Posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa / Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption

Introducción: El posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa < 4mm es una técnica quirúrgica sensible que disminuye los tiempos operatorios. Sin embargo, es considerada cirujano-dependiente y en caso de no darse el manejo adecuado puede generar complicaciones. Objetivo: Evaluar, luego de 24 meses de carga funcional, la estabilidad de los tejidos periimplantares del implante dental que se posicionó simultáneo a la elevación de seno maxilar en un reborde alveolar con reabsorción ósea severa < 4mm. Presentación de caso: Paciente masculino de 62 años con reabsorción ósea severa en zona de primer molar superior derecho. Luego de analizar los medios diagnósticos y la evidencia científica; se logró posicionar un implante dental simultáneo a la elevación de seno maxilar técnica de ventana lateral; cuatro meses después se realizó la segunda fase quirúrgica y finalmente fue rehabilitado con una corona en zirconio. Tuvo un periodo de seguimiento de 24 meses. Conclusiones: Un buen diagnóstico, manejo quirúrgico adecuado, la colaboración del paciente y los controles periódicos, resultan en una técnica segura, que proporciona estabilidad de los tejidos periimplantares(AU)

Introduction: Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption < 4 mm is a sensitive surgical technique that shortens the duration of interventions. However, it is considered to be operator dependent, and may cause complications if not appropriately managed. Objective: After 24 months of functional load, evaluate the stability of the peri-implant tissue of a dental implant placed simultaneously with maxillary sinus lifting on an alveolar ridge with severe bone resorption. Case presentation: A case is presented of a male 62-year-old patient with severe bone resorption in the area of the first upper right molar. Analysis of the diagnostic means and scientific evidence involved led to placement of a dental implant simultaneous with maxillary sinus lifting (lateral window technique). The second surgical stage was performed four months later. A zirconium crown was finally placed, and a 24-month follow-up period was started. Conclusions: With a good diagnosis, appropriate surgical management, patient cooperation and periodic controls, it is a safe technique that ensures the stability of peri-implant tissue(AU)

Association between intra-operative cardiac arrest and country Human Development Index status: a systematic review with meta-regression analysis and meta-analysis of observational studies.

Intra-operative cardiac arrests differ from most in-hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra-operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra-operative cardiac arrest and baseline ASA physical status were extracted. Intra-operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta-regression analysis. Proportional meta-analysis was performed to compare intra-operative cardiac arrest rates and ASA physical status in low- vs. high-HDI countries and in two time periods. Eighty-two studies from 25 countries with more than 29 million anaesthetic procedures were included. Intra-operative cardiac arrest rates were inversely correlated with country HDI (p = 0.0001); they decreased over time only in high-HDI countries (p = 0.040) and increased with increasing ASA physical status (p < 0.0001). Baseline ASA physical status did not change in high-HDI countries (p = 0.106), while it decreased over time in low-HDI countries (p = 0.040). In high-HDI countries, intra-operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59-13.16) pre-1990 to 5.17 (95%CI 4.42-5.97) in 1990-2020 (p = 0.013). During the same time periods, no improvement was observed in the intra-operative cardiac arrest rates in low-HDI countries (p = 0.498). Odds ratios of intra-operative cardiac arrest rates in ASA 3-5 patients were 8.48 (95%CI 1.67-42.99) times higher in low-HDI countries than in high-HDI countries (p = 0.0098). Intra-operative cardiac arrest rates are related to country-HDI and decreased over time only in high-HDI countries. The widening gap in these rates between low- and high-HDI countries needs to be addressed globally.

Colangiografía intraoperatoria: curva de aprendizaje en una Residencia de Cirugía General / Intraoperative cholangiography: Learning curve in a General Surgery residency

RESUMEN Antecedentes: el uso de la colangiografía intraoperatoria dinámica (CIOd) durante la colecistectomía laparoscópica (Colelap) sigue siendo un tema en discusión. Objetivos: Este trabajo tiene como objetivo describir y evaluar la curva de aprendizaje y los hallazgos en la CIOd durante las colecistectomías laparoscópicas realizadas por residentes de Cirugía General, incluyéndola como herramienta para una colecistectomía segura, así como entrenamiento para el de sarrollo de habilidades y destrezas. Material y métodos: se incluyeron pacientes con indicación de colecistectomía laparoscópica pro gramada o de urgencia. En las cirugías se realizó tracción según Hunter, visión crítica de seguridad y CIOd sistemática, por un residente mayor y la CIOd por un residente inferior, tutorizado por cirujano de planta. Se evaluaron curva de aprendizaje, tiempos operatorios, relación del tiempo de CIOd con el tiempo de duración de la Colelap (CIO/CX), redisección del cístico y litiasis cística y coledociana. Resultados: se operaron 456 pacientes durante un año (2017-2018). Se observó que, independiente mente de quien realice la CIOd, los residentes pudieron mejorar su curva de aprendizaje, objetiván dose tiempos más cortos para la Colelap, CIOd y la relación CIO/CX. Los coeficientes de aprendizaje fueron mejores en cirugías más complejas en relación con el semestre. El 5,26% presentó litiasis cole dociana (n = 24); de estas, 66,7% tenían litiasis cística (n = 16) y 25% colecistitis (n = 6) asociadas. Todas se resolvieron por vía transcística. No hubo conversiones y se realizó CIOd en el 100%. Conclusión: la CIOd es un procedimiento ideal para ser practicado de manera sistemática durante la Residencia, porque da el entrenamiento necesario para el manejo de la vía transcística, permite evitar una lesión quirúrgica de vía biliar mayor y el diagnóstico de coledocolitiasis.

ABSTRACT Background: The use of dynamic intra-operative cholangiography (dIOC) during laparoscopic cholecystectomy (Lap Chole) remains a topic under discussion. Objectives: This study aims to describe and evaluate the learning curve and findings in the dIOC during laparoscopic cholecystectomies performed by Residents of General Surgery, including it as a tool for a safe cholecystectomy, as well as training for the development of skills and abilities. Material and methods: Patients with indication of scheduled or emergency laparoscopic cholecystectomy were included. In the surgeries, traction was performed according to Hunter, critical safety vision and systematic dIOC, by a senior Resident and the dIOC by a less trained resident, tutored by a staff surgeon. Learning curve, operative times, dIOC time relationship with Lap Chole duration time (IOC/LC), repeated cystic dissection, cystic lithiasis and choledocholithiasis were evaluated. Results: 456 patients were operated for one year (2017-2018). It was observed that regardless of who performs the dIOC, they were able to improve their learning curve, objectifying shorter times for Lap Chole, dIOC and the IOC/LC relationship. The learning coefficients were better in complex surgeries in relation to the semester. 5.26 % had choledocholithiasis (n = 24), of these, 66.7% had cystic lithiasis (n = 16) and 25% associated cholecystitis (n = 6). All were resolved trancystically. There were no conversions and dIOC was performed in 100% of cases. Conclusion: The dIOC is an ideal procedure to be practiced systematically during residency. Because it gives the necessary training for the management of the transcystic pathway, allows avoiding an upper bile duct injury and the diagnosis of choledocholithiasis.

Preliminary assessment of electrochemotherapy feasibility in dogs with vesical transitional cell carcinoma.

Electroporation is a technique that increases the uptake of chemotherapeutic drugs by tumors. Electrochemotherapy (ECT) has been successfully used to treat solid tumors. Recently, novel applications have been explored in the treatment of visceral tumors. This report aimed to describe the ECT as an approach to vesical carcinoma in three dogs. The patients received ECT with bleomycin as an intravenous bolus and intra-lesional cisplatin (cases 2 and 3). The ECT was performed by electroporator (Onkodisruptor®) using a plate and/or a single pair needle array electrode. Case 1 was a 7-year-old female Pitbull dog with a history of hematuria and stranguria. The ECT was performed during cystotomy using a single pair array electrode. However, the patient developed uroabdomen two days post-ECT and died 5 days later. Case 2 was a 12-year-old female Poodle dog with hematuria, dysuria, and pollakiuria. Cystotomy and ECT were performed using plate array electrodes. Complete remission of the intra-luminal mass was observed 11 days post-ECT. However, 21 days after the procedure, an acute unilateral renal failure occurred possibly due to a neoplastic embolus into the right ureter leading to kidney hydronephrosis, and the patient was euthanized. Case 3 was a 10-year-old female Cocker dog with hematuria and pollakiuria. The patient was fully competent after ECT without clinical signs of pollakiuria and recovered from hematuria 7 days post-ECT. The bladder returned to normal status 28 days post-ECT. The ECT was not able to increase the overall survival of the patients evaluated and should be indicated carefully.

Correlación clínica y ultrasonográfica con los hallazgos intra-operatorios de pacientes con diagnóstico de ruptura de manguito rotador en el servicio de traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014 / Clinical and ultrasonographic correlation with the intra-operative findings of patients with diagnosis of division of muff rotador in the service of traumatology of the Hospital Obrero Nº 1, during period 2010 ­ 2014

INTRODUCCIÓN: una gran parte de la población adulta padece dolor de hombro en algún momento de su vida. Dejando aparte las enfermedades neoplásicas, sistémicas y traumáticas directas, una de las causas de dolor de hombro es la patología inflamatoria o degenerativa del manguito rotador, que puede ser responsable de una limitación funcional importante adulto. OBJETIVO: determinar el grado de correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014. MATERIAL Y MÉTODOS: estudio descriptivo transversal y analítico. Se estudiaron 56 pacientes de ambos sexos, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº1, durante el periodo del 1° de enero del 2010 al 31 de diciembre del año 2014. Se realizó la valoración clínica (maniobra de Jobe y manobra de Yocum) y ultrasonográfica y se compararon los resultados con los hallazgos intra-operatorios, para determinar la validez y la seguridad de la clínica y la ecografía. RESULTADOS: se determina que el test diagnóstico clínico tiene mayor validez (Sensibilidad: 92,7-87,8% y Especificidad: 73,3-60%) y seguridad (Valor Predictivo Positivo: 90,5-85,7% y Valor Predictivo Negativo: 78,6-64,3%) que el test diagnóstico ultrasonográfico (Sensibilidad: 85,4%, Especificidad: 66,7%, Valor Predictivo Positivo: 87,5% y Valor Predictivo Negativo: 62,5%). CONCLUSIÓN: se determina que existe una correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1

INTRODUCTION: a great part of the adult population suffers shoulder pain at some moment of life. Leaving aside direct neoplastic systems and traumatic diseases, one of the causes of pain of shoulder is the inflammatory or degenerative pathology of the muff rotator, which can result in an important functional limitation. OBJECTIVE: determining the degree of clinical and ultrasonographic correlation with the intra-operative findings in patients with yielding-point diagnosis of muff rotator in the service of Traumatology of the Hospital Obrero Nº 1, during the period 2010 ­ 2014. MATERIAL AND METHODS: cross-sectional descriptive and analytical study. 56 patients of both sexes were surveyed, inpatients in the service of Traumatology y Orthopedic of the Hospital Obrero Nº 1, during the period January 1 of 2010 to December 31 of 2014. The clinical assessment was carried out (maneuver of Jobe and maneuver of Yocum) and ultrasonographic and the results were compared with the intra operative findings, in order to determine the value and security of the clinic and the echography. RESULTS: it is determined that the diagnostic test has higher validity (Sensitivity: 92,7-87,8% and specificity: 73,3-60%) and certainty (Positive Predictive Value: 90,5-85,7% and Negative Predictive Value: 78,6-64,3%) than the diagnostic ultrasonographic test (Sensitivity: 85.4%, Specificity: 66.7%, Positive Predictive Value: 87.5% and Negative Predictive Value: 62.5%). CONCLUSIONS: it is determined that there is a clinical and ultrasonographic correlation with the intra operative findings in patients with yielding-point diagnosis of muff rotator at the service of Traumatology of the Hospital Obrero Nº 1

Epidemiological profile and findings found intra operatively of glioblastoma at the neurosurgery service of Santa Casa of Ribeirão Preto Hospital - SP - Brazil / Perfil epidemiológico y hallazgos intraoperatorios de los glioblastomas en el servicio de neurocirurgia del Hospital Santa Casa de Ribeirão Preto - SP - Brasil

Introducción: El Glioblastoma (GB) o Astrocitoma grado IV (OMS), representan 15-20 por ciento de los tumores del SNC y aproximadamente 50 por ciento de los gliomas en adultos. Objetivo: Revelar el perfil epidemiológico del HSCMRP, correlacionar los hallazgos macroscópicos y microscópicos durante la cirugía de enero de 2011 a noviembre de 2015. Método: Estudio epimedeológico observacional, descriptivo, retrospectivo, 429 casos de tumores intracraneales a partir de los datos obtenidos de los archivos de La institución y los registros patológicos de los pacientes tratados quirúrgicamente. Resultados: Tumores encontrados 429 y 96 (22,37 por ciento) GB, edad media de 59 años, predominante séptima década 33 por ciento. Una relación entre mujeres y hombres fue de 1:1.12, respectivamente. Las quejas más frecuentes: dolor de cabeza (58 por ciento), confusión (41 por ciento), hemiparesia 37 por ciento. Comorbilidades frecuentes: hipertensión (64 por ciento), diabetes (22 por ciento) y fumadores (24 por ciento). La topografía más común fue la frente izquierdo. El tiempo medio de inicio de los síntomas a la cirugía fue de 39 días. Resección completa en 76 por ciento de los casos. La duración media de la recurrencia fue de 96 días, en 68% de los pacientes se observó una exuberancia de los vasos trombosados durante la cirugía Hallazgos patológicos: necrosis 98 por ciento, mitosis atípica 96 por ciento, proliferación microvascular 73 por ciento y polimorfismo nuclear 57 por ciento. Discusión: GB estado del arte. Conclusión: Nuestros resultados son similares con la literatura. Observación intraoperatoria de vasos trombosados y agresividad tumoral en pacientes con peor pronóstico y menor tiempo de recaída sugiere que es real, sin embargo. El pequeño número de casos, necesita más investigación, incluyendo otros hallazgos y resultados inmunohistoquímicos.

Introduction: Glioblastoma (GB) or Astrocytoma grade IV (WHO), represent 15-20 percent of CNS tumors and approximately 50 percent of gliomas in adults. Objective: Reveal the epidemiological profile of HSCMRP, correlate macroscopic and microscopic findings during surgery treated from January 2011 to November 2015. Method: Observational epidemiological study, descriptive, retrospective, of medical records of 429 cases of intracranial tumors from data obtained from the files of the institution and pathological records of patients treated surgically. Results: Total tumors found 429 and 96 (22.37 percent) GB with a mean age of 59 years, predominant seventh decade of life 33 percent. A relationship between women and men was with little difference 1:1.12, respectively. The most common complaints were headache (58 percent), confusion (41 percent), hemiparesis 37 percent. Most prevalent comorbidities: hypertension (64 percent) and diabetes (22 percent) and smokers (24 percent). Most common topography were followed by left front lesions. The average time of onset of symptoms to surgery was 39 days. Complete resection in 76 percent of cases. The mean length of postoperative recurrence was 96 days, in 68 percent patients were noticed an exuberance of thrombosed vessels during surgery. Pathological findings: necrosis 98%, atypical mitosis 96%, microvascular proliferation 73 percent and nuclear polymorphism 57 percent. Discussion: GB state of art. Conclusion: Our results are very slightly with the literature. The association of intraoperative observation thrombosed vessels, and tumor aggressiveness in patients with worse prognosis and shorter time to relapse, suggests that it is real, however, the small number of cases, needs further investigation, including other findings and immunohistochemical results.

Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil / Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil

ABSTRACT BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

RESUMO JUSTIFICATIVA: Nos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incidência de parada cardíaca (PC). Postula-se que a incidência de parada cardíaca intraoperatória (PCI) tem diminuído ao longo dos anos, especialmente em países desenvolvidos. A nossa hipótese foi que, como no resto do mundo, a incidência de PCI está diminuindo no Brasil, um país em desenvolvimento. OBJETIVOS: O objetivo deste estudo foi pesquisar e avaliar na literatura as publicações que relacionam a incidência de PCI no Brasil e analisar a tendência na incidência de PCI. CONTEÚDO: Descobrimos quatro artigos que atenderam aos critérios de inclusão, que resultaram em 204.072 pacientes submetidos à anestesia regional ou geral em dois hospitais terciários e acadêmicos e 627 casos de PCI. A média de incidência de PCI para o período de 25 anos foi de 30,72:10.000 anestesias. Houve uma diminuição de 39:10.000 anestesias para 13:10.000 anestesias no período analisado, com letalidade relacionada de 48,3% para 30,8%. Além disso, as principais causas de mortalidade relacionadas à anestesia mudaram de mau funcionamento de máquinas e overdose de medicamentos para hipovolemia e causas respiratórias. CONCLUSÕES: Houve uma clara redução na incidência de PCI nos últimos 25 anos no Brasil. Essa redução é observada em todo o mundo e pode ser o resultado de vários fatores, incluindo novas leis que regulam medicamentos no Brasil, incorporação de tecnologias, melhor nível de desenvolvimento humano do país e melhor assistência ao paciente.

Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil.

BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

[Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil]. / Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil.

BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

Sublingual misoprostol is as effective as intravenous oxytocin to reduce intra-operative blood loss during cesarean delivery in women living at high altitude.

OBJECTIVE: To assess the effect of sublingual misoprostol compared to intravenous oxytocin for blood loss during cesarean delivery in women living at high altitude. STUDY DESIGN: In a randomized trial, conducted in Quito, Ecuador (2800 m above sea level), 100 women received either sublingual misoprostol (400 µg) or intravenous oxytocin (10 IU). RESULTS: Bleeding in the misoprostol was no different than in the oxytocin group. Shivering was reported in 66% of women in the misoprostol group. CONCLUSION: Sublingual misoprostol might be a valid alternative to oxytocin reduce intra-operative blood loss during cesarean section in women living at high altitude.

Fatores intraoperatórios nas cirurgias de revascularização do miocárdio em hospitais do município do Rio de Janeiro / Intra-operative factors in coronary artery bypass graft (GABG) surgery in government hospitals, Rio de Janeiro, Brazil

Fundamentos: Performance cirúrgica depende de condições pré e pós-operatórias. Eventos que ocorrem no período intraoperatório também podem estas associados à evolução. Objetivo: Avaliar a associação de fatores intraoperatórios com época de óbito de pacientes submetidos à cirurgia de revascularização miocárdica (RVM), em quatro hospitais públicos da cidade do Rio de Janeiro, entre janeiro 1999 e dezembro 2001. Métodos: Selecionadas, em quatro hospitais públicos da cidde do Rio de Janeiro, amostras aleatórias e ponderadas de 150 prontuários de pacientes, entre sobreviventes e óbitos. Informações sobre características intraoperatórias e época do óbito foram coletadas retrospectivamente dos prontuários e das declarações de óbitos. Estimaram-se taxas de letalidade em diversas faixas de tempo até um ano após cirurgia. Resultados: Na sala de operações ocorreram 7,4 por cento dos ópbitos; até o terceiro dia, 40,3 por cento; e até o 15º dia, 69 por cento dos óbitos do primeiro ano. Ao final do primeiro ano, 14,9 por cento dos pacientes faleceram. Tempos mais elevados de circulação extracorporea ou de clampeamento aórtico ocorreram naqueles que morreram durante acirurgia. Baixo débito, parada cardiorrespiratória (PCR) e arritmia ventricular grave intraoperatórios se associaram significativamente com o óbito precoce. Fibrilação atrialintraoperatória se associou com óbito mais frequente nos segundo e terceiro dias de pós-operatório. Conclusão: Fatores intraoperatórios favoreceram aocorrência de óbitos precoces, representando 2/3 das mortes do primeiro ano.

Background: Although surgical performance depends largely on pre- and post-operative conditions, intraoperative events may also be associated with these outcomes.Objective: To evaluate the association between intraoperative factors and times of death among patientsundergoing CABG surgery in four government hospitals in the City of Rio de Janeiro, between January 1999 andDecember 2003. Methods: Random weighted samples of 150 patient records with survivors and deaths were selected at four government hospitals in the City of Rio de Janeiro. Information on intra-operative characteristics and timesof death was collected retrospectively from the medical records and declarations of death. The lethality rates were estimated for several timeframes extending up to a year after the operation. Results: 7.4% of the deaths occurred in the operating theater; 40.3% by Day 3 and by Day 15, 69% of the deaths occurring during the first year. By the end of the first year, 14.9% of the patients were deceased. Longerextracorporeal circulation or aortic clamping times were found among patients who died during surgery. Low debit, cardio-respiratory failure (CRF) and severe intra-operative ventricular arrhythmia were significantly associated with early death. Intra-operative atrialfibrillation was associated more frequently with death on the second and third days after surgery. Conclusion: Intra-operative factors contributed to theoccurrence of early deaths, representing two thirds of deaths during the first year after surgery.