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?
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 noutros tipos de cirurgia (incidência: até 35%)3,5,6
Especificamente, as CLCs estão associados 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
Em 2019, o National Institute for Health and Care Excellence (NICE), como agência de avaliação de tecnologias de saúde em Inglaterra, analisou a TPN PICO de uso único, demonstrando que é uma alternativa mais eficaz aos pensos cirúrgicos padrão, pois ajuda a prevenir CLCs 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.
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
- Fecho 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.
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