Redução de CLC em Cirurgia Geral... É POSSÍVEL
Gostaria de conhecer a tabela de consenso recentemente publicada com o Algoritmo de Fator de Risco do Paciente e do Procedimento?
O que são complicações no local cirúrgico? (CLC)
Sempre que falamos de complicações no local cirúrgico, estas estão principalmente relacionadas com a infeção do local cirúrgico. Mas há também outras como deiscência, seroma e hematoma principalmente1.
De acordo com a Organização Mundial de Saúde (OMS), na Europa existem 6,5% de infeções associadas aos cuidados de saúde (IACS), sendo as mais frequentes as do trato respiratório, seguidas das infeções do local cirúrgico e do trato urinário e, finalmente, das infeções por cateter sanguíneo2.
As ILC são um desafio em hospitais de todo o mundo3 e podem aumentar substancialmente o tempo de internamento em 14 dias após a cirurgia colorretal4.
As taxas dea ILC são mais elevadas na cirurgia abdominal do que em outros tipos de cirurgia (incidência: até 35%)3,5,6
Especificamente, as CLCs estão associadas a3:
Particularmente na Europa, ocorrem anualmente 800.000 ILC, representando quase 20% das infeções por IACS e causando mais de 16.000 mortes por ano.
Especialmente em Espanha, o desenvolvimento de uma ILC representa um aumento de € 10.232 por paciente7.
Como podem ser evitados?
No final de 2016, a OMS publicou as primeiras diretrizes globais para a prevenção da infeção do local cirúrgico. Inclui um conjunto de medidas pré-intra-pos-operatórias. Nelas, e no intraoperatório, refere-se ao tratamento profilático com pressão negativa onde afirma "O painel sugere o uso de TPNi em pacientes adultos com incisões cirúrgicas fechadas em feridas de alto risco, a fim de prevenir ILC, levando em consideração os recursos" 8
O NICE (National Institute for Health and Care Excellence), como agência de avaliação de tecnologia de saúde na Inglaterra, revisou recentemente as evidências para o uso profilático do PICO para infeções do local cirúrgico e continua a recomendar seu uso em pacientes de alto risco. A TPN continua a provar ser uma alternativa mais eficaz aos pensos tradicionais, pois ajuda a prevenir as CLC em pacientes de risco com incisões cirúrgicas fechadas, a um custo semelhante.
De acordo com o modelo de custos, por cada 1000 kits PICO, poupam-se até 367 dias de hospitalização devido à redução da ILC9.
A redução da ILC pode levar à redução das reintervenções cirúrgicas e dos antibióticos9.
Atualmente, existem muitos estudos que apoiam o uso do PICO na prevenção de complicações do local cirúrgico.
Nova publicação da “The Lancet” endossa a TPNi
Descubra uma meta-análise atualizada e os resultados da análise sequencial dos ensaios (TSA) que foi conduzida por um conselho de revisão externo independente, para fornecer uma visão geral da eficácia da Terapia de Pressão Negativa (TPN) versus pensos tradicionais na incidência de Infeção do Local Cirúrgico (ILC), onde 57 ECRs envolvendo 13.744 pacientes foram incluídos1 .
PICO após cirurgia abdominal
A utilização profilática de PICO◊ TPN demonstrou reduzir significativamente*10 a incidência de
- Complicações no local cirúrgico10-12, 14-16
- Incidência de Infeções do Local Cirúrgico
- Tempo de internamento11,13-15
- Readmissões subsequentes14,15
Numa variedade de aplicações cirúrgicas após laparotomia abdominal:
- Procedimento Whipple10
- Cirurgia Colorretal, Geral e Ginecológica11
- Encerramento do estoma13
- Doença de Crohn14
- Reparação de Hérnia15
O seu paciente é de alto risco?
Na Smith+Nephew, é nossa responsabilidade garantir que todos os pacientes em risco submetidos a cirurgia possam ter acesso à TPNi.
O risco de desenvolver ILC pós-operatório depende do tipo de cirurgia e do risco do paciente.
Fatores de risco para ILC em cirurgia colorretal
- 52% das cirurgias colorretais podem durar mais de 3 horas17, a cirurgia colorretal que dura mais de 3 horas tem um risco significativo de desenvolver uma ILC*18.
- Quase 1/3 dos pacientes necessitam de cirurgia de emergência,17 aumentando significativamente o risco de desenvolver ILC após cirurgia geral†19.
- Pessoas com IMC maior que 30 têm maior probabilidade de ter ILC após cirurgia colorretal‡17.
Apesar de conhecer o benefício clínico da TPNi e os fatores de risco em geral, não há consenso na comunidade científica sobre que tipo de paciente ou procedimento seria candidato a este tipo de terapia.
Em 2023, foi publicado um artigo de um grupo de especialistas em cirurgia geral (parede abdominal e colorretal) de Espanha e Portugal, combinando fatores de risco associados ao doente e ao procedimento e visualizando dois cenários de complicações do local cirúrgico, que são de risco moderado e elevado.
Gostaria de conhecer a tabela de consenso com o Algoritmo de Fator de Risco?
Mecanismo de ação do PICO
A TPN possui múltiplos mecanismos de ação que podem ajudar a melhorar a velocidade, a força e a qualidade da cicatrização de feridas incisionais, o que pode minimizar as complicações no local cirúrgico19-24.
Tecnologia de penso exclusiva
O sistema PICO com tecnologia AIRLOCK permite a administração de pressão negativa por todo o penso para garantir que o tratamento é administrado numa área mais ampla para além da própria ferida.
Usando um design de penso exclusivo e um equipamento inovador, a TPN PICO demonstrou reduzir a tensão lateral*25 e pode ajudar a reduzir o edema26-28 promovendo drenagem linfática***29 com um silicone macio que ajuda a minimizar o trauma e a dor na área perilesional durante a remoção dos pensos.30-32
Adequado para uso em:
- Incisões cirúrgicas fechadas
- Feridas agudas, traumáticas, subagudas e deiscências
- Feridas e úlceras crónicas (tais como úlceras diabéticas ou por pressão)
- Queimaduras, retalhos e enxertos de espessura parcial
Produtos de interesse
Evidência de alta qualidade para doentes de alto risco
Referências
1. World Union of Wound Healing Societies (WUWHS) Consensus Document. Surgical wound dehiscence: improving prevention and outcomes. Wounds International, 2018
2. Global report on infection prevention and control. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789240051164
3. Elia-Guedea M, de Laspra ECD, Echazarreta-Gallego E, Valero-Lazaro MI, Ramirez-Rodriguez JM, Aguilella-Diago V. Colorectal surgery and surgical site infection: Is a change in attitude necessary? Int J Colorectal Dis. 2017;32(7):967–974.
4.Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of
Hospital Infection. 2009 Jul 1;72(3):243–50
5. Alkaaki A, Al-Radi OO, Khoja A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111–117.
6. O’Leary DP, Peirce C, Anglim B, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations. A randomised controlled open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
7. Health First Europe . Identifying the gaps between evidence and practice in the prevention of surgical site infections 3 Insight Report: identifying the gaps between evidence and practice in the prevention of surgical site infections [Internet]. 2020 Nov [cited 2023 Sep 16] p. 1–25. Available from: https://healthfirsteurope.eu/wp-content/uploads/2020/11/A3A4-48pp-Booklet-Spreads-1.pdf
8. WHO Guidelines Approved by the Guidelines Review Committee. (2016). Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization. https://www.who.int/gpsc/ssi-guidelines/en/.
9. National Institute for Health and Care Excellence (NICE) Medical technology guidance - PICO negative pressure wound dressings for closed surgical incisions. May 2019. Available at: https://www.nice.org.uk/guidance/mtg43 (accedido 15 octubre 2019).
10. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after whipple procedures. Am Surg. 2017;83(10):1166–1169.
11. O'Leary DP, Peirce C, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
12. Abadía P, Ocaña J, Ramos D, et al. Prophylactic use of negative pressure wound therapy reduces surgical site infections in elective colorectal surgery: A prospective cohort study. Surg Infect. 2020 Jun 10. [Epub ahead of print].
13. Obeid N, Sharma E, Dunstan M, et al. Negative pressure therapy for stoma closure sited – a nonrandomised case control study. Int J Colorectal Dis. 2020 Sep 14;[Epub ahead of print].
14. Selvaggi F, et al. New advances in NPWT for surgical wounds of patients affected with Crohn’s disease. Surg Technol Int. 2014;24:83–89.
15. Interim data: Pellino G, et al. Effects of a new pocket device for NPWT on surgical wounds of patients affected with Crohn’s disease: a pilot trial. Surg Innov. 2014;21(2):204–212.
16. Bueno-Lledó J, Franco-Bernal A, Garcia-Voz-Mediano MT, Torregrosa-Gallud A, Bonafé S. Prophylactic Single-use Negative Pressure Dressing in Closed Surgical Wounds After Incisional Hernia Repair: A Randomized, Controlled Trial. Annals of Surgery. 2020 Nov 12.
*comparado con el tratamiento estándar
17. Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of Hospital Infection. 2009 Jul 1;72(3):243–50.
18. Wick EC, Gibbs L, IndorfLA, Varma MG, Garcia-Aguilar J. Implementation of quality measures to reduce surgical site infection in colorectal patients. Diseases of the colon & rectum. 2008 Jul 1;51(7):1004–9
19. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infectious Diseases. 2008 Dec 1;8(1):34.
* p = 0.042; † p = 0.002; ‡ p = 0.045
19. Canonico S, Campitiello F, Della Corte A. Therapeutic possibilities of portable NPWT. Acta Vulnologica 10 (2012): 57-64.
20. Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, Mogensen O, Lamont RF, Bille C. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. British Journal of Surgery. 2016
Apr;103(5):477-86.
21. Loveluck J, Copeland T, Hill J, Hunt A, Martin R. Biomechanical modeling of the forces applied to closed incisions during single-use negative pressure wound therapy. ePlasty. 2016;16.
22. Malmsjö M, Huddleston E, Martin R. Biological effects of a disposable, canisterless negative pressure wound therapy system. ePlasty. 2014;14.
23. Pellino G, Sciaudone G, Candilio G, Campitiello F, Selvaggi F, Canonico S. Effects of a new pocket device for negative pressure wound therapy on surgical wounds of pacientes affected with Crohn’s disease: a pilot trial. Surgical innovation. 2014 Apr;21(2):204-12.
24. Data on file reference 1102010 – Bacterial Barrier Testing (wet-wet) of PICO Dressing with a 7 day test Duration against S. marcescens.
*Como se demostró en los modelos biomecánicos.
**Como se demostró in vivo.
***Como se demostró en pruebas de laboratorio.
25.Loveluck J, et al. ePlasty. 2016;16:183-195.
16.Birke-Sorensen H, et al. J Plast Reconstr Aesthet Surg. 2011;64 Suppl:S1-16.
27.Kamolz LP, et al. Burns. 2004;30(3):253-258.
28.Molnar JA, et al. J Burns Wounds. 2005;4:83-92.
29.Kilpadi DV, et al. Wound Repair Regen. 2011;19(5):588-596.
30.Payne C, et al. ePlasty. 2014:152-166.
31.Stryja J, et al. Prolekare. 2015;94(8):322 - 328.
32.Smith+Nephew 2015. Internal Report. ST865 CT09/02.
Imagen 1
11. Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of Hospital Infection. 2009 Jul 1;72(3):243–50.
12. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infectious Diseases. 2008 Dec 1;8(1):34.
13. Wick EC, Gibbs L, Indorf LA, Varma MG, Garcia-Aguilar J. Implementation of quality measures to reduce surgical site infection in colorectal patients. Diseases of the colon & rectum. 2008 Jul 1;51(7):1004–9.
14. Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Annals of surgery. 2004 May;239(5):599.
16. Serra-Aracil X, Espin-Basany E, Biondo S, Guirao X, Orrego C, Sitges-Serra A. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Archives of surgery. 2011 May 1;146(5):606–12.
Imagen 3
1. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after whipple procedures. Am Surg. 2017;83(10):1166–1169.
2. O'Leary DP, Peirce C, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
4. Obeid N, Sharma E, Dunstan M, et al. Negative pressure therapy for stoma closure sited – a nonrandomised case control study. Int J Colorectal Dis. 2020 Sep 14;[Epub ahead of print].
5. Selvaggi F, et al. New advances in NPWT for surgical wounds of patients affected with Crohn’s disease. Surg Technol Int. 2014;24:83–89.
7. Bueno-Lledó J, Franco-Bernal A, Garcia-Voz-Mediano MT, Torregrosa-Gallud A, Bonafé S. Prophylactic Single-use Negative Pressure Dressing in Closed Surgical Wounds After Incisional Hernia Repair: A Randomized, Controlled Trial. Annals of Surgery. 2020 Nov 12.
2. Global report on infection prevention and control. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789240051164
3. Elia-Guedea M, de Laspra ECD, Echazarreta-Gallego E, Valero-Lazaro MI, Ramirez-Rodriguez JM, Aguilella-Diago V. Colorectal surgery and surgical site infection: Is a change in attitude necessary? Int J Colorectal Dis. 2017;32(7):967–974.
4.Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of
Hospital Infection. 2009 Jul 1;72(3):243–50
5. Alkaaki A, Al-Radi OO, Khoja A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111–117.
6. O’Leary DP, Peirce C, Anglim B, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations. A randomised controlled open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
7. Health First Europe . Identifying the gaps between evidence and practice in the prevention of surgical site infections 3 Insight Report: identifying the gaps between evidence and practice in the prevention of surgical site infections [Internet]. 2020 Nov [cited 2023 Sep 16] p. 1–25. Available from: https://healthfirsteurope.eu/wp-content/uploads/2020/11/A3A4-48pp-Booklet-Spreads-1.pdf
8. WHO Guidelines Approved by the Guidelines Review Committee. (2016). Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization. https://www.who.int/gpsc/ssi-guidelines/en/.
9. National Institute for Health and Care Excellence (NICE) Medical technology guidance - PICO negative pressure wound dressings for closed surgical incisions. May 2019. Available at: https://www.nice.org.uk/guidance/mtg43 (accedido 15 octubre 2019).
10. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after whipple procedures. Am Surg. 2017;83(10):1166–1169.
11. O'Leary DP, Peirce C, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
12. Abadía P, Ocaña J, Ramos D, et al. Prophylactic use of negative pressure wound therapy reduces surgical site infections in elective colorectal surgery: A prospective cohort study. Surg Infect. 2020 Jun 10. [Epub ahead of print].
13. Obeid N, Sharma E, Dunstan M, et al. Negative pressure therapy for stoma closure sited – a nonrandomised case control study. Int J Colorectal Dis. 2020 Sep 14;[Epub ahead of print].
14. Selvaggi F, et al. New advances in NPWT for surgical wounds of patients affected with Crohn’s disease. Surg Technol Int. 2014;24:83–89.
15. Interim data: Pellino G, et al. Effects of a new pocket device for NPWT on surgical wounds of patients affected with Crohn’s disease: a pilot trial. Surg Innov. 2014;21(2):204–212.
16. Bueno-Lledó J, Franco-Bernal A, Garcia-Voz-Mediano MT, Torregrosa-Gallud A, Bonafé S. Prophylactic Single-use Negative Pressure Dressing in Closed Surgical Wounds After Incisional Hernia Repair: A Randomized, Controlled Trial. Annals of Surgery. 2020 Nov 12.
*comparado con el tratamiento estándar
17. Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of Hospital Infection. 2009 Jul 1;72(3):243–50.
18. Wick EC, Gibbs L, IndorfLA, Varma MG, Garcia-Aguilar J. Implementation of quality measures to reduce surgical site infection in colorectal patients. Diseases of the colon & rectum. 2008 Jul 1;51(7):1004–9
19. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infectious Diseases. 2008 Dec 1;8(1):34.
* p = 0.042; † p = 0.002; ‡ p = 0.045
19. Canonico S, Campitiello F, Della Corte A. Therapeutic possibilities of portable NPWT. Acta Vulnologica 10 (2012): 57-64.
20. Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, Mogensen O, Lamont RF, Bille C. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. British Journal of Surgery. 2016
Apr;103(5):477-86.
21. Loveluck J, Copeland T, Hill J, Hunt A, Martin R. Biomechanical modeling of the forces applied to closed incisions during single-use negative pressure wound therapy. ePlasty. 2016;16.
22. Malmsjö M, Huddleston E, Martin R. Biological effects of a disposable, canisterless negative pressure wound therapy system. ePlasty. 2014;14.
23. Pellino G, Sciaudone G, Candilio G, Campitiello F, Selvaggi F, Canonico S. Effects of a new pocket device for negative pressure wound therapy on surgical wounds of pacientes affected with Crohn’s disease: a pilot trial. Surgical innovation. 2014 Apr;21(2):204-12.
24. Data on file reference 1102010 – Bacterial Barrier Testing (wet-wet) of PICO Dressing with a 7 day test Duration against S. marcescens.
*Como se demostró en los modelos biomecánicos.
**Como se demostró in vivo.
***Como se demostró en pruebas de laboratorio.
25.Loveluck J, et al. ePlasty. 2016;16:183-195.
16.Birke-Sorensen H, et al. J Plast Reconstr Aesthet Surg. 2011;64 Suppl:S1-16.
27.Kamolz LP, et al. Burns. 2004;30(3):253-258.
28.Molnar JA, et al. J Burns Wounds. 2005;4:83-92.
29.Kilpadi DV, et al. Wound Repair Regen. 2011;19(5):588-596.
30.Payne C, et al. ePlasty. 2014:152-166.
31.Stryja J, et al. Prolekare. 2015;94(8):322 - 328.
32.Smith+Nephew 2015. Internal Report. ST865 CT09/02.
Imagen 1
11. Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. Journal of Hospital Infection. 2009 Jul 1;72(3):243–50.
12. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infectious Diseases. 2008 Dec 1;8(1):34.
13. Wick EC, Gibbs L, Indorf LA, Varma MG, Garcia-Aguilar J. Implementation of quality measures to reduce surgical site infection in colorectal patients. Diseases of the colon & rectum. 2008 Jul 1;51(7):1004–9.
14. Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Annals of surgery. 2004 May;239(5):599.
16. Serra-Aracil X, Espin-Basany E, Biondo S, Guirao X, Orrego C, Sitges-Serra A. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Archives of surgery. 2011 May 1;146(5):606–12.
Imagen 3
1. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after whipple procedures. Am Surg. 2017;83(10):1166–1169.
2. O'Leary DP, Peirce C, et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: The P.I.C.O. Trial. Ann Surg. 2017;265:1082–1086.
4. Obeid N, Sharma E, Dunstan M, et al. Negative pressure therapy for stoma closure sited – a nonrandomised case control study. Int J Colorectal Dis. 2020 Sep 14;[Epub ahead of print].
5. Selvaggi F, et al. New advances in NPWT for surgical wounds of patients affected with Crohn’s disease. Surg Technol Int. 2014;24:83–89.
7. Bueno-Lledó J, Franco-Bernal A, Garcia-Voz-Mediano MT, Torregrosa-Gallud A, Bonafé S. Prophylactic Single-use Negative Pressure Dressing in Closed Surgical Wounds After Incisional Hernia Repair: A Randomized, Controlled Trial. Annals of Surgery. 2020 Nov 12.