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Artroplastia total do joelho no Centro Hospitalar Cova da Beira

Estudo da Infeção e dos Custos Hospitalares
Authors: Araújo, Beatriz Dias de;

Artroplastia total do joelho no Centro Hospitalar Cova da Beira

Abstract

Introdução: A Artroplastia articular é uma técnica cirúrgica que se baseia na substituição das superfícies articulares, tendo-se tornado o tratamento de escolha para doentes com mais de 55 anos com artrose do joelho, dor intensa e incapacitante. É uma intervenção com uma eficácia maior ou igual a 90%, fornece alívio sintomático, restabelece a função articular, melhorando a mobilidade e a independência. A infeção é uma complicação devastadora e uma das principais causas de morbilidade após artroplastia total do joelho. Estudos estimam que 0.86%-3% das artroplastia do joelho desenvolvem infeção profunda. Objetivos: Calcular a taxa de infeção na artroplastia primária do joelho, no Serviço de Ortopedia do Centro Hospitalar Cova da Beira, no período de agosto de 2010 a agosto de 2013 e estudar os fatores de risco. Analisar os custos hospitalares associados ao tratamento médico e cirúrgico desta complicação. Metodologia: É um estudo retrospetivo, observacional e analítico de uma amostra de doentes internados no Serviço de Ortopedia do Centro Hospitalar Cova da Beira, sujeitos a artroplastia total primária do joelho, entre agosto de 2010 e agosto de 2013. A recolha de dados foi realizada por consulta de processos clínicos. Resultados: Este estudo foi incorporado por 125 doentes submetidos a artroplastia total do joelho. Nesta amostra de doentes foram realizadas 139 cirurgias, maioritariamente do sexo feminino [(67,2%) (n=84)]. 47,2% dos doentes entre 70 e 79 anos (inclusive), sendo a média de idade de 73,46 anos (DP=8,21 anos, variação 48-93 anos). Foi observada uma relação estatística significativa entre a estação do ano e a taxa de infeção (p<0,05), as complicações pós-cirurgia e a variável idade (p<0,05), a patologia psiquiátrica e a taxa de infeção (8,3%; p<0,05). Foi feito o cálculo dos custos médios relacionados com o tratamento de quatro doentes com infeção profunda da prótese total do joelho. Contabilizaram-se 10 episódios em que estes doentes recorreram aos cuidados de saúde do Centro Hospitalar Cova da Beira, tendo um custo médio de 6.809,99 euros por episódio e um custo total médio por infeção de 17.209,11 euros. Conclusões: No nosso estudo, a taxa de infeção calculada está de acordo com estudos prévios. Existe uma correlação entre a estação do ano em que a prótese total do joelho foi realizada e a incidência aumentada de infeção. Para evitar um grande impacto financeiro, é muito importante estudar os possíveis fatores de risco para uma prevenção deste tipo de complicações.

The joint Arthroplasty is a surgical technique based on the replacement of the articular surfaces, having become the treatment for patients with more than 55 years with knee arthrosis, intense pain and disabling. Is an intervention with efficiency greater than or equal to 90%, provides symptomatic relief, re-establishing the joint function, improving mobility and independence. The infection is a devastating complication and one of the main causes of morbidity after total knee arthroplasty. Studies estimate that 0.86 % -3% of knee arthroplasty develops deep infection. Objectives: Calculate the rate of infection in primary knee arthroplasty, at the Orthopedics Service of Central Hospital of Cova da Beira, in the period of August 2010 to August 2013 and studying the risk factors. Analyze the hospital costs associated with the medical and surgical treatment of this complication. Methodology: This is a retrospective, observational and analytical study of a sample of patients admitted at the Orthopedics Service of Central Hospital of Cova da Beira, subject to primary total arthroplasty of the knee, between August of 2010 and August 2013. The data collected was carried out by consultation of clinical processes. Results: This study was incorporated by 125 patients undergoing total knee arthroplasty. In this sample of patients were performed 139 surgeries, mainly female (67.2 %) (n= 84). 47.2% of the patients between 70 and 79 years (inclusive), with a mean age of 73.46 years (SD=8.21 years, range 48-93 years). There was a significant statistical relationship between the season and the rate of infection (p< 0.05), the postoperative complications and the age variable (p< 0.05), the psychiatric pathology and the rate of infection (8.3 %; p< 0.05). Calculations of average costs were made associated with the treatment of four patients with deep infection of the total knee prosthesis. Were accounted 10 episodes in which these patients have relied on the health care system of Central Hospital of Cova da Beira, having an average cost of 6809.99 euros per episode and a mean total cost per infection of 17209.11 euros. Conclusions: In our study, the rate of infection is calculated in accordance with previous studies. There is a correlation between the season of the year in which the primary total arthroplasty was performed and the increased incidence of infection. To avoid a major financial impact, it is very important to study the possible risk factors to prevent these types of complications.

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Portugal
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Keywords

Fatores de Risco e Custos Hospitalares, Artroplastia Total Primária, Joelho, Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina, Taxa de Infeção

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This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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