RESUMO
BACKGROUND AND OBJECTIVES: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. METHOD: A cohort study of six months duration. Patients aged ≥ 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. RESULTS: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively). When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048), serum sodium (OR = 0.962), and volume of irrigation fluid administered during surgery (OR = 1.001) were independent variables. CONCLUSION: The incidence of serious complications in endoscopic surgeries is high. Serum sodium at the end of the operation, amount of irrigation fluid, and age were strong independent factors associated with the problem. Thus, these factors must be taken into account in these surgeries.
Assuntos
Endoscopia/efeitos adversos , Irrigação Terapêutica/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Análise de Regressão , Fatores de Risco , Sódio/sangueRESUMO
BACKGROUND AND OBJECTIVES: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. METHOD: A cohort study of six months duration. Patients aged ≥ 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. RESULTS: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively). When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048), serum sodium (OR = 0.962), and volume of irrigation fluid administered during surgery (OR = 1.001) were independent variables.
Assuntos
Endoscopia/efeitos adversos , Irrigação Terapêutica/efeitos adversos , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de RiscoRESUMO
In chronic hepatitis C (CHC), liver biopsy is the gold standard method for assessing liver histology, however it is invasive and can have complications. Non-invasive markers have been proposed and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) has been shown as an easy and inexpensive marker of liver fibrosis. This study evaluated the diagnostic performance of APRI for significant fibrosis and cirrhosis prediction in CHC patients. This study included treatment-naive CHC patients who had undergone liver biopsy from January 2000 to August 2006. All histological slides were reviewed according to the METAVIR system. APRI was calculated based on laboratory results performed within four months from the biopsy. Twenty-eight (56%) patients had significant fibrosis (F2-F4) and 13 (26%) had cirrhosis (F4). The area under ROC curves of APRI for predicting significant fibrosis and cirrhosis were 0.92 (0.83-1.00) and 0.92 (0.85-1.00), respectively. Using cut-off values recommended by prior studies, significant fibrosis could be identified, in accordance with liver biopsy, in 44% and cirrhosis in 66% of patients. APRI could identify significant fibrosis and cirrhosis at a high degree of accuracy in studied patients.
Assuntos
Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Ensaios Enzimáticos Clínicos , Hepatite C Crônica/diagnóstico , Cirrose Hepática/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Progressão da Doença , Métodos Epidemiológicos , Feminino , Hepatite C Crônica/patologia , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Adulto JovemRESUMO
JUSTIFICATIVA E OBJETIVOS: A medicina endoscópica está cada vez mais sendo usada atualmente, porém não é isenta de riscos. Portanto, este estudo avaliou os fatores associados com complicações perioperatórias em cirurgias endoscópicas com irrigação intraoperatória. MÉTODO: Estudo de coorte durante seis meses. Foram incluídos pacientes com > 18 anos, submetidos a cirurgias endoscópicas que usariam fluidos de irrigação no intraoperatório. Pacientes em uso de diuréticos, com insuficiência renal, distúrbios cognitivos, hiponatremia prévia a cirurgia, gestantes e moribundos foram excluídos. Foram alocados em dois grupos os pacientes que apresentaram complicações ou não no período perioperatório. As complicações avaliadas estavam relacionadas a alterações neurológicas, cardiovasculares, renais e sangramentos no perioperatório. RESULTADOS: Foram incluídos 181 pacientes e 39 excluídos, portanto 142 preencheram os critérios. Apresentaram complicações 21,8% dos pacientes, com maior ocorrência em cirurgias endoscópicas de próstata, seguidas de histeroscopias, bexiga, artroscopia de joelho e ombro, respectivamente 58,1%, 36,9%, 19,4%, 3,8% e 3,2%. Comparando os grupos, apresentaram associação com complicações na análise univariada; idade, sexo, tabagismo, cardiopatia, ASA, sódio sérico no fim da cirurgia, total de fluido de irrigação administrado, ressecção transuretral de próstata, histeroscopia. Entretanto, apenas idade (OR = 1,048), sódio sérico (OR = 0,962) e volume de fluido de irrigação administrado no intraoperatório (OR = 1,001) foram variáveis independentes para complicações na regressão múltipla. CONCLUSÃO: Graves complicações em cirurgias endoscópicas têm grande ocorrência. O sódio sérico no fim da operação, a quantidade de fluido de irrigação e a idade foram fortes fatores independentes associados ao problema. Dessa forma, tais fatores devem ser levados em consideração nesses tipos de cirurgias.
BACKGROUND AND OBJECTIVES: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. METHOD: A cohort study of six months duration. Patients aged > 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. RESULTS: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively). When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048), serum sodium (OR = 0.962), and volume of irrigation fluid administered during surgery (OR = 1.001) were independent variables. CONCLUSION: The incidence of serious complications in endoscopic surgeries is high. Serum sodium at the end of the operation, amount of irrigation fluid, and age were strong independent factors associated with the problem. Thus, these factors must be taken into account in these surgeries.
JUSTIFICATIVA Y OBJETIVOS: Hoy por hoy, la medicina endoscópica se usa cada vez más aunque no esté exenta de riesgos. Por eso, este estudio evaluó los factores que están asociados con las complicaciones perioperatorias en las cirugías endoscópicas con irrigación intraoperatória. MÉTODO: Estudio de cohorte durante seis meses. Se incluyeron pacientes con > 18 años, sometidos a cirugías endoscópicas que usarían fluidos de irrigación en el intraoperatorio. Pacientes que usaban diuréticos, que tenían insuficiencia renal, trastornos cognitivos, hiponatremia previa a la cirugía, gestantes y moribundos quedaron fuera del estudio. Fueron divididos en dos grupos los pacientes que tenían complicaciones o no en el período perioperatorio. Las complicaciones evaluadas estaban relacionadas con las alteraciones neurológicas, cardiovasculares, renales y con los sangramientos en el perioperatorio. RESULTADOS: Fueron incluidos 181 pacientes quedando fuera 39, por tanto 142 respetaron los criterios. Tenían complicaciones el 21,8% de los pacientes, con una incidencia mayor en las cirugías endoscópicas de próstata, seguidas de histeroscopias, vejiga, artroscopia de rodilla y de hombro, respectivamente 58,1%, 36,9%, 19,4%, 3,8% y 3,2%. Comparando los grupos, tenían una asociación con las complicaciones en el análisis univariado; edad, sexo, tabaquismo, cardiopatía, ASA, sodio sérico al final de la cirugía, total de fluido de irrigación administrado, resección transuretral de próstata, histeroscopia. Sin embargo, solamente la edad (OR = 1,048), sodio sérico (OR = 0,962) y el volumen de fluido de irrigación administrado en el intraoperatorio (OR = 1,001), fueron variables independientes para las complicaciones en la regresión múltiple. CONCLUSIONES: Las graves complicaciones en las cirugías endoscópicas tienen un gran porcentaje de incidencia. El sodio sérico al final de la operación, la cantidad de fluido de irrigación y la edad, fueron fuertes factores independientes asociados al problema. Tales factores deben ser tenidos en cuenta en esos tipos de cirugías.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Endoscopia/efeitos adversos , Irrigação Terapêutica/efeitos adversos , Estudos de Coortes , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de RiscoRESUMO
In chronic hepatitis C (CHC), liver biopsy is the gold standard method for assessing liver histology, however it is invasive and can have complications. Non-invasive markers have been proposed and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) has been shown as an easy and inexpensive marker of liver fibrosis. This study evaluated the diagnostic performance of APRI for significant fibrosis and cirrhosis prediction in CHC patients. This study included treatment-naive CHC patients who had undergone liver biopsy from January 2000 to August 2006. All histological slides were reviewed according to the METAVIR system. APRI was calculated based on laboratory results performed within four months from the biopsy. Twenty-eight (56 percent) patients had significant fibrosis (F2-F4) and 13 (26 percent) had cirrhosis (F4). The area under ROC curves of APRI for predicting significant fibrosis and cirrhosis were 0.92 (0.83-1.00) and 0.92 (0.85-1.00), respectively. Using cut-off values recommended by prior studies, significant fibrosis could be identified, in accordance with liver biopsy, in 44 percent and cirrhosis in 66 percent of patients. APRI could identify significant fibrosis and cirrhosis at a high degree of accuracy in studied patients.