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1.
Rev. enferm. UERJ ; 29: e56924, jan.-dez. 2021.
Article in English, Portuguese | LILACS | ID: biblio-1224444

ABSTRACT

Objetivo: descrever a incidência de complicações em feridas operatórias de mastectomia e identificar fatores associados. Método: estudo retrospectivo desenvolvido em uma coorte hospitalar de 545 mulheres mastectomizadas por câncer de mama no ano 2018 em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados a partir dos prontuários, permitindo cálculos da taxa de incidência e da razão da taxa de incidência para cada complicação. Resultados: a complicação que apresentou maior taxa de incidência foi o sangramento (57,14/100 mastectomias-dia), tendo como fatores associados a raça/cor da pele não branca (Razão da Taxa de Incidência: 3,11) e a diabetes mellitus (Razão da Taxa de Incidência: 0,48). Conclusão: os fatores associados ao sangramento da ferida operatória apontam para a necessidade de novas práticas no cuidado ao pós-operatório de mulheres mastectomizadas.


Objective: to describe the incidence of complications in mastectomy surgical wounds and to identify associated factors. Method: this retrospective study was conducted in a hospital cohort of 545 women mastectomized for breast cancer in 2018 at a high-complexity cancer care center Rio de Janeiro City, Brazil, after approval by the research ethics committee. Data were collected from medical records, allowing incidence rate and incidence rate ratio to be calculated for each complication. Results: the complication with the highest incidence rate was bleeding (57.14/100 mastectomies-day), associated factors being non-white race/skin color (incidence rate ratio 3.11) and diabetes mellitus (incidence rate ratio 0.48). Conclusion: the factors associated with bleeding from the surgical wound point to the need for new practices in post-operative care for women with mastectomies.


Objetivo: describir la incidencia de complicaciones en heridas quirúrgicas de mastectomía e identificar factores asociados. Método: estudio retrospectivo desarrollado en una cohorte hospitalaria de 545 mujeres mastectomizadas por cáncer de mama en 2018 en un centro de atención de alta complejidad en oncología de la ciudad de Río de Janeiro, Brasil, previa aprobación del Comité de Ética en Investigación. Los datos se obtuvieron de las historias clínicas, lo que permitió calcular la tasa de incidencia y el cociente de la tasa de incidencia para cada complicación. Resultados: la complicación que presentó mayor tasa de incidencia fue el sangrado (57,14 / 100 mastectomías-día), con factores asociados a la raza / color de piel no blanca (índice de tasa de incidencia: 3,11) y diabetes mellitus (índice de tasa de incidencia: 0,48). Conclusión: los factores asociados al sangrado de la herida quirúrgica apuntan a la necesidad de nuevas prácticas en el cuidado al postoperatorio de las mujeres con mastectomía.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Postoperative Complications/epidemiology , Surgical Wound/complications , Mastectomy/adverse effects , Brazil/epidemiology , Breast Neoplasms/surgery , Incidence , Retrospective Studies , Risk Factors , Postoperative Hemorrhage/epidemiology
2.
Coluna/Columna ; 20(3): 229-231, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339755

ABSTRACT

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.


RESUMO Objetivo O objetivo deste estudo é fazer um levantamento das diferentes complicações da sacrectomia parcial, total ou estendida para tratamento de tumores da coluna vertebral. Métodos O estudo é uma análise descritiva de prontuários de uma série de 18 pacientes submetidos à sacrectomia entre 2010 e 2019 em um centro terciário especializado em cirurgias de neoplasia na coluna. As variáveis analisadas foram sexo, idade, tempo de internação, diagnóstico oncológico, padrão de fixação posterior, taxa de complicações e escalas de Frankel, ASA e ECOG. Resultados Dos 18 pacientes, 10 (55,5%) eram homens e 8 (44,5%) mulheres com média de idade de 48 anos. O tempo médio de internação foi de 23 dias. Dos 18 pacientes, 8 (44,5%) contraíram infecções pós-operatórias com necessidade de cirurgia. As complicações perioperatórias incluíram fistula liquórica (22,25%), instabilidade hemodinâmica com necessidade de medicação vasoativa no pós-operatório imediato (22,25%), deiscência da ferida operatória (11,1%), abdome obstrutivo agudo (11,1%), oclusão da artéria ilíaca externa esquerda (11,1%), óbito pós-operatório imediato por infarto agudo do miocárdio (11,1%) e óbito intraoperatório por instabilidade hemodinâmica (11,1%). Conclusões A sacrectomia parcial, total ou estendida é um procedimento complexo com alta taxa de mortalidade e morbidade, mesmo em centros especializados no tratamento de tumores na coluna. Nível de evidência IV; Série de casos.


RESUMEN Objetivo El objetivo de este estudio es evaluar las diferentes complicaciones de la sacrectomía parcial, total o extendida para el tratamiento de tumores vertebrales. Métodos El estudio es un análisis descriptivo de las historias clínicas de 18 pacientes sometidos a sacrectomía entre 2010 y 2019 en un centro terciario especializado en cirugías de neoplasia de columna. Las variables analizadas fueron sexo, edad, estancia hospitalaria, diagnóstico de cáncer, patrón de fijación posterior, tasa de complicaciones, escalas de Frankel, ASA y ECOG. Resultados De los 18 pacientes, 10 (55,5%) eran hombres y 8 (44,5%) mujeres con una edad promedio de 48 años. La estancia hospitalaria promedio fue de 23 días. De los 18 pacientes, 8 (44,5%) contrajeron infecciones posoperatorias que requirieron cirugía. Las complicaciones perioperatorias incluyeron fístula de líquido cefalorraquídeo (22,25%), inestabilidad hemodinámica que requirió medicación vasoactiva en el posoperatorio inmediato (22,25%), dehiscencia de la herida quirúrgica (11,1%), abdomen obstructivo agudo (11,1%), oclusión de la arteria ilíaca externa izquierda (11,1%), muerte posoperatoria inmediata por infarto agudo de miocardio (11,1%) y muerte intraoperatoria por inestabilidad hemodinámica (11,1%). Conclusiones La sacrectomía parcial, total o extendida es un procedimiento complejo con una alta tasa de mortalidad y morbilidad, incluso en centros especializados en el tratamiento de tumores de la columna. Nivel de evidencia IV; Series de casos


Subject(s)
Humans , Postoperative Complications , Sacrum , Spinal Neoplasms , Intraoperative Complications
3.
Rev. urug. cardiol ; 36(2): e702, ago. 2021. fot.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1290000

ABSTRACT

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.


A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.


Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.


Subject(s)
Humans , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Surgical Sponges , Foreign Bodies/diagnostic imaging , Postoperative Complications/surgery , Postoperative Complications/diagnostic imaging , Thoracic Surgery , Foreign Bodies/surgery
4.
Rev. bras. ortop ; 56(4): 478-484, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1341173

ABSTRACT

Abstract Objective To describe the epidemiological and clinical profile of patients with Dupuytren disease treated by selective fasciectomy and the factors associated with the severity of the disease. Methods Retrospective descriptive observational study involving 247 patients with Dupuytren disease, from 2013 to 2019. Multivariate logistic regression was performed for data analysis. Results Most patients were male (83.8%), self-declared white (65.2%), alcoholics (59.6%) and 49% were smokers, with a mean age of 66 ± 9 years old, with 77.2% presenting symptoms of the disease after the age of 51 years old. Approximately 51.9, 29.6 and 17.3%, respectively, had arterial hypertension, diabetes mellitus and dyslipidemia comorbidities. Bilateral involvement of the hands was observed in 73.3% of the patients. The rate of intra- and post-selective fasciectomy complications was of 0.6 and 24.3%, respectively, with 5.2% of the patients needing reintervention after 1 year of follow-up. After multivariate analysis, males were associated with bilateral involvement of the hands (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.03-4.31) and with a greater number of affected rays (OR = 3.41; 95% CI: 1.66-7.03). Dyslipidemia was associated with reintervention (OR = 5.7; 95% CI = 1.03-31.4) and bilaterality with a higher number of complications (35.7 versus 19.7%). Conclusion A low rate of reintervention and operative complications was observed in patients with Dupuytren disease treated by selective fasciectomy. Male gender was associated with severe disease (bilaterality and more than two affected rays), and dyslipidemia with reintervention.


Resumo Objetivo Descrever o perfil epidemiológico e clínico dos pacientes com doença de Dupuytren tratados por fasciectomia seletiva e os fatores associados com a gravidade da doença. Metodologia Estudo observacional descritivo retrospectivo envolvendo 247 pacientes com doença de Dupuytren, no período de 2013 a 2019. Foi realizada regressão logística multivariada para análise dos dados. Resultados A maioria dos pacientes era do sexo masculino (83,8%), autodeclarados brancos (65,2%), etilistas (59,6%), e 49% eram tabagistas. A média de idade foi de 66 ± 9 anos, sendo que 77,2% apresentaram os sintomas da doença após os 51 anos. Aproximadamente 51,9, 29,6, e 17,3%, respectivamente, apresentaram hipertensão arterial, diabetes mellitus e dislipidemia. O acometimento bilateral das mãos foi observado em 73,3% dos pacientes. A taxa de complicações intra- e pós-fasciectomia seletiva foi de 0,6 e 24,3%, respectivamente, sendo que 5,2% dos pacientes necessitaram de reintervenção após 1 ano de acompanhamento. Após análise multivariada, o sexo masculino foi associado com acometimento bilateral das mãos (odds ratio [OR] = 2,10; intervalo de confiança [IC] 95%: 1,03-4,31) e com maior número de raios acometidos (OR = 3,41; IC 95%: 1,66-7,03). A dislipidemia foi associada com a reintervenção (OR = 5,7; CI 95%: 1,03-31,4) e a bilateralidade com maior número de complicações (35,7% versus 19,7%). Conclusão Foi observada uma baixa taxa de reintervenção e complicações operatórias nos pacientes com doença de Dupuytren tratados por fasciectomia seletiva. O sexo masculino foi associado com o quadro grave da doença (bilateralidade e mais de dois raios acometidos), e a dislipidemia com a reintervenção.


Subject(s)
Humans , Postoperative Complications , Risk Factors , Dupuytren Contracture , Fasciotomy
5.
Säo Paulo med. j ; 139(3): 241-250, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252244

ABSTRACT

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.


Subject(s)
Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & control
6.
Rev. cuba. cir ; 60(2): e1078, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280218

ABSTRACT

Introducción: La enfermedad de Crohn consiste fundamentalmente en el control de los síntomas para alcanzar la remisión clínica, cuando esto no se logra o aparecen complicaciones, puede ser necesario el tratamiento quirúrgico. Objetivo: Evaluar los resultados del tratamiento quirúrgico de los pacientes con enfermedad de Crohn complicada. Método: Se realizó un estudio ambispectivo, descriptivo y longitudinal con una muestra de 20 pacientes con enfermedad de Crohn complicada que acudieron a la consulta de cirugía general y gastroenterología del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" y del Instituto de Gastroenterología, en el periodo de enero del 2010 a mayo del 2019. Se recogieron todas las variables demográficas; estudios hemoquímicos, por imágenes y endoscópicos. Resultados: La mayor incidencia de las complicaciones por enfermedad de Crohn se observó en pacientes mayores de 50 años, con un tiempo de evolución entre 1 y 10 años. La fístula y el plastrón fueron las principales causas de tratamiento quirúrgico. La vía de acceso laparoscópica mostró ventajas respecto a la convencional. El desequilibrio hidromineral y la infección del sitio quirúrgico fueron las principales complicaciones postoperatorias, con mortalidad baja. Conclusiones: El tratamiento quirúrgico electivo, planificado y secuencial de pacientes con enfermedad de Crohn complicada ofrece buenos resultados y es posible utilizar la vía de acceso videoasistida con resultados alentadores en pacientes seleccionados(AU)


Introduction: The managment of Crohn's disease consists in symptoms control for achieving clinical remission. When this is not accomplished or complications reappear, surgical treatment may be necessary. Objective: To assess the outcomes of surgical treatment of patients with complicated Crohn's disease. Method: An ambispective, descriptive and longitudinal study was carried out with a sample of twenty patients with complicated Crohn's disease who attended the general surgery and gastroenterology consultation at Hermanos Ameijeiras Clinical Surgical Hospital and the Gastroenterology Institute, in the period from January 2010 to May 2019. All demographic variables were collected, as well as the results of hemochemical, imaging and endoscopic studies. Results: The highest incidence of complications from Crohn's disease was observed in patients over fifty years of age and with an evolution time between one and ten years. Fistula and plastron were the main causes for surgical treatment. The laparoscopic approach showed advantages over the conventional one. Hydromineral imbalance and surgical site infection were the main postoperative complications, with low mortality. Conclusions: Elective, planned and sequential surgical treatment of patients with complicated Crohn's disease offers good outcomes. It is possible to use the video-assisted approach, with encouraging outcomes in selected patients(AU)


Subject(s)
Humans , Postoperative Complications , Crohn Disease/surgery , Crohn Disease/epidemiology , Epidemiology, Descriptive , Longitudinal Studies
7.
Arch. argent. pediatr ; 119(3): S67-S76, Junio 2021. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1248259

ABSTRACT

El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía


Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.


Subject(s)
Humans , Male , Female , Child , Tonsillectomy , Adenoidectomy , Postoperative Complications , Respiration Disorders , Adenoids/surgery , Sleep Apnea, Obstructive
8.
J. coloproctol. (Rio J., Impr.) ; 41(2): 131-137, June 2021. tab, graf
Article in English | LILACS | ID: biblio-1286993

ABSTRACT

Abstract Background Colorectal resection anastomosis is the commonest cause of rectal strictures. Anastomotic site ischemia, incomplete doughnuts from stapled anastomosis and pelvic infection, are some of the risk factors that play a role in the development of postoperative rectal strictures. However, the role of diverting stoma in the development of rectal strictures has not been studied extensively. Objectives To study the difference in the occurrence of anastomotic strictures (AS) in patients submitted to low anterior resection (LAR) with covering ileostomy (CI), and to LAR without CI for carcinoma rectum. Methods This was a prospective, comparative case control study carried out at a tertiary care referral center. Low anterior resection with covering ileostomy was performed in patients with rectum carcinoma in the study group, while LAR without covering ileostomy was performed in the control group. The study group had 29 patients, while the control group had 33 patients with rectum carcinoma. Results During themean follow-up period of 9.1months, 8 (28%) patients in the study group and 2 (6%) patients in the control group developed AS (p =0.019). Out of these 8 patients with AS in the study group, 50% had Grade-I AS, 25% had Grade-II AS, while 25% of the patients had Grade-III (severe) AS. However, both patients who developed AS in the control group had a mild type (Grade I) of AS. Conclusion Covering ileostomy increases the chances of AS formation after LAR for rectum carcinoma. Also, the SKIMS Clinical Grading of Rectal Strictures is a simple and


Resumo Introdução A anastomose de ressecção colorretal é a causa mais comum de estenoses retais. A isquemia do local da anastomose, donuts (anéis) incompletos de anastomose grampeada e infecção pélvica são alguns dos fatores de risco que desempenham um papel no desenvolvimento de estenoses retais pós-operatórias. No entanto, o papel do estoma de desvio no desenvolvimento de estenoses retais não foi estudado extensivamente. Objetivos Estudar a diferença na ocorrência de estenoses anastomóticas (EA) em pacientes submetidos à ressecção anterior baixa (LAR) com ileostomia de proteção e a LAR sem ileostomia de proteção para carcinoma de reto. Métodos Este foi um estudo prospectivo e comparativo de caso-controle realizado em um centro de referência de atenção terciária. A ressecção anterior baixa com ileostomia de proteção foi realizada em pacientes com carcinoma de reto no grupo de estudo, enquanto LAR sem ileostomia de proteção foi realizada no grupo controle. O grupo de estudo tinha 29 pacientes, enquanto o grupo controle tinha 33 pacientes com carcinoma de reto. Resultados Durante o período de acompanhamento médio de 9, 1 meses, 8 (28%) pacientes no grupo de estudo e 2 (6%) pacientes no grupo controle desenvolveram EA (p=0,019). Destes 8 pacientes com EA no grupo de estudo, 50% tinham EA de Grau I, 25% tinhamEA de Grau II, enquanto 25% dos pacientes tinham EA de Grau III (grave). No entanto, ambos os pacientes que desenvolveram EA no grupo de controle tinham um tipo leve (Grau I) de EA. Conclusão A ileostomia de proteção aumenta as chances de formação de AS após LAR para carcinoma de reto. Além disso, o SKIMS Clinical Grading of Rectal Strictures é uma ferramenta simples e útil disponível para cada cirurgião para graduar, classificar e monitorar as estenoses retais pós-operatórias.


Subject(s)
Humans , Anastomosis, Surgical , Ileostomy , Proctectomy , Postoperative Complications , Rectal Neoplasms , Rectum/surgery , Carcinoma , Anastomotic Leak
9.
Enferm. foco (Brasília) ; 12(1): 191-195, jun. 2021. ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-1280850

ABSTRACT

Objetivo: descrever a experiência relacionada a reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior durante a execução de um programa de extensão universitária. Método: relato de experiência, com abordagem descritiva, sobre a criação de um programa interdisciplinar de reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior com parceria entre universidade pública e hospital municipal de Imperatriz, Maranhão. Resultados: as atividades do programa universitário de reabilitação respiratória para pacientes em pós-operatório são desempenhadas em três eixos in locus: Educação em Exercícios Respiratórios, Capacitação sobre assistência de enfermagem no pós-operatório de cirurgias torácicas e abdominais e, Educação em saúde e intervenções de enfermagem na atenção ao paciente no período pós-operatório. Conclusão: a atuação em projeto respiratório interdisciplinar, focado em ações educativas, mostrou-se uma ferramenta inovadora de apoio ao cuidado clínico de pacientes submetidos à cirurgia torácica e abdominal superior. (AU)


Objective: To describe the experience related to respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery during the execution of a university extension program. Methods: Experience report, with a descriptive approach, on the creation of an interdisciplinary program of respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery in partnership with a public university and a municipal hospital in Imperatriz, Maranhão. Results: The activities of the university respiratory rehabilitation program for patients in the postoperative period are performed in three axes in locus: Education in Respiratory Exercises, Training in nursing care in the postoperative period of thoracic and abdominal surgeries, and Health education and interventions nursing in patient care in the postoperative period. Conclusion: Acting in an interdisciplinary respiratory project, focused on educational actions, proved to be an innovative tool to support the clinical care of patients undergoing thoracic and upper abdominal surgery. (AU)


Objetivo: Describir la experiencia relacionada con la rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior durante la ejecución de un programa de extensión universitaria. Métodos: Informe de experiencia, con un enfoque descriptivo, sobre la creación de un programa interdisciplinario de rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior en colaboración con una universidad pública y un hospital municipal en Imperatriz, Maranhão. Resultados: Las actividades del programa universitario de rehabilitación respiratoria para pacientes en el postoperatorio se realizan en tres ejes en el locus: educación en ejercicios respiratorios, capacitación en cuidados de enfermería en el postoperatorio de cirugías torácicas y abdominales, y educación e intervenciones de salud enfermería en atención al paciente en el postoperatorio. Conclusión: Actuar en un proyecto respiratorio interdisciplinario, centrado en acciones educativas, demostró ser una herramienta innovadora para apoyar la atención clínica de pacientes sometidos a cirugía torácica y abdominal superior. (AU)


Subject(s)
Teaching , Postoperative Complications , Breathing Exercises , Perioperative Care , Interdisciplinary Placement
10.
Arch. argent. pediatr ; 119(2): e163-e166, abril 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1152118

ABSTRACT

La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis.El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.


Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, post-surgical perinatal complications, or sepsis.This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.


Subject(s)
Humans , Female , Infant, Newborn , Endophthalmitis/diagnostic imaging , Postoperative Complications , Endophthalmitis/therapy , Enterobacter cloacae , Sepsis
11.
Rev. colomb. cir ; 36(3): 481-486, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1254307

ABSTRACT

Introducción. La prevención de las complicaciones en el manejo de la apendicitis aguda sigue siendo un reto para el cirujano pediatra; por lo que es de gran importancia comparar las opciones de manejo quirúrgico, para saber si es posible prevenir dichos resultados, que finalmente llevan a un aumento en el uso de recursos necesarios para tratar a un paciente. El objetivo de este estudio fue comparar las complicaciones postoperatorias y los costos de la laparoscopia transumbilical asistida y la laparoscopia multipuerto, en pacientes pediátricos en un hospital general de cuarto nivel de la ciudad de Bogotá, D.C., Colombia, entre octubre de 2011 y enero de 2019. Métodos. Estudio observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico a conveniencia, en el que se incluyeron los pacientes entre 0 y 16 años de edad, con historia clínica completa y diagnóstico postquirúrgico de apendicitis aguda, los cuales fueron intervenidos mediante cirugía laparoscópica transumbilical asistida o por multipuerto. Se hizo un análisis descriptivo univariado y bivariado. Resultados. De los 850 pacientes operados en ese periodo, la técnica quirúrgica más usada fue multipuerto (n=528, 62,1%) y se presentaron complicaciones en 59 (6,94%) de los pacientes. El diagnóstico postquirúrgico más frecuente fue apendicitis no perforada (n=762, 89,6%). Al comparar los dos grupos se encontró un valor de p de 0,9685 para la edad, 0,5364 para el diagnóstico postquirúrgico, 0,1127 para las complicaciones postoperatorias y 0,0085 para el costo. Discusión. El costo de hospitalización y las complicaciones de los pacientes a quienes se les practicó apendicectomía transumbilical asistida es similar a la técnica por multipuerto


Introduction. The prevention of complications in the management of acute appendicitis remains a challenge for the pediatric surgeon. Therefore, it is of great importance to compare the surgical management options, to know if it is possible to prevent these results, which ultimately lead to an increase in the use of resources necessary to treat a patient. The objective of this study was to compare the postoperative complications and costs of assisted transumbilical laparoscopy and multiport laparoscopy in pediatric patients. Method. Observational, descriptive, retrospective, cross-sectional study with non-probabilistic convenience sampling, where patients between 0 and 16 years old with a complete medical history, with a postsurgical diagnosis of acute appendicitis, who underwent assisted transumbilical surgery or by multiport performed at a fourth level general hospital in Bogotá, Colombia, between October 2011 and January of 2019. A descriptive univariate and bivariate analysis was performed. Results. Of the 850 patients operated on in this period, the most used surgical technique was multiport (n=528; 62.1%) and complications occurred in 59 (6.94%) of the patients. The most frequent postsurgical diagnosis was non-perforated appendicitis (n=762; 89.6%). Comparing the two groups, a p-value of 0.9685 was found for age, 0.5364 for postsurgical diagnosis, 0.1127 for postoperative complications, and 0.0085 for cost. Discussion. The cost of hospitalization and complications for patients who underwent assisted transumbilical appendectomy is similar to the multiport technique


Subject(s)
Humans , Appendicitis , Minimally Invasive Surgical Procedures , Appendectomy , Postoperative Complications , Costs and Cost Analysis
12.
Rev. bras. cir. cardiovasc ; 36(2): 244-252, Mar.-Apr. 2021. graf., tab.
Article in English | LILACS, SES-SP, CONASS, SESSP-IDPCPROD, SES-SP | ID: biblio-1251100

ABSTRACT

Abstract Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.


Subject(s)
Humans , Aorta, Thoracic/surgery , Postoperative Complications , Retrospective Studies , Blood Vessel Prosthesis Implantation , Treatment Outcome
13.
Rev. colomb. cardiol ; 28(2): 153-159, mar.-abr. 2021. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1341277

ABSTRACT

Resumen Objetivo: Determinar las características sociodemográficas, clínicas y de procedimiento asociadas a complicaciones en pacientes diabéticos con enfermedad coronaria severa, sometidos a revascularización quirúrgica. Métodos: Estudio de cohortes retrospectivo en pacientes mayores de 18 años con diagnóstico de diabetes mellitus y enfermedad coronaria multivaso, sometidos a revascularización quirúrgica, en el que se evaluaron las características individuales, clínicas y de procedimiento asociadas a complicaciones posquirúrgicas. Se realizó un análisis bivariado y multivariado mediante regresión logística binaria. Resultados: Los factores asociados a complicaciones fueron edad, índice de masa corporal, fracción de eyección del ventrículo izquierdo, clase funcional de la Asociación del Corazón de Nueva York (NYHA, su sigla en inglés por New York Heart Association) preintervención y antecedente de consumo de alcohol y tabaco; de estos, la edad es la variable que persiste con significancia estadística tras el modelo de regresión logística binaria. Conclusión: La incidencia de complicaciones posoperatorias en pacientes diabéticos sometidos a revascularización quirúrgica es comparable con la observada en estudios previos, y el factor asociado encontrado para este grupo de pacientes es la edad. El modelo podría explicar el 23 % del desarrollo de complicaciones en la cohorte estudiada.


Abstract Objective: To determine the sociodemographic, clinical and procedural characteristics associated with complications in diabetic patients with severe coronary disease treated by coronary artery bypass surgery. Methods: A retrospective cohort study in patients over 18 years old with a diagnosis of diabetes mellitus and multivessel coronary disease, undergoing surgical revascularization, where individual, clinical and procedural characteristics associated with surgical complications were evaluated. A bivariate and multivariate analysis was performed using binary logistic regression. Results: The factors associated with complications that were found were: age, body mass index, left ventricular ejection fraction, pre intervention New York Heart Association (NYHA) functional class, alcohol and tobacco history. Of these, age was the only variable that persists with statistical significance after the logistic regression model. Conclusion: The incidence of postoperative complications in diabetic patients undergoing surgical revascularization is comparable to that observed in previous studies. The associated factor found for this group of patients is the age.


Subject(s)
Humans , Male , Middle Aged , Diabetes Mellitus , Postoperative Complications , Risk Factors , Coronary Disease , Myocardial Revascularization
14.
Rev. Asoc. Odontol. Argent ; 109(1): 20-27, ene.-abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1280773

ABSTRACT

Objetivo: Analizar y describir los requerimientos de atención quirúrgica bucomaxilofacial de urgencia en el Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires durante el aislamiento social preventivo y obligatorio por la pandemia de COVID-19. Materiales y métodos: Se realizó un estudio observacional descriptivo de análisis retrospectivo durante el período de aislamiento social preventivo y obligatorio inicial de 93 días, comprendido entre el 20 de marzo y el 20 de junio de 2020. Se evaluó la totalidad de historias clínicas de los pacientes que acudieron al Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires y se caracterizó a aquellos que requerían distintos tipos de tratamiento quirúrgico bucal y maxilofacial. Resultados: Durante el período estudiado, se atendieron 4564 pacientes, de los cuales 1337 (29,3%) requirieron tratamientos quirúrgicos como terapéutica para la resolución de la urgencia. De estos, el 93,2% fueron exodoncias de piezas erupcionadas o retenidas; el 1,7%, biopsias quirúrgicas; el 2,4%, tratamientos agudos de infecciones que involucran espacios anatómicos vecinos; el 0,8%, resolución de traumatismos en los maxilares, y el 1,9%, tratamientos de complicaciones posquirúrgicas. Conclusión: Los resultados ponen de relieve la necesidad de disponer de servicios de guardia odontológica en el ámbito del AMBA que cuenten con recursos humanos calificados y entrenados para resolver urgencias de tipo quirúrgico


Aim: The objective of this study was to analyze and describe the requirements for the emergency care of oral and maxillofacial surgical treatment in the emergency dental department of the School of Dentistry of the University of Buenos Aires during the Preventive and Mandatory Social Isolation. Materials and methods: We conducted a retrospective analysis of a descriptive observational study during the initial period of 93 days of Preventive and Compulsory Social Isolation, from March 20, 2020 to June 20, 2020. All the medical records of the patients who attended the emergency dental department of the School of Dentistry of the University of Buenos Aires were evaluated and those who required different types of oral and maxillofacial surgical treatment were characterized. Results: A total of 4564 patients were attended during the period studied, of which 1337 (29.3%) required surgical treatment as a therapy for the resolution of their emergencies. Of these, 93.2% were exodontia of erupted or retained teeth, 1.7% surgical biopsies, 2.4% acute treatment of infections involving neighboring anatomical spaces, 0.8% resolution of maxillary alveolar trauma and 1.9% treatment of post-surgical complications. Conclusion: The results highlight the need to have dental emergency services in the AMBA area that have qualified and trained human resources to solve the surgical type emergencies that may arise (AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Emergency Medical Services , COVID-19 , Health Services Needs and Demand , Argentina/epidemiology , Postoperative Complications , Schools, Dental , Tooth Extraction/statistics & numerical data , Biopsy , Clinical Protocols , Epidemiology, Descriptive , Retrospective Studies , Tooth Injuries/epidemiology , Age and Sex Distribution , Observational Study , Focal Infection, Dental/epidemiology , Intraoperative Care , Maxillofacial Injuries/epidemiology
15.
Int. braz. j. urol ; 47(2): 426-435, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154471

ABSTRACT

ABSTRACT Objective: To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. Materials and Methods: Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. Results: Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. Conclusions: The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.


Subject(s)
Humans , Male , Female , Urinary Diversion/adverse effects , Urinary Bladder Neoplasms/surgery , Postoperative Complications , Anastomosis, Surgical/adverse effects , Cystectomy/adverse effects , Follow-Up Studies , Ileum/surgery , Middle Aged
16.
Rev. cuba. oftalmol ; 34(1): e1058, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289531

ABSTRACT

Objetivo: Describir la posible presencia de complicaciones posoperatorias en pacientes diabéticos tipo 2, operados de catarata por la técnica de facochop. Métodos: Se realizó un estudio observacional, descriptivo, y longitudinal prospectivo, con 128 pacientes diabéticos (168 ojos) operados de catarata en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre septiembre del año 2017 y diciembre de 2018. Las variables clínicas y epidemiológicas objeto del estudio fueron la edad, el sexo, el color de la piel, la queratometría, la profundidad de la cámara, la longitud axial, la dureza del cristalino, la presión intraocular pre- y posoperatoria y las complicaciones posoperatorias en las primeras 72 horas. Resultados: En el estudio predominaron las mujeres (63,3 por ciento), de piel blanca (74,2 por ciento), quienes presentaron ojos biométricamente normales, con una diferencia estadísticamente significativa. La presión intraocular aumentó a las 24 horas de la cirugía. De los 128 pacientes diabéticos tipo 2 operados de catarata senil por la técnica de facochop, se pudo determinar que el promedio y la desviación estándar de la edad se ubicaron en los 69,49 ± 8,96 años, y osciló entre los 50 y 88 años. Conclusiones: Las complicaciones posoperatorias más frecuentes son el edema corneal y la uveítis. Es significativamente más probable encontrar la uveítis posquirúrgica en pacientes menores de 70 años, y el edema corneal en quienes sobrepasan esta edad(AU)


Objective: Describe the possible presence of postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery. Methods: An observational prospective longitudinal descriptive study was conducted of 128 diabetic patients (168 eyes) undergoing cataract surgery at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2017 to December 2018. The clinical and epidemiological variables analyzed were age, sex, skin color, keratometry, chamber depth, axial length, crystalline hardness, pre- and postoperative intraocular pressure, and postoperative complications in the first 72 hours. Results: A predominance was found of women (63.3 percent) of white skin color (74.2 percent) and biometrically normal eyes, with a statistically significant difference. Intraocular pressure rose 24 hours after surgery. Mean age and standard deviation were 69.49 ± 8.96 years, range of 50-88 years, in the 128 type 2 diabetic patients undergoing senile cataract surgery by the phaco chop technique. Conclusions: The most common postoperative complications are corneal edema and uveitis. It is significantly more probable to find postsurgical uveitis in patients aged under 70 years and corneal edema in patients aged over 70 years(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Postoperative Complications/therapy , Uveitis/complications , Cataract Extraction/methods , Diabetes Mellitus, Type 2/etiology , Microsurgery/methods , Corneal Edema/complications , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Observational Studies as Topic
17.
Int. j. med. surg. sci. (Print) ; 8(1): 1-13, mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1151621

ABSTRACT

El objetivo de este artículo es determinar si los factores socioeconómicos inciden en las complicaciones posoperatorias de la colecistectomía. Para ello, se definió realizar un estudio de tipo observacional, analítico y enfoque cuantitativo, en 100 pacientes en los que se les realizó colecistectomía. Se aplicó un modelo de regresión logística en el que se incorporaron como variables, factores de riesgo, características socioeconómicas, junto con una variable de control. Se aplicaron tres modelos con variables dependientes alternativas que están delimitadas por el tipo de complicación posoperatoria registrado. Los resultados encontrados mostraron que las mujeres manifiestan un mayor riesgo de presentar complicaciones posteriores a la colecistectomía, igual ocurre en los pacientes de mayor edad. Asimismo el riesgo es mucho menor en las personas con niveles de educación superior y en los pacientes en los que se realizó colecistectomía laparoscópica, alcanzando solo un 5% de riesgo de presentar complicaciones. Las complicaciones posoperatorias luego de la colecistectomía se minimizan al emplear la técnica laparoscópica y los factores socioeconómicos incidirían en el riesgo de padecer complicaciones posoperatorias luego de dicha cirugía, lo que la convierte a la colecistectomía laparoscópica en una operación segura y con muchos otros beneficios y ventajas sobre la cirugía tradicional o convencional.


The article ́s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.


Subject(s)
Humans , Male , Female , Postoperative Complications , Socioeconomic Factors , Cholecystectomy/adverse effects , Cholecystectomy/methods , Biliary Tract Diseases/epidemiology , Cholecystitis/epidemiology , Epidemiology, Descriptive , Surveys and Questionnaires , Risk Factors , Ecuador , Observational Study
18.
Rev. méd. Urug ; 37(1): e202, mar. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1180959

ABSTRACT

Resumen: Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones. Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.


Summary: Introduction: laparoscopic cholecystectomy (LC) is the most frequent surgery of the digestive tract. Despite it being considered a safe procedure, morbidity is reported to be up to 10%, there being no record at the national level. Objective: to describe the incidence of complications and morbimortality of elective LC in a non-selected population group in a university hospital. Method: retrospective observational study of patients who underwent elective LC between January 1, 2010 and December 31, 2019 in the Surgical Clinic B at the Clinicas Hospital and the surgery assistance Teaching Unit at Español Hospital. The following variables were included: demographics, surgical diagnosis, conversion, morbimortality, reoperations and readmissions. Results: 1.499 CL were found, average age was 49 years old (15-87), 79% were women, main bile duct lithiasis in 210 cases (17%), 25 conversions (1.7%). There were 64 complications (4.3%), the incidence being significantly higher in patients with main bile duct lithiasis (2.8% vs 7.6%, p 0,01). Two bile duct-hepatic lesions (Hannover type D and C), both detected and repaired in the same surgery, and three visceral lesions (0.20 %). There were 16 readmissions (1.07%) and 9 reoperations (0.6%). Two patients died (0.13%) in the postoperative: decompensated chronic liver failure and post Endoscopic retrograde cholangiopancreatography (ERCP) severe pancreatitis. Conclusions: CL in a non-selected population at the university service analysed in the study proved to be a safe procedure, and complications, reoperation and readmission rates found in the study are positively compared to those reported in literature. The presence of lithiasis in the bile duct was associated with postoperative complications and a greater severity.


Resumo: Introdução: a colecistectomia laparoscópica (CL) é a cirurgia mais comum do trato digestivo. Apesar de ser considerado um procedimento seguro, a morbidade descrita é de 10%, e não há um registro nacional. Objetivo: descrever a incidência de complicações e morbimortalidade das CL eletivas, em uma população não selecionada em serviço universitário. Método: estudo observacional retrospectivo de pacientes submetidos à CL eletiva, realizado no período 1 de janeiro de 2010 - 31 de dezembro de 2019 na Clínica Cirúrgica B do Hospital de Clínicas e Unidade Docente Assistencial de Cirurgia do Hospital Espanhol. Foram incluidas variáveis demográficas, diagnóstico operatório, conversão, morbimortalidade, reoperações e reinternações. Resultados: foram incluidas 1.499 LCs eletivas, a idade média dos pacientes foi 49 anos (15-87), sendo 79% mulheres com incidência de cálculos biliares principais (LVBP) em 210 (17%) casos; 25 conversões (1,7%). Houve um total de 64 complicações (4,3%) com uma incidência significativamente maior em pacientes com LVBP (2,8% vs 7,6%, p 0,01). Ocorreram duas lesões hepato-colédoco (0,13%) (Hannover tipos D e C), ambas detectadas e reparadas na mesma cirurgia, e três lesões viscerais (0,20%). Ocorreram 16 readmissões (1,07%) e 9 reoperações (0,6%). Dois pacientes morreram (0,13%) no pós-operatório (insuficiência hepatocítica crônica descompensada e pancreatite pós-operatória grave por CPRE). Conclusões: a LC na população não selecionada do serviço universitário analisado neste estudo, mostrou-se como um procedimento seguro, com índices de complicações, reoperações e reinternações que neste estudo se comparam favoravelmente com os relatados na literatura. A presença de litíase no ducto biliar principal foi associada a uma incidência significativamente maior de complicações pós-operatórias e de maior gravidade.


Subject(s)
Postoperative Complications , Indicators of Morbidity and Mortality , Cholecystectomy, Laparoscopic
19.
Rev. bras. ortop ; 56(1): 104-108, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288657

ABSTRACT

Abstract Objective This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures. Methods A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay. Results The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition. Conclusion This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.


Resumo Objetivo Avaliar e correlacionar o estado nutricional com possíveis complicações no pós-operatório imediato de pacientes submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Métodos Estudo transversal prospectivo analítico e de abordagem quantitativa, tendo como população-alvo pacientes com idade igual ou superior a 60 anos, internados em uma instituição hospitalar no Amazonas, submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Foram avaliadas as complicações cirúrgicas no pós-operatório imediato e sua relação com o estado nutricional através da mini avaliação nutricional (MAN), assim como a mensuração da contagem de linfócitos e albumina e a sua correlação com o tempo de internação. Resultados A amostra foi composta por 19 pacientes idosos, de ambos os sexos, com média de idade de 70,8 anos. A maioria dos pacientes (68,4%) eram do sexo feminino. Por meio da variável antropométrica índice de massa corporal (IMC), identificou-se a presença de desnutrição em 15,8% dos pacientes e, por meio da MAN, de 31,6%. Na avaliação do cálculo da contagem total de linfócitos, 100% da amostra apresentou associação positiva com desnutrição em graus variáveis e, fazendo-se uso da albumina sérica como parâmetro, a desnutrição foi identificada em 89,4%. Os pacientes desnutridos apresentaram a maior média de tempo de internação. As complicações cirúrgicas, por infecções do sítio cirúrgico, ocorreram em 10,5% nos pacientes em risco nutricional. Conclusão Neste estudo, observou-se maior índice de complicações no pós-operatório em idosos diagnosticados com desnutrição.


Subject(s)
Postoperative Complications , Prosthesis Design , Surgical Wound Infection , Prosthesis Failure , Arthroplasty, Replacement, Knee , Fractures, Bone , Knee Prosthesis
20.
Rev. bras. cir. cardiovasc ; 36(1): 1-9, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155799

ABSTRACT

Abstract Introduction: Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient's age on risk factors for acute kidney injury after cardiac valve surgery. Methods: We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018. Results: The prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery. Conclusions: In elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure.


Subject(s)
Humans , Male , Female , Aged , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Glomerular Filtration Rate , Heart Valves
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