Abstract
ABSTRACTObjectives: To describe the rate of surgical site infections in children undergoing orthopedic surgery in centers of excellence and analyze the patients’ profiles. Methods: Medical records of pediatric patients undergoing orthopedic surgery in the Jamil Haddad National Institute of Traumatology and Orthopedics from January 2012 to December 2013 were analyzed and monitored for one year. Patients diagnosed with surgical site infection were matched with patients without infection by age, date of admission, field of orthopedic surgery and type of surgical procedure. Patient, surgical and follow-up variables were examined. Descriptive, bivariate and correspondence analyses were performed to evaluate the patients’ profiles. Results: 347 surgeries and 10 surgical site infections (2.88%) were identified. There was association of infections with age - odds ratio (OR) 11.5 (confidence interval - 95%CI 1.41-94.9) -, implant - OR 7.3 (95%CI 1.46-36.3) -, preoperative period - OR 9.8 (95%CI 1.83-53.0), and length of hospitalization - OR 20.6 (95%CI 3.7-114.2). The correspondence analysis correlated the infection and preoperative period, weight, weight Z-score, age, implant, type of surgical procedure, and length of hospitalization. Average time to diagnosis of infection occurred 26.5±111.46 days after surgery. Conclusions: The rate of surgical site infection was 2.88%, while higher in children over 24 months of age who underwent surgical implant procedures and had longer preoperative periods and lengths of hospitalization. This study identified variables for the epidemiological surveillance of these events in children. Available databases and appropriate analysis methods are essential to monitor and improve the quality of care offered to the pediatric population.
Highlights
This study was conducted in the pediatric ward of the Jamil Haddad National Institute of Traumatology and Orthopedics (INTO), a Ministry of Health hospital; its excellence is a national reference of the Brazilian Unified Health System (SUS) for the treatment of osteoarticular diseases and rehabilitation
Patients did not suffer from any underlying diseases (69.8%)
This study was motivated by the importance of gathering information on SSIs for the pediatric population
Summary
Surgical site infections (SSIs) are severe events that have direct repercussions on patients’ surgical morbidity and mortality, generating both direct and indirect costs for the health care system, society, and their families.[1,2] These events are directly related to the increased hospitalization periods and a greater number of diagnostic and therapeutic procedures.[3]SSI control is an important indicator for monitoring surgical patients for administrators and health care professionals.[4,5] The systematic monitoring of this rate is conducive to identifying groups at greater risk and following up these events, which helps plan preventive actions and develop strategies to control these infections.[6,7]The adult population has an estimated SSI rate of approximately 11%, which is related to the clinical and epidemiological characteristics of this population and the structural characteristics of the studied sites.[8]. Surgical site infections (SSIs) are severe events that have direct repercussions on patients’ surgical morbidity and mortality, generating both direct and indirect costs for the health care system, society, and their families.[1,2] These events are directly related to the increased hospitalization periods and a greater number of diagnostic and therapeutic procedures.[3]. The variability in the SSI rate in the pediatric population may be due to differences between hospitals, procedures, follow-up, and intrinsic factors related to pediatric patients.[11,12] Increased SSI estimation accuracy for the pediatric population involves using prerequisites as specific protocols for SSI data collection and referring patients to centers of excellence for pediatric care, combining expertise and case studies The SSI rate for the pediatric population varies between 2.5 and 20.0%.9,10 The variability in the SSI rate in the pediatric population may be due to differences between hospitals, procedures, follow-up, and intrinsic factors related to pediatric patients.[11,12] Increased SSI estimation accuracy for the pediatric population involves using prerequisites as specific protocols for SSI data collection and referring patients to centers of excellence for pediatric care, combining expertise and case studies
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