Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial.

INTRODUCTION: Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). METHODS: An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. RESULTS: A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. CONCLUSION: Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT05260710 and ReBEC - RBR-7×j4wyp.

Mortality, hospitalizations, and persistence of symptoms in the outpatient setting of the first COVID-19 wave in Brazil: results of SARS-Brazil cohort study.

OBJECTIVE: To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil. METHODS: This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge. RESULTS: Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038). CONCLUSION: COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves.ClinicalTrials.gov Identifier: NCT04479488.

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study.

OBJECTIVE: To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions. METHOD: This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05). RESULTS: The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet. CONCLUSION: Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.

[Strategie of the "acute respiratory disease room" in two tertiary referral clinics: a retrospective multicenter cohort study]. / Estrategia de "sala enfermedad respiratoria aguda" en dos clínicas de referencia de tercer nivel de complejidad: estudio de cohorte multicéntrica retrospectiva.

Respiratory diseases are one of the main causes of morbidity and mortality in children under 5 years of age. The acute respiratory disease (ERA in Spanish) room strategy implemented in Colombia is an important tool to reduce hospitalization and mortality rates in this population. OBJECTIVE: To describe the health outcomes of the implementation of the ERA room strategy in two health institutions in Bogota. PATIENTS AND METHOD: Multicenter descriptive study including 1785 patients admitted to the ERA rooms of two institutions in Bogota, between December 2019 and 2022. Data on sex, age, admission diagnosis, length of stay in ERA room, education provided, and post discharge follow-up were collected. The main outcomes were evaluated through hospitalization requirement, ICU requirement, and post discharge improvement. RESULTS: 1785 patients were included during the study period. 57% were male; median age was 26.6 months (IQR: 11.8 to 40.6); length of stay in ERA room was 2.62 hours (IQR: 1.73 to 4.88); 91.65% of family members and/or caregivers received educational measures. CONCLUSIONS: This study describes the results of the implementation of the ERA room strategy; the low proportion of patients requiring hospitalization is evident. Additionally, the education provided to parents and caregivers on home management is relevant, as well as the post discharge follow-up of this cohort of patients with acute respiratory disease.

[Rehospitalization of preterm infants below 32 weeks of gestational age in the first 2 years post discharge]. / Rehospitalización en prematuros menores de 32 semanas o menores de 1.500 g en los primeros 2 años posteriores al alta.

Preterm infants, especially those of lower gestational age (GA), are at high risk of hospital readmission in the early years. OBJECTIVE: To describe the frequency and characteristics of readmissions in preterm infants younger than 32 weeks of GA or weighing less than 1500 g (< 32w/< 1500 g) at 2 years post-discharge from neonatology. PATIENTS AND METHOD: Retrospective observational study of a cohort of newborns < 32w/< 1500 g discharged from a public health care center (2009-2017). The frequency, time of occurrence, risk factors, causes, and severity of hospital readmissions were analyzed. The respective perinatal characteristics and subsequent readmissions were described. The Ethics Committee approved the data collection protocol. RESULTS: 989 newborns < 32w/< 1500 g were included; 410 (41.5%) were readmitted at least once before the age of 2 years, equivalent to 686 episodes (1.7/child); 129 children (31.4%) were admitted to the Pediatric Intensive Care Unit (PICU), with a mean length of stay of 7.7 days. The greatest risk for hospital readmission was during the first 6 months post-discharge. The main cause was respiratory (70%) and respiratory syncytial virus was the most frequent germ. The risk factors associated with readmission due to respiratory causes were bronchopulmonary dysplasia (BPD) (OR: 1.73; 95%CI: 1.26-2.37) and number of siblings (OR: 1.18; 95%CI: 1.04-1.33). CONCLUSIONS: Newborns < 32s/< 1500 g are at high risk of hospital readmission due to respiratory causes and PICU admission in the first months post-discharge; BPD and number of siblings were the main risk factors.

Factors Associated with Readmission within 30 Days of Hospital Discharge of Psychiatric Patients: Case-Control Study.

BACKGROUND: Readmission, defined as any admission after discharge from the same hospital, has negative implications for health outcomes. This study aims to identify the sociodemographic and clinical factors associated with hospital readmission among psychiatric patients. METHODOLOGY: This case-control study analyzed 202 clinical records of patients admitted to a psychiatric hospital between 2019-2021. The sample was selected using simple random sampling. Qualitative variables were presented using frequencies, percentages, and chi-square tests for association. Quantitative variables were described using central tendency measures and dispersion of data, investigated with the Kolmogorov-Smirnov test, Student's t-test or Wilcoxon test as appropriate. Regression analysis was conducted to determine factors linked to readmission. p < 0.05 was considered. RESULTS: Women accounted for a higher readmission rate (59%). Patients diagnosed with schizophrenia had a higher readmission rate (63%), experienced longer transfer times to the hospital during readmissions, and had shorter hospital stays. Polypharmacy and pharmacological interactions were associated with readmission. Olanzapine treatment was identified as a risk factor for readmission (ExpB = 3.203, 95% CI 1.405-7.306, p = 0.006). CONCLUSIONS: The findings suggest avoiding polypharmacy and medications with high side effect profiles to reduce readmissions. This study offers valuable insights for clinical decision-making from admission to discharge planning, aiming to enhance the quality of care.

Comparing the clinical characteristics and outcomes of septic shock children with and without malignancies: a retrospective cohort study.

OBJECTIVE: There is an amelioration in mortality rates of septic shock patients with malignancies over time, but it remains uncertain in children. Therefore, the authors endeavored to compare the clinical characteristics, treatment needs, and outcomes of septic shock children with or without malignancies. METHODS: The authors retrospectively analyzed the data of children admitted to the PICU due to septic shock from January 2015 to December 2022 in a tertiary pediatric hospital. The main outcome was in-hospital mortality. RESULTS: A total of 508 patients were enrolled. The proportion of Gram-negative bacteria and fungal infections in children with malignancies was significantly higher than those without malignancies. Septic shock children with malignancies had a longer length of stay (LOS) in the hospital (21 vs. 11 days, p<0.001). However, there were no statistically significant differences in the LOS of PICU (5 vs. 5 days, p = 0.591), in-hospital mortality (43.0 % vs. 49.4 %, p = 0.276), and 28-day mortality (49.2 % vs. 44.7 %, p = 0.452). The 28-day survival analysis (p = 0.314) also showed no significant differences. CONCLUSION: Although there are significant differences in the bacterial spectrum of infections, the septic shock children with or without malignancies showed a similar mortality rate. The septic shock children with malignancies had longer LOS of the hospital.

Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study.

BACKGROUND: Retrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC. METHODS: Consecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM). RESULTS: Two hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient = - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases). CONCLUSION: The learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.

Enteral adequacy of the diet of low-birth-weight preterm newborns: A prospective cohort study.

OBJECTIVE: This study aimed to verify the dietary adequacy of full enteral feeding in preterm newborns (PTNB) and its relationship with birth weight (BW) during the period of hospitalization in the neonatal intensive care unit (NICU). METHODS: This is a prospective cohort study whose population were babies born at less than 37 gestational weeks and weighing less than 2500 g, admitted to a NICU. PTNB were monitored regarding their dietary evolution, considering parenteral and enteral nutrition and adequacy of diet supply in terms of volume, energy, and protein. For statistical analysis, the Statistical Package for the Social Sciences (SPSS) software was used, considering p < 0.05 as significant. RESULTS: A total of 76 PTNB were included. The mean time of using parenteral nutrition was 14 days. The mean time to reach the full enteral feeding for nutrition (FEF-N) was 29 days. However, half of the PTNB reached nutritional recommendations after this means. The time to achieve FEF-N was influenced by BW. Additionally, BW significantly influenced the length of stay in the NICU (p < 0.001). When reaching the recommended full enteral feeding for hydration (FEF-H), 60% of the sample was unable to reach the recommended energy and protein intake. CONCLUSIONS: BW influenced the time needed to reach the FEF-H and FEF-N. The lower the BW, the longer it took to achieve dietary adequacy. Despite achieving the FEF-H, most premature babies did not reach the necessary energy and protein intake at the appropriate time.

Laparoscopic Versus Open Pancreatoduodenectomy for Periampullary Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: Laparoscopic pancreatoduodenectomy (LPD) has emerged as an alternative to open technique in treating periampullary tumors. However, the safety and efficacy of LPD compared to open pancreatoduodenectomy (OPD) remain unclear. Thus, we conducted an updated meta-analysis to evaluate the efficacy and safety of LPD versus OPD in patients with periampullary tumors, with a particular focus on the pancreatic ductal adenocarcinoma patient subgroup. METHODS: According to PRISMA guidelines, we searched PubMed, Embase, and Cochrane Library in December 2023 for randomized controlled trials (RCTs) that directly compare LPD versus OPD in patients with periampullary tumors. Endpoints and sensitive analysis were conducted for short-term endpoints. All statistical analysis was performed using R software version 4.3.1 with a random-effects model. RESULTS: Five RCTs yielding 1018 patients with periampullary tumors were included, of whom 511 (50.2%) were randomized to the LPD group. Total follow-up time was 90 days. LPD was associated with a longer operation time (MD 66.75; 95% CI 26.59 to 106.92; p = 0.001; I2 = 87%; Fig. 1A), lower intraoperative blood loss (MD - 124.05; 95% CI - 178.56 to - 69.53; p < 0.001; I2 = 86%; Fig. 1B), and shorter length of stay (MD - 1.37; 95% IC - 2.31 to - 0.43; p = 0.004; I2 = 14%; Fig. 1C) as compared with OPD. In terms of 90-day mortality rates and number of lymph nodes yield, no significant differences were found between both groups. CONCLUSION: Our meta-analysis of RCTs suggests that LPD is an effective and safe alternative for patients with periampullary tumors, with lower intraoperative blood loss and shorter length of stay.

Long-term oxygen therapy to reduce length of hospital stay in COVID-19.

OBJECTIVE: The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS: Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS: A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION: Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.

Factors associated with mortality of patients with COVID-19 on invasive mechanical ventilation: A retrospective cohort study in a university hospital in Northeastern Brazil.

The aim of this study is to identify the factors associated with mortality in patients with COVID-19 undergoing invasive mechanical ventilation at a university hospital in Northeastern Brazil. This is a retrospective cohort from April to August 2020 through an analysis of medical records, considering the demographic profile, comorbidities, complications, supports, respiratory and laboratory parameters. A total of 65 patients required invasive mechanical ventilation, of which 64.6% died in the ICU. They were older, had more comorbidities, shorter length of stay in the intensive care unit, received more support such as palliative care and two vasopressors simultaneously, showed lower levels of pH, hemoglobin and calcium, and higher levels of bicarbonate, lactate, prothrombin time, international normalized ratio, troponin and ferritin at the start of invasive mechanical ventilation. Furthermore, the time course of pH, arterial oxygen partial pressure to fractional inspired oxygen ratio, arterial carbon dioxide partial pressure, lactate, hemoglobin, platelets, lymphocytes, neutrophil-to-lymphocyte ratio, coagulation parameters, calcium, urea, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, ferritin, static compliance, airway resistance, tidal volume, and noradrenaline doses showed association with mortality. There was a high mortality rate in invasively mechanically ventilated COVID-19 patients, with some associated factors identified at the start of invasive mechanical ventilation and others identified over time.

Body mass index-adjusted calf circumference is associated with mortality in hospitalized older patients with excess weight.

OBJECTIVES: Given the innovative nature of the method, our study aimed to assess the prognostic significance of body mass index (BMI)-adjusted calf circumference (CC) in older patients who are hospitalized. METHODS: This was a unique analysis as part of other cohorts comprising general hospitalized patients aged 60 years or older of both sexes. Only patients with excess weight (BMI ≥ 25 kg/m2) were included. CC was adjusted by reducing 3, 7, or 12 cm for BMI (in kg/m2) within 25-29.9, 30-39.9, and ≥40 kg/m2, respectively. CC was considered low if ≤ 34 cm for males and ≤ 33 cm for females. Clinical outcomes included prolonged length of hospital stay (LOS) and mortality. RESULTS: A total of 222 patients were included. After BMI adjustments, 72.1% of the patients were reclassified from a normal CC category to a low CC category. The frequency of low CC increased from 33.8% to 81.9% following BMI adjustments. Among those reclassified to the low CC, 11 died, compared to only 2 patients in the group that maintained a normal CC classification. BMI-adjusted CC was inversely associated with mortality (HR adjusted 0.84, 95% CI 0.73 to 0.95), but not with prolonged LOS. CONCLUSIONS: Our novel study highlights the prognostic value of BMI-adjusted CC. As an anthropometric marker of muscle mass, it proved to be a predictor of mortality in older patients with high BMI. This adjustment is further important because it may help to better detect low muscle mass in these patients where such conditions might be masked.

Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy.

OBJECTIVE: The objective of this study was to examine the use and outcomes of perioperative anticoagulation (AC) in obese patients with a known history of venous thromboembolism event (VTE). METHOD: A retrospective review of a prospective database for patients with a VTE history undergoing bariatric and general surgery at a single center (1/2008-12/2017) was performed. Factors assessed included demographics, surgical details, and outcomes. RESULTS: Sixty-five patients underwent 76 procedures: 46 females (71%); mean age 51 years (range 26-73), mean weight 284 pounds (range 110-558), mean body mass index 45 (range 19-87). Comorbidities include hypertension (60%), gastroesophageal reflux disease (54%), osteoarthritis (49%), obstructive sleep apnea (45%), and diabetes (37%). Operations: 22 general surgeries (29%), 20 sleeve gastrectomies (26%), 12 revisions/conversions (16%), 12 Roux-en-Y gastric bypasses (16%), and 10 gastric bands (13%). Modalities: 67% laparoscopic, 28% robotic, and 5% open. Twenty-two patients (34%) had a pre-operative inferior vena cava filter placed with no complications. The mean length of stay was 4.4 days (range 1-31). Complications: seven 30-day readmissions (9%), one 30-day reoperation (1%), and two 90-day VTEs (3%). Thirty-day readmissions: four for inability to tolerate PO, two for small bowel obstruction, and one for symptomatic anastomotic ulcer. CONCLUSIONS: In our patients, post-operative AC could be started without an increased risk of bleeding in patients with a history of VTE undergoing bariatric surgery.

OBJETIVO: Examinar el uso y los resultados de la anticoagulación perioperatoria en pacientes bariátricos con antecedentes de tromboembolia venosa (TEV). MÉTODO: Revisión retrospectiva (base de datos prospectiva) de pacientes sometidos a cirugía general y bariátrica (1/2008-12/2017). Se evaluaron datos demográficos, detalles quirúrgicos y resultados. RESULTADOS: Sesenta y cinco pacientes se sometieron a 76 procedimientos: 46 mujeres (71%), edad media 51 años (rango: 26-73), peso medio 284 libras (rango: 110-558), índice de masa corporal medio 45 (rango: 19-87). Comorbilidad: hipertensión (60%), enfermedad por reflujo gastroesofágico (54%), osteoartritis (49%), apnea obstructiva del sueño (45%), diabetes (37%). Operaciones: 22 cirugía general (29%), 20 gastrectomías en manga (26%), 12 revisiones/conversiones (16%), 12 Y-de-Roux (16%), 10 bandas gástricas (13%). Modalidades: 67% laparoscópica, 28% robótica, 5% abierta. A 22 pacientes (34%) se les colocó un filtro de vena cava inferior preoperatorio sin complicaciones. La estancia media fue de 4.4 días (rango: 1-31). Complicaciones: 7 reingresos a los 30 días (9%), 1 reoperación a los 30 días (1%), 2 TEV a los 90 días (3%). Reingresos a los 30 días: 4 por incapacidad para tolerar la vía oral, 2 obstrucciones de intestino delgado y 1 úlcera anastomótica sintomática. CONCLUSIONES: En nuestros casos, la anticoagulación posoperatoria pudo iniciarse sin aumento del riesgo de sangrado en pacientes con antecedentes de TVE sometidos a cirugía bariátrica.

Morbidity and mortality of emergency surgery in octogenarian patient.

OBJECTIVE: To evaluate the health outcomes (postoperative morbidity and mortality) and the functional status at discharge of elderly patients older than 80 years who underwent emergency surgery. METHOD: Patients > 80 years of age who underwent emergency surgery during one year at the Marqués de Valdecilla University Hospital, Santander, Spain. Preoperative data (age, sex, type of surgery, comorbidity) and postoperative data (complications) were evaluated, as well as in-hospital mortality, at 30 days and 6 months after surgery. RESULTS: Five-hundred-sixty-eight patients underwent emergency surgery between 2018 and 2019. After the review, 407 patients were included in the study. Average age: 86.9 years. Women 61.7%. Mean hospital stay: 10.4 days. Traumatic interventions 41.3%, vascular surgery 19.7%, general-digestive surgery 25.3%. Medium ASA risk: 2.88. Functional status at discharge: 3.15. Postoperative complications: Clavien-Dindo I 40.8%, II 40.3%, IIIA 3.4%, IIIB 2.5%, IVA 3.9%, IVB 2.0% and V 7.1%. Hospital mortality 7.1%, 30-day mortality 10.3%, mortality at 6 months 24.6%. CONCLUSIONS: Patients > 80 years of age undergoing urgent surgery have high preoperative comorbidity, postoperative complications, and high mortality at 30 days and 6 months after surgery. This mortality is more significant in those ASA IV, nonagenarians and those undergoing high-risk surgery.

OBJETIVO: Evaluar los resultados en salud (morbilidad y mortalidad posoperatorias) y el estado funcional al alta de los pacientes mayores de 80 años sometidos a cirugía de urgencia. MÉTODO: Pacientes de edad > 80 años sometidos a cirugía de urgencia durante 1 año en el Hospital Universitario Marqués de Valdecilla, Santander, España. Se evaluaron datos preoperatorios (edad, sexo, tipo de cirugía, comorbilidad) y posoperatorios (complicaciones), así como mortalidad hospitalaria, a los 30 días y a los 6 meses de la cirugía. RESULTADOS: En 2018-2019 fueron operados de urgencia 568 pacientes, de los cuales 407 fueron incluidos en el estudio. Edad media: 86.9 años. El 61.7% fueron mujeres. Estancia media hospitalaria: 10.4 días. El 41.3% fueron intervenciones traumatológicas, el 19.7% cirugía vascular, el 25.3% cirugía general-digestiva. Riesgo ASA medio: 2.88. Estado funcional al alta: 3.15. Complicaciones posoperatorias: Clavien-Dindo I 40.8%, II 40.3%, IIIA 3.4%, IIIB 2.5%, IVA 3.9%, IVB 2.0% y V 7.1%. Mortalidad: hospitalaria 7.1%, a los 30 días 10.3% y a los 6 meses 24.6%. CONCLUSIONES: Los pacientes > 80 años sometidos a cirugía urgente presentan elevada comorbilidad preoperatoria, complicaciones posoperatorias y elevada mortalidad a 30 días y 6 meses de la cirugía. Esta mortalidad es más significativa en los ASA IV, nonagenarios y sometidos a cirugía de alto riesgo.

Preoperative evaluation profile of patients undergoing arterial vascular surgery in a tertiary hospital.

BACKGROUND: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. METHODS: This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. RESULTS: 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). CONCLUSION: The increased request for exams didn't have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.

Cost and time of hospitalization for elderly people with bone fractures in a reference hospital.

OBJECTIVE: To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital. METHODS: A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used. RESULTS: During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures. CONCLUSION: Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.

Economic burden of respiratory syncytial virus disease in Latin America: A systematic review.

This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.

Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19.

OBJECTIVE: To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19. METHODS: This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge. RESULTS: Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001). CONCLUSION: Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.

Moderate and serious adverse reactions to antimicrobials among hospitalized children: A systematic review.

AIMS: This systematic review aimed to investigate the occurrence of moderate and severe adverse drug reactions (ADRs) to antimicrobials among hospitalized children. METHODS: The PubMed/Medline, Cochrane Library, Embase, Web of Science, Scopus, Lilacs and CINAHL databases were searched in April 2023 to systematically review the published data describing the characteristics of moderate and severe ADRs to antimicrobials among hospitalized children. The search was carried out without date restrictions, up to the search date (April, 2023). RESULTS: At the end of the selection process, 30 articles met the inclusion criteria. Cutaneous reactions were the primary serious clinical manifestations in most articles (19/30), followed by erythema multiforme (71 cases), Stevens-Johnson syndrome (72 cases), and toxic epidermal necrolysis (22 cases). The main antimicrobials involved in moderate and severe ADRs were penicillins, cephalosporins and sulfonamides. Regarding the primary outcomes, 30% (9/30) of the articles reported deaths, and 46.7% (14/30) of studies reported increased lengths of hospital stay, need for intensive care, and transfer to another hospital. Regarding the main interventions, 10% (3/30) of the articles mentioned greater monitoring, suspension, medication substitution or prescription of specific medications for the symptomatology. CONCLUSIONS: The findings of this review could be used to identify areas for improvement and help health professionals and policymakers develop strategies. In addition, we emphasize the importance of knowing about ADRs so that there is adequate management to avoid undesirable consequences.