RESUMO
To adequately identify patients at risk for surgical site infection in dermatological surgery and effectively prescribe antibiotic prophylaxis, a prediction model may be helpful. Such a model was developed using data from 1,407 patients who underwent dermatological surgery without antibiotic prophylaxis. The multivariable logistic regression model included type of closure, tumour location and defect size as risk factors. Bootstrapping was used for internal validation. The overall performance of the model was good, with an area under the curve of 84.1%. The decision curve analysis showed that the model is potentially useful if one is willing to treat more than 8 patients with antibiotic prophylaxis to avoid one infection. For those who prefer more restrictive use of antibiotic prophylaxis, a default strategy of treating no patients at all with prophylaxis would be the best choice. External validation of the model is required before it can be widely applied.
Assuntos
Técnicas de Apoio para a Decisão , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Área Sob a Curva , Criança , Tomada de Decisão Clínica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Seleção de Pacientes , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto JovemRESUMO
Current literature on risk factors for surgical site infection (SSI) in dermatological surgery in the absence of antibiotic prophylaxis is limited. The aim of this study was to retrospectively evaluate patients presenting for dermatological surgery. A total of 1,977 procedures were reviewed. SSI was clinically suspected in 79 (4.0%) patients and confirmed by culture in 38 (1.9%). Using the strictest definition of SSI (clinical symptoms with positive culture) significantly higher risk of SSI was found for location on the ear (odds ratio (OR) 6.03, 95% confidence interval (95% CI) 2.12-17.15), larger defects (OR 1.08 per cm2 increase, 95% CI 1.03-1.14), closure with flaps (OR 6.35, 95% CI 1.33-30.28) and secondary intention (OR 3.01, 95% CI 1.11-8.13). These characteristics were also associated with higher risk of clinically suspected SSI regardless of culture results with slightly lower ORs. In conclusion, the risk of acquiring a SSI is increased in surgeries performed on the ear, in larger wounds and in defects closed with flaps or healed by secondary intention.
