ÖZET
Sonuç:
Altmış üç buçuk yaşın üzerinde, ameliyatı 167,5 dakikadan daha uzun süren, ameliyat öncesi albümin değeri 3,05’in ve Hct değeri 33,15’in altında olan hastalarda ameliyat sonrası cerrahi alan enfeksiyonu gelişme ihtimalinin yüksek olduğunu düşünmekteyiz. Eğer kolorektal kanser nedeniyle opere edilecek hastalar; diyabetik, ASA 3 risk grubunda, ameliyat sırasında saptırıcı ileostomi ya da kolostomi açılmış, kronik akciğer hastalığına sahip, kanser rektumda yerleşmiş ve postop yapılan sınıflamada hastalığın evre 3 olduğu tespit edilmiş ise yukarıdaki kesim değerleri ile beraber değerlendirilerek hastada yüzeyel ya da derin cerrahi alan enfeksiyonu gelişme ihtimalinin yüksek olduğunu akılda tutmak ve enfeksiyona ait belirti ve bulguları iyi değerlendirmek gerektiğini düşünüyoruz.
Bulgular:
Cinsiyet ve vücut kitle indeksi dışında kalan tüm parametrelerin cerrahi alan enfeksiyonu gelişmesinde anlamlı olduğu tespit edildi. Yaş için; 63,5, operasyon süresi için; 167,5 dakika, albümin için; 3,05 ve Hct için de; 33,15 kesim değeri olarak bulundu.
Yöntem:
2015-2017 yılları arasında hastanemiz genel cerrahi bölümünde kolorektal kanser nedeniyle acil ya da elektif olarak opere edilmiş 86 hastaya ait datalar retrospektif olarak incelendi. Hastalara ait; yaş, cinsiyet, vücut kitle indeksi, Amerikan Anestezistler Derneği (ASA) skoru, kronik akciğer hastalığı varlığı, hematokrit (Hct) seviyeleri, albümin düzeyi, operasyon süresi, hastalığın lokalizasyonu (kolon ya da rektum), operasyonda kolostomi ya da ileostomi açılıp açılmadığı, hiperglisemi varlığı, cerrah volümünün; yüzeyel ya da derin cerrahi alan enfeksiyonu gelişimini etkileyip etkilemediğinin değerlendirilmesi amaçlandı.
Amaç:
Bu çalışmada kolorektal kanser nedeniyle opere edilen hastalarda cerrahi alan enfeksiyonu gelişmesine predispozisyon yaratan faktörler ve kesim değerleri ortaya konmak istenmiştir.
Anahtar Kelimeler:
Kolorektal kanser, cerrahi alan enfeksiyonu, prediktif değer
Kaynaklar
1
Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ; Participants in the VA National Surgical Quality Improvement Program. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005;242:326-341.
2
Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2011;32:970-986.
3
Isik O, Kaya E, Dundar HZ, Sarkut P. Surgical site infection: re-assessment of the risk factors. Chirurgia (Bucur) 2015;110:457-461.
4
Bull A, Wilson J, Worth LJ, Stuart RL, Gillespie E, Waxman B, Shearer W, Richard M. A bundle of care to reduce colorectal surgical infections: an Australian experience. J Hosp Infect 2011;78:297-301.
5
Kirby A, Burnside G, Bretsztajn L, Burke D. Postoperative infections following colorectal surgery in an english teaching hospital. Infect Dis (Lond) 2015;47:825-829.
6
Limón E, Shaw E, Badia JM, Piriz M, Escofet R, Gudiol F, Puyol M; VINCat Program and REIPI. Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program. J Hosp Infect 2014;86:127-132.
7
Centers For Disease Control And Prevention (CDC). Procedure-Associated Module: surgical site infection event. Atlanta: 2016:29.
8
Glatz T, Lederer AK, Kulemann B, Seifert G, Holzner PA, Hopt UT, Hoeppner J, Marjanovıc G. The degree of local inflammatory response after colonic resection depends on surgical approach: an observational study in 61 patients. BMC Surg 2015;15:108
9
Jauch KW, Mutschler W, Hoffmann JN, Kanz KG. Chirurgie Basisweiterbildung [Internet]. In: Jauch KW, Mutschler W, Hoffmann JN, Kanz KG, eds. Springer Berlin Heidelberg: Berlin, Heidelberg; 2013:863.
10
de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387-397.
11
Eagye KJ, Nicolau DP. Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs. Am J Surg 2009;198:359-367.
12
Kaebnick HW, Bandyk DF, Bergamini TM, Towne JB. The microbiology of explanted vascular prostheses. Surgery 1987;102:756-762.
13
Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract 2004;10(Suppl 2):21-33.
14
Swenne CL, Lindholm C,Borowiec J, Schnell AE, Carlsson M. Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft. J Hosp Infect 2005;61:201-212.
15
Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS Jr. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 2001;22:607-612.
16
Van Den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Viasselaers D, Ferdinande P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-1367.
17
Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med 2005;33:1624-1633.
18
Nagachinta N, Stephens M, Reitz B, Polk BF. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967-973.
19
Ambiru S, Kato A, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Miyazaki M. Poor postoperative blood glucose control
increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan. J Hosp Infect 2008;68:230-233.
20
Cayci C, Russo M, Cheema FH, Martens T, Ozcan V, Argenziano M, Oz MC, Ascherman J. Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg 2008;61:294-301.
21
Brown IW Jr, Moor GF, Hummel BW, Marshall WG Jr, Collins JP. Toward further reducing wound infections in cardiac operations. Ann Thorac Surg 1996;62:1783-1789.
22
Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;12:206-215.
23
Blumetti J, Luu M, Sarosi G, Hartless K, Mcfarlin J, Parker B, Dineen S, Huerta S, Asolati M, Varela E, Anthony T. Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 2007;142:704-711.
24
Ho VP, Stein SL, Trencheva K, Barie PS, Milsom JW, Lee SW, Lee SW, Sonoda T . Differing risk factors for incisional and organ/space surgical site infections following abdominal colorectal surgery. Dis Colon Rectum 2011;54:818-825.
25
Frasson M, Granero-Castro P, Ramos Rodriguez JL, Flor-Lorente B, Braithwaite M, Martí Martínez E, Alvarez Perez JA, Codina Cazador A, Espi A, Gorda Granero E; ANACO Study Group. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients.
Int J Colorectal Dis 2016;31:105-114.
26
Ercole FF, Chianca TC, Duarte D, Starling CE, Carneiro M. Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction. Rev Lat Am Enfermagem 2011;19:269-276.
27
Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, Kyaw MH. A systematic review of risk factors associated with surgical site infections among surgical patients. Plos One 2013;8:e83743.
28
Lotfi CJ, Cavalcanti Rde C, Costa e Silva AM, Latorre Mdo R, Ribeiro Kde C, Carvalho AL, Kowalski LP. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 2008;138:74-80.
29
Franco LMC, Ercole FF, Mattia A. Infecção cirúrgica em pacientes submetidos a cirurgia ortopédica com implante. Rev SOBECC, SAO PAULO 2015;20:163-170.
30
Sehgal R, Berg A, Figueroa R, Poritz LS, McKenna KJ, Stewart DB, Koltun WA. Risk factors for surgical site infections after colorectal resection in diabetic patients. J Am Coll Surg 2011;212:29-34.
31
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2011;234:181-189.
32
Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006;244:758-763.
33
Sutton CD, Williams N, Marshall LJ, Lloyd G, Thomas WM. A technique for wound closure that minimizes sepsis after stoma closure. Aust NZ J Surg 2002;72:766-767.
34
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2001;234:181-189.
35
American Diabetes Association, Standards of Medical Care. Diabetes Care in the Hospital. Diabetes Care 2016;39:99-104.
36
Blakytny R, Jude E. The molecular biology of chronic wounds and delayed healing in diabetes. Diabet Med 2006;23:594-608.
37
McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg 2009;13:508-515.
38
Bot J, Piessen G, Robb WB, Roger M, Mariette C. Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum 2013;56:568-576.
39
Ishikawa K, Kusumi T, Hosokawa M, Nishida Y, Sumikawa S, Furukawa H. Incisional surgical site infection after elective open surgery for colorectal cancer. Int J Surg Oncol 2014;2014:419712.
40
Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, Hatade K, Watanabe M. Risk factors for wound infection after surgery for colorectal cancer. World J Surg 2008;326:1138-141.
41
Shaffer VO,Baptıste CD, Liu Y, Srınıvasan JK, Galloway JR, Sullıvan PS, Staley CA, Sweeney JF, Sharma J, Gillespie TW. Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection. Am Surg 2014;80:759-763.
42
Koskela M, Gäddnäs F, Ala-Kokko TI, Laurila JJ, Saarnio J, Oikarinen A, Koivukangas V. Epidermal wound healing in severe sepsis and septic shock in humans. Crit Care 2009;13:R100.
43
Sehgal R, Berg A, Figueroa R, Poritz LS, McKenna KJ, Stewart DB, Koltun WA. Risk factors for surgical site infections after colorectal resection in diabetic patients. J Am Coll Surg 2011;212:29-34.
44
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Whiter DC. Systematic review of pre- operative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 2015;102:462-479.
45
Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 2010;252:325-329.
46
Ihedioha U, Gravante G, Lloyd G, Sangal S, Sorge R, Singh B, Chaudhri S. Curative colorectal resections in patients aged 80 years and older: Clinical characteristics, morbidity, mortality and risk factors. Int J Colorectal Dis 2013;28:941-947.
47
Klima DA, Brintzenhoff RA, Agee N, Walters A, Heniford BT, Mostafa G. A review of factors that affect mortality following colectomy. J Surg Res 2012;174:192-199.
48
Fazio VW, Tekkis PP, Remzi F, Lavery IC. Assessment of operative risk in colorectal cancer surgery: The Cleveland Clinic Foundation Colorectal Cancer Model. Dis Colon Rectum 2004;47:2015-2024.
49
American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer. Amer Inst for Cancer Research; 2007.
50
Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, McTiernan A, Gansler T, Andrews KS, Thun MJ; American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2006;56:254-281.
51
World Health Organization. Obesity : preventing and managing the global epidemic : report of a WHO consultation. World Health Organization; Geneva: 2000.
52
Amri R, Bordeianou LG, Sylla P, Berger DL. Obesity, Outcomes and Quality of Care: BMI Increases the Risk of Wound-Related Complications in Colon Cancer Surgery. Am J Surg 2014;207:17-23.
53
Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W. Urgent surgery in colon carcinoma. Zentralbl Chir 2007;132:16-25.
54
Lawson EH, Hall BL, Ko CY. Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 2013;148:849-858.
55
Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015;262:416-425.
56
Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg 2015;262:331-337.
57
Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 2009;24:711-723.
58
Ricciardi R, Roberrts PL, Hall JF, Read TE, Francone TD, inchot SN, Schoetz DJ, Marcello PW. What is the effect of stoma construction on surgical site infection after colorectal surgery? J Gastrointest Surg 2014;18:789-795.
59
Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses.World J Surg 2007;31:1142-1151.
60
Bayar B, Yılmaz KB, Akıncı M ,Şahin A, Kulaçoğlu H. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. Ulus Cerrahi Derg 2015;32:11-17.
61
Itatsu K, Sugawara G, Kaneoka Y, Kato T, Takeuchi E, Kanai M, Hasegawa H, Arai T, Yokoyama T, Nagino M. Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today 2014,44:1242-1252.
62
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY. Risk factors for surgical site infection after elective resection of the colon and rectum: a single center prospective study of 2,809 consecutive patients. Ann Surg 2001;234:181-189.