Trauma surgery workforce in the state of Rio Grande do Sul, Brazil.

OBJECTIVE: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. METHOD: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. RESULTS: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. CONCLUSION: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.

Trauma surgery workforce in the state of Rio Grande do Sul, Brazil / Perfil do cirurgião do trauma no Rio Grande do Sul

ABSTRACT Objective: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. Method: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. Results: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. Conclusion: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.

RESUMO Objetivo: descrever o perfil dos cirurgiões do trauma formados no estado do Rio Grande do Sul, incluindo dados demográficos, distribuição geográfica, remuneração, e perspectivas relacionadas à área de atuação. Método: estudo transversal do tipo inquérito, baseado em informações coletadas por meio de questionário enviado via plataforma digital para os profissionais da amostra em questão. Resultados: a taxa de resposta dos questionários foi de 64% (n=75). Houve predomínio do sexo masculino (72%) com idade média de 43 anos. A maior parte dos profissionais foi graduada pelo Hospital de Pronto Socorro de Porto Alegre, e atua em serviços de referência em Cirurgia do Trauma na capital e região metropolitana. Mais de 60% não realizou outra formação em subespecialidade cirúrgica, embora apenas um terço dos profissionais tenha declarado que a Cirurgia do Trauma seja sua principal fonte de renda. Conclusão: os centros de trauma são mal distribuídos e a maioria dos profissionais atua em hospitais de referência da região metropolitana de Porto Alegre. Devido ao baixo reconhecimento, incentivo financeiro limitado e desgaste da modalidade de trabalho em regime de plantão, a carreira com dedicação exclusiva na área de Cirurgia do Trauma é pouco atrativa, com apenas um terço dos profissionais desempenhando a maior parte de suas atividades na área.

Predictive factors of mortality in damage control surgery for abdominal trauma.

INTRODUCTION: damage control surgery (DCS) is well recognized as a surgical strategy for patients sustaining severe abdominal trauma. Literature suggests the indications, operative times, therapeutic procedures, laboratory parameters and intraoperative findings have a direct bearing on the outcomes. OBJECTIVE: to analyze the clinical profile of patients undergoing DCS and determine predictors of morbidity and mortality. METHODS: a retrospective cohort study was conducted on all patients undergoing DCS following abdominal trauma from November 2015 and December 2021. Data on subjects' demographics, baseline presentation, mechanism of injury, associated injuries, injury severity scores, laboratory parameters, operative details, postoperative complications, length of stay and mortality were assessed. A binary logistic regression analysis was performed to determine potential risk factors for mortality. RESULTS: During the study period, 696 patients underwent trauma laparotomy. Of these, 8.9% (n=62) were DCS, with more than 80% due to penetrating mechanisms. Overall mortality was 59.6%. In the logistic regression stratified by survival, several variables were significantly associated with mortality, including hypotension, and altered mental status at admission, intraoperative cardiorespiratory arrest, need for resuscitative thoracotomy, metabolic acidosis, hyperlactatemia, coagulopathy, fibrinolysis, and severity of the trauma injury scores. CONCLUSION: DCS may be appropriate in critically injured patients; however, it remains associated with significant morbidity and high mortality, even at specialized trauma care centers. From pre and postoperative clinical and laboratory parameters, it was possible to predict the risk of death in the studied sample.

Predictive factors of mortality in damage control surgery for abdominal trauma / Fatores preditivos de mortalidade na cirurgia de controle de danos no trauma abdominal

ABSTRACT Introduction: damage control surgery (DCS) is well recognized as a surgical strategy for patients sustaining severe abdominal trauma. Literature suggests the indications, operative times, therapeutic procedures, laboratory parameters and intraoperative findings have a direct bearing on the outcomes. Objective: to analyze the clinical profile of patients undergoing DCS and determine predictors of morbidity and mortality. Methods: a retrospective cohort study was conducted on all patients undergoing DCS following abdominal trauma from November 2015 and December 2021. Data on subjects' demographics, baseline presentation, mechanism of injury, associated injuries, injury severity scores, laboratory parameters, operative details, postoperative complications, length of stay and mortality were assessed. A binary logistic regression analysis was performed to determine potential risk factors for mortality. Results: During the study period, 696 patients underwent trauma laparotomy. Of these, 8.9% (n=62) were DCS, with more than 80% due to penetrating mechanisms. Overall mortality was 59.6%. In the logistic regression stratified by survival, several variables were significantly associated with mortality, including hypotension, and altered mental status at admission, intraoperative cardiorespiratory arrest, need for resuscitative thoracotomy, metabolic acidosis, hyperlactatemia, coagulopathy, fibrinolysis, and severity of the trauma injury scores. Conclusion: DCS may be appropriate in critically injured patients; however, it remains associated with significant morbidity and high mortality, even at specialized trauma care centers. From pre and postoperative clinical and laboratory parameters, it was possible to predict the risk of death in the studied sample.

RESUMO Introdução: a cirurgia de controle de danos (CCD) é estratégia bem definida de manejo cirúrgico para pacientes vítimas de trauma grave. A literatura sugere que as indicações, tempo operatório, medidas terapêuticas adotadas, alterações laboratoriais e achados transoperatórios apresentam impacto direto sobre o desfecho. Objetivo: analisar o perfil clínico-demográfico dos pacientes submetidos à CCD e identificar fatores preditivos de morbimortalidade na amostra. Métodos: coorte retrospectiva a partir da análise de prontuários de pacientes submetidos à CCD por trauma abdominal entre novembro de 2015 e dezembro de 2021. As variáveis analisadas incluíram dados demográficos, tempo da admissão, mecanismo do trauma, lesões associadas, escores de trauma, parâmetros laboratoriais, achados cirúrgicos, reposição volêmica e de hemoderivados, complicações pós-operatórias, tempo de internação e mortalidade. Para analisar os fatores de risco para mortalidade, foi utilizada análise de regressão logística binária. Resultados: no período, foram realizadas 696 laparotomias por trauma abdominal e destas, 8.9% (n=62) foram CCD, sendo mais de 80% por mecanismo penetrante. A mortalidade foi de 59.6%. Na regressão logística estratificada pela sobrevida, diversas variáveis foram associadas à mortalidade com significância estatística, incluindo hipotensão e alteração do estado mental à admissão, parada cardiorrespiratória no transoperatório, necessidade de toracotomia de reanimação, acidose metabólica, hiperlactatemia, coagulopatia, fibrinólise, gravidade dos escores de trauma e necessidade de hemoderivados. Conclusão: apesar da condução da estratégia de CCD em centro de trauma, a morbimortalidade ainda é elevada. A partir de parâmetros clínicos e laboratoriais pré e pós-operatórios, é possível predizer o risco de evolução para óbito na amostra estudada.

Complicações pós-operatórias em apendicectomias: análise comparativa entre as abordagens aberta e videolaparoscópica / Postoperative complications in appendectomies: comparative analysis between open and laparoscopic approaches

Introdução: A apendicectomia é o tratamento de escolha da apendicite aguda. Embora a preferência pelas técnicas minimamente invasivas seja tendência mundial, a cirurgia aberta ainda é realidade na maioria dos hospitais públicos. O índice de complicações pós-operatórias varia de acordo com a técnica cirúrgica empregada. O presente estudo objetiva comparar a incidência de complicações pós-operatórias entre a apendicectomia aberta e laparoscópica. Métodos: Coorte retrospectiva incluindo pacientes submetidos à apendicectomia no Hospital de Pronto Socorro de Porto Alegre entre novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, tempo de evolução dos sintomas, técnica cirúrgica, achados transoperatórios, necessidade de drenos ou ostomias, tempo cirúrgico, tempo de internação, experiência do cirurgião e desfechos. Resultados: Foram incluídos 358 pacientes, com idade de 32 ± 13,8 anos, e predomínio do sexo masculino (58,9%); 58,1% foram submetidos a cirurgia aberta, 41,9% a laparoscopia e 8% necessitaram conversão. As apendicites foram classificadas como complicadas em um terço dos casos. O tempo cirúrgico foi menor na cirurgia aberta (79,3 ± 38,8 vs. 104 ± 35,2 minutos; p < 0,001). O índice de complicações pós-operatórias foi de 21,2%, sendo significativamente maior na técnica aberta (26,4% vs. 13%; p = 0,003). O tempo de internação, a necessidade de reintervenção e mortalidade não apresentaram diferença entre as técnicas. Conclusão: Embora a apendicectomia aberta seja um procedimento seguro, com bons resultados e baixa morbimortalidade, a laparoscopia oferece potenciais vantagens em termos de evolução pós-operatória, inclusive em casos complicados. Deve ser indicada rotineiramente havendo disponibilidade de material e capacitação da equipe cirúrgica. (AU)

Introduction: Appendectomy is the treatment of choice for acute appendicitis. Although the preference for minimally invasive techniques is a worldwide trend, open surgery remains a reality in most public hospitals. The rate of postoperative complications varies according to the surgical technique employed. The present study aimed to compare the incidence of postoperative complications between open and laparoscopic appendectomy. Methods: This retrospective cohort study included patients undergoing appendectomy at the Hospital de Pronto Socorro de Porto Alegre between November 2015 and November 2019. Demographic and clinical data, duration of symptoms, surgical technique, intraoperative findings, use of abdominal drains or stomas, operative time, length of stay, surgeon's experience, and outcomes were assessed. Results: Three hundred and fifty-eight patients were included, predominantly male (58.9%), with a mean age of 32 ± 13.8 years; 58.1% underwent open surgery, 41.9% underwent laparoscopic surgery, and 8% required conversion. One third of the cases were classified as complicated. The mean operative time was shorter for open surgery (79.3 ± 38.8 vs. 104 ± 35.2 minutes; p < 0.001). The rate of postoperative complications was 21.2%, with a significantly higher incidence in the open technique (26.4% vs. 13%; p = 0.003). Length of stay, reoperation rate, and mortality did not differ between the techniques. Conclusions: Although open appendectomy is a safe and efficient procedure, associated with low morbidity and mortality rates, laparoscopy provides potential clinically beneficial advantages in terms of postoperative outcomes, even in complicated cases. Therefore, it should be routinely performed where laparoscopic equipment and skillful staff are available. (AU)

Gastric neobladders: surgical outcomes of 91 cases using different techniques

ABSTRACT Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

Torção testicular: suspeita clínica e abordagem / Testicular torsion: clinical suspicion and approach

A torção testicular é uma emergência urológica frequente e seu reconhecimento e conduta precoces são necessários visto que a janela terapêutica é estreita e são graves os prejuízos quando retardada a correção, que geralmente é cirúrgica.

Testicular torsion is a frequent urological emergency and its early recognition and management are imperative, since the therapeutic window is narrow and there are serious losses when the correction is delayed, which is usually surgical.