ÖZET
Amaç:
Cerrahi alan enfeksiyonu (CAE), total diz artroplastisi (TDA) sonrası revizyon cerrahisine yol açan önemli faktörlerden biridir. Hemşireler riskli hastaların tanısında önemli rol oynamaktadır. Bu çalışmada TDA sonrası revizyon cerrahisi gerektiren CAE gelişimine yol açan faktörlerin belirlenmesi amaçlanmıştır.
Yöntem:
Bu çalışma, büyük bir hastanede TDA sonrası revizyon cerrahisi gerektiren cerrahi alan enfeksiyonunun nedenleri üzerine yapılmış retrospektif bir olgu-kontrol çalışmasıdır. Rastgele seçilen revizyonlu hastaların (n=77) ve kontrol grubunun (n=77) sosyodemografik ve tıbbi özellikleri karşılaştırıldı. Verilerin analizinde tanımlayıcı istatistikler, ki-kare testi, bağımsız örneklem t-testi, çoklu lojistik regresyon analizi kullanıldı.
Bulgular:
Revizyon ve kontrol grubundaki hastaların yaş ortalaması sırasıyla; 68,11±7,62 ve 66,48±5,17 idi. Revizyon grubundaki hastaların ameliyat öncesi (36,36±0,24 ºC), ameliyat sırası (36,30±0,26 ºC) ve ameliyat sonrası (36,56±0,39 ºC) vücut sıcaklıkları anlamlı derecede düşük iken (p<0,05), ortalama beden kütle indeksi (BKİ) (37,49±5,22) ve ameliyat süresi (58,24±17,20 dk) anlamlı olarak yüksekti. Hastaların ASA skorları, antibiyotik kullanım süresi, ameliyat öncesi eklem içi kortikosteroid enjeksiyonu ile CAE gelişimi arasında ilişki olduğu (p<0,05) ve yüksek BKİ, uzun ameliyat süresi ve ameliyat öncesi intraartiküler kortikosteroid enjeksiyonu uygulanmasının revizyon cerrahisine neden olan en önemli faktörler olduğu saptandı.
Sonuç:
Cerrahi alan enfeksiyonu gelişimine bağlı revizyon cerrahisinde yüksek BKİ, uzun ameliyat süresi, düşük vücut sıcaklığı, yüksek ASA skoru, uzun postoperatif antibiyotik kullanım süresi ve ameliyat öncesi dönemde eklem içi kortikosteroid enjeksiyonu yapılmasının etkili faktörler olduğu söylenebilir.
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