Sezaryen sonrası yara yeri enfeksiyonu için risk faktörlerinin değerlendirilmesi

Öz

Amaç: Sezaryen sonrası gelişen yara yeri enfeksiyonu önemli ve sık bir sağlık sorunudur. Literatürde ilişkili risk faktörlerini gösteren çalışmalar mevcut olmakla birlikte Türk popülasyonunda sezaryen sonrası yara yeri enfeksiyonu için risk faktörlerini değerlendiren çok kısıtlı veri bulunmaktadır. Çalışmamızın amacı toplumumuzdaki bu risk faktörlerini belirlemek ve önleyici protokoller geliştirmek için veri sağlamaktır. Yöntem: Bu retrospektif olgu-kontrol çalışmamıza Haziran 2016-Aralık 2017 tarihleri arasında hastanemize başvuran, 16-45 yaşında ve kliniğimizde sezaryen olup postpartum 6 hafta içinde yara yeri enfeksiyonu nedeniyle yatış yapılan 76 hasta ile takiplerinde herhangi bir enfeksiyon bulgusu saptanmayan 149 hasta dahil edildi. Hastaların sosyodemografik özellikleri, laboratuvar parametreleri, ek hastalık varlığı ve cerrahi özellikleri kaydedildi. İstatistiksel analizler için SPSS 21,0 programı kullanıldı ve P<0,05 değeri anlamlı kabul edildi. Bulgular: Hastane yatışı gerektiren yara yeri enfeksiyonu oranımız %1 (76/7590) olarak bulundu. Risk faktörleri açısından değerlendirildiğinde vücut kitle indeksi ve açlık kan şekeri yara yeri enfeksiyonu olan grupta anlamlı olarak yüksek bulundu (P<0,001 ve P=0,021). Yine bu grupta preoperatif hemoglobin değerleri daha düşük bulunurken, cerrahi süresi ise daha uzun idi (P<0,001 ve P=0,005). Lojistik regresyon analizinde vücut kitle indeksi artışının enfeksiyonu 1,4 kat (OR 1,463, %95 CI 1,273-1,681, P<0,001), açlık kan şekeri yüksekliğinin ise 1,2 kat (OR 1,21, %95 CI 1,16-1,37, P=0,007) arttırdığı gösterildi. Ayrıca cerrahi süresinin kısalmasının (OR 0,749, %95 CI 0,709-0,789, P=0,010) ve preoperatif hemoglobin değerindeki artışın (OR 0,532, %95 CI 0,408-0,695, P<0,001) riski azalttığı saptandı. Sonuç: Sezaryen sonrası gelişen yara yeri enfeksiyonu risk faktörlerinin büyük bir kısmı modifiye edilebilir özelliktedir. Bu nedenle hastalar postpartum gelişebilecek enfeksiyon ve risk faktörleri konusunda gebelik takipleri süresince bilgilendirilmeli, bu risk faktörleri mümkün olduğunca ortadan kaldırılmalıdır.

Anahtar Kelimeler

• sezaryen
• risk faktörleri
• yara yeri enfeksiyonu

Evaluation of risk factors for surgical site infection after cesarean section

Öz

Aim: Surgical site infection after cesarean section is an important and common health issue. Although there are several studies researching risk factors in the literature, limited data is present evaluating these factors in the Turkish population. In this study, we aimed to determine the risk factors and provide management protocols for the Turkish population. Methods: In this retrospective case-control study, 76 patients between 16-45 years of age who underwent cesarean section and were hospitalized for surgical site infection within 6 weeks and 149 patients who had no postpartum infection between June 2016 and December 2017 were included. Sociodemographic features, laboratory parameters, comorbid diseases and surgical characteristics were recorded. SPSS 21.0 was used for statistical analysis and P-value <0.05 was considered statistically significant. Results: The rate of surgical site infection requiring hospitalization was 1% (76/7590). In the infection positive group, body mass index and fasting blood glucose levels were higher (P<0.001 and P=0.021). Moreover, preoperative hemoglobin was lower and surgery time was longer in this group (P<0.001 and P=0.005). In logistic regression analysis, the risk of surgical site infection was found to increase by 1.4-fold with increased body mass index (OR 1.463, 95%CI 1.273-1.681, P<0.001) and 1.2-fold with higher fasting glucose level (OR 1.21, 95%CI 1.16-1.37, P=0.007). Patients with shorter surgery time (OR 0.749, 95%CI 0.709-0.789, P=0.010) and high preoperative hemoglobin levels (OR 0.532, 95%CI 0.408-0.695, P<0.001) had decreased infection risk. Conclusion: The risk factors of surgical site infection after cesarean section are generally modifiable. Thus, healthcare providers should inform patients for postpartum infection and risk factors during pregnancy and eliminate these factors if possible.

Anahtar Kelimeler

• cesarean
• risk factors
• surgical site infection

Kaynakça

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