bachelorThesis
Análisis de regresión para evaluar los factores que se asocian infección en el sitio operatorio en los pacientes llevados a eventrorrafia. Hospital universitario Mayor Méderi (2016-Diciembre del 2018)
Autor
Orozco-Martin, Viviana
Orjuela, Jose
Institución
Resumen
Introduction: Eventrations are one of the most frequent long-term complications of abdominal surgeries. Depending on their complexity, the correction of these can be considered a major procedure and also have complications, the most frequent being the infection of the operative site, involving morbidity and increased treatment costs. Knowing the factors associated with developing a complication with the presurgical data of each patient would be for the surgeon an ideal tool for decision making. Objective: To perform a regression analysis of the factors associated with infection at the surgical site in patients taken to eventrorraphy. Hospital Universitario Mayor Méderi (2016-December 2018) Methodology: 3-year retrospective case-control study where the variables of interest will be collected, a multivariate analysis will be carried out with a logistic regression, with the variables that show statistical significance, their ability discriminative will be determined with a ROC curve. Results: 106 randomly selected patients who underwent eventrorrhaphy were obtained during the period from January 2016 to December 2018. 31.1% of the patients presented infection in the first month after surgery, 64.2% were female and 36.4% of the infections occurred in males. The median age in general was 65.5 years, being a little higher in the patients who presented infection with a median of 67 years, the most frequent type of surgery was scheduled with 74.5%. The most frequent comorbidity was hypertension, followed by diabetes and obesity. The surgical time was generally with a median of 125 minutes (90 - 180), being higher in patients who presented infection in the first month of follow-up with a median of 155 minutes (100 - 210) vs 120 minutes (87 - 160 ) respectively. In addition, intraoperative bleeding was also higher in patients who presented infection, with a median of 30cc (10 - 80) vs 20cc (15 - 100). 37.7% of the patients had some occurrence associated with the operative site, distributed as follows; Hematoma 18 (17.0%), Seroma 14 (13.2) and ISO 8 (7.5%). Two multivariate models were performed with the variables that were significant in the bivariate analysis. The first model elaborated with all the variables that had a p value ≤0.2 in the bivariate analysis, from these the variable L1 and the occurrence of the operative site were significant, with an AUROC of 72% with CI: (60% - 83.3%) , with a specificity of 96%, sensitivity 42.4%. The second model elaborated with all the variables that had a p value ≤0.2 in the bivariate analysis and adding the BMI variable, had an AUROC of 72%, with CI: (60.3% - 83.5%), with a specificity of 65.8%, a 72.7% sensitivity. Conclusions: model 1 is useful to discriminate patients who will not present infection of the operative site, on the other hand, model 2 has a better sensitivity to discriminate patients who will present ISO, however it is not very specific, therefore it is not a model with sufficient discriminatory ability was obtained to be used as a predictive tool. The variables most associated with infection were the presence of occurrences of the operative site such as seroma and hematoma, therefore using techniques that reduce these outcomes can also reduce the infection, in turn the location of the eventrations presented some type of association