR = 3.2) and the body mass index (BMI) (OR = 1.1). Patients who received intraoperative blood transfusions were at risk of SSI almost five times more (4.6) (p = 0.007). In logistic regression to identify factors associated with blood transfusion, it was demonstrated that the greater the severity of the patient (ASA> 2), the trochanteric fracture, the performance of the second surgery and the body mass index (BMI) were associated as a risk factor for blood transfusion. ISC significantly increased the chance of death by approximately five times. It is recommended to focus on knowledge of the evidence based on blood transfusion guidelines to avoid excessive procedures and associated adverse events, whether infectious or not.