ABSTRACT
Background: Peritoneal dialysis (PD) is a frequent method for renal replacement therapy in pediatric population. However, PD is associated with a high incidence of early and late complications. Thus, this study aims to evaluate the perioperative factors associated with these complications. Methods: Clinical records of patients who had peritoneal dialysis catheter (PDC) placement between January 2013 and June 2016 were retrospectively analyzed. Sociodemographic and perioperative variables were recorded and analyzed. Results: A total of 92 patients required PDC insertion. Primary PDC failure occurred in 21.74% of cases, and 17.39% required reoperation. The most common complication was occlusion (13.04%), followed by leak (8.7%). Age younger than 1 year and weight less than 10 kg were significant risk factors for catheter dysfunction, reoperation, leak, PDC occlusion, hernia, and death. The open technique was associated with higher risks of operation, leak, and peritonitis than the laparoscopic technique. Placement of the catheter by the laparoscopic technique reduced the odds of occlusion by 38%. Conclusions: Patients younger than 1 year and weighing less than 10 kg have an increased risk of complications and death, regardless of the technique used. The most frequent complication is catheter failure; however, the laparoscopic technique appears to reduce this complication.
Subject(s)
Laparoscopy , Peritoneal Dialysis , Humans , Child , Retrospective Studies , Catheters, Indwelling/adverse effects , Peritoneum/surgery , Peritoneal Dialysis/adverse effects , Peritoneal Dialysis/methods , Laparoscopy/methods , Risk FactorsABSTRACT
Abstract Introduction: Appendicitis can be classified as non-perforated and perforated; based on such classification, the reported organ-space surgical site infection (OS-SSI) rate is 0.8% and 18%, respectively. Objective: To establish the prevalence of OS-SSI in patients with perforated appendicitis treated in a pediatric hospital in 2012. Materials and methods: Retrospective, observational and descriptive study conducted at Fundación Hospital Pediátrico La Misericordia, with a random sample of200 patients, ofwhich 160 met the inclusion criteria. Results: 20 patients (12.5%) presented with OS-SSI and all of them received antibiotic treatment; 70% did not require abscess drainage. Patients ≥8 years of age had 5 times more abscesses than younger ones (17.6% vs. 3.4%). OS-SSI was found in 33% of patients with free fecalith and in 50% of the patients who required postoperative management at the ICU vs. 9.5% of the patients who received management in the intermediate care unit and the inpatient hospital floors. The total rate of surgical site infection was 24.3% (11.8% superficial, 0% deep and 12.5% organ-space). Conclusions: The prevalence of OS-SSI found here is lower than what has been reported in the literature. Being 8 years or older and having free fecalith are risk factors to develop this type of infection. The higher frequency of OS-SSI in patients treated at the ICU during the post-operative period observed here suggests that this condition may be associated with septic shock.
Resumen Introducción. La apendicitis se clasifica en no perforada y perforada; de acuerdo a esta clasificación, la tasa de infección del sitio operatorio órgano-espacio (ISO-OE) es de 0.8% y 18%, respectivamente. Objetivo. Determinar la prevalencia de ISO-OE en pacientes con apendicitis perforada en un hospital pediátrico en 2012. Materiales y métodos. Estudio retrospectivo y observacional descriptivo de corte transversal. La muestra fue aleatoria y de 200 pacientes, 160 cumplieron los criterios de inclusión. Resultados. Los 20 pacientes (12.5%) que presentaron ISO-OE recibieron manejo antibiótico; 70% no requirió drenaje de colección. Los pacientes ≥8 años presentaron 5 veces más ISO-OE (17.6% vs. 3.4%). El 33% de los pacientes con fecalito en cavidad y el 50% que se hospitalizó en post-operatorio inmediato en la unidad de cuidados intensivos (UCI) desarrollaron ISO-OE versus 9.5% de los pacientes atendidos en la unidad de cuidados intermedios y pisos. El total de ISO fue 24.3%: 11.8% superficial, 0% profunda y 12.5% de órgano-espacio. Conclusiones. La prevalencia de ISO-OE encontrada es menor a la reportada en la literatura. La edad ≥8 años y el fecalito en cavidad son factores de riesgo para desarrollar este tipo de infección. La mayor frecuencia de ISO-OE en pacientes manejados en el posoperatorio en UCI sugiere que esta condición puede estar asociada con el choque séptico.
