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No disponible
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Humanos , Adulto , Anormalidades Cardiovasculares/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Veia Ázigos/anormalidadesRESUMO
INTRODUCTION: Mortality following surgery for lung cancer increases at 90 days. The objective of this study was to determine the rate, factors, time to death, hospital stay until discharge, time to death after discharge and causes of mortality at 90 days following surgery for lung cancer. METHODS: A prospective follow-up study was performed in a cohort of 378 patients who underwent surgery for lung cancer between January 2012 and December 2016. Data on preoperative status, postoperative complications, and mortality were collected. RESULTS: Rates of mortality were 1.6% vs. 3.2% at 30 and 90 days, respectively. Half of deaths occurred between 31 and 90 postoperative days following discharge. The variables found to be related to mortality at 90 days were a Charlson Index >3 (pâ¯<â¯0.001), a history of stroke (pâ¯=â¯0.036), postoperative pneumonia (pâ¯=â¯0.001), postoperative pulmonary or lobar collapse (pâ¯=â¯0.001), reintubation (pâ¯<â¯0.001) and postoperative arrhythmia (pâ¯=â¯0.0029). The risk of mortality was also observed to be associated with the type of surgical technique -being higher for thoracotomy as compared to video-assisted thoracoscopy (VATS) (pâ¯=â¯0.011) -, and hospital readmission after discharge (pâ¯<â¯0.001). Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Multivariate analysis revealed that a Charlson Index >3 (pâ¯=â¯0.001) OR 2.0 (1.55,2.78), a history of stroke (pâ¯=â¯0.018) OR 5.1 (1.81, 32.96) and postoperative pulmonary or lobar collapse (pâ¯=â¯0.001) OR 8.5 (2.41,30.22) were independent prognostic factors of mortality. The most common causes of death were related to respiratory (58.3%) and cardiovascular (33.2%) complications. CONCLUSIONS: Mortality at 90 days following surgery for lung cancer doubles 30-day mortality, which is a relevant finding of which both, patients and healthcare should be aware. Half the deaths within 90 days after surgery for lung cancer occur after discharge. Specific outpatient follow-up programs should be designed for patients at a higher risk of 90-day mortality.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Alta do Paciente/estatística & dados numéricos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Toracotomia/mortalidade , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Tempo de Internação , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Prognóstico , Taxa de SobrevidaRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Fibroma Desmoplásico/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Fibroma Desmoplásico/cirurgia , Parede Torácica/patologia , Fibromatose Agressiva/diagnóstico por imagemRESUMO
BACKGROUND: The purpose of this study was to assess the rate, cause, and factors associated with readmissions following pulmonary resection for lung cancer and their relationship with 90-day mortality. METHODS: A prospective cohort study was conducted of 379 patients who underwent surgery for lung cancer at the university hospitals Granada, Spain between 2012 and 2016. RESULTS: The rate of readmissions within 30 postoperative days was 6.2%. The most common reason for readmission was subcutaneous emphysema (21.7%), pneumonia (13%), and pleural empyema (8.5%). A higher probability of requiring urgent readmission was associated with a higher Charlson index (OR 2.0,95% confidence interval 1.50-2.67, P = 0.001); peripheral arterial vasculopathy (OR 4.8, 95%CI 1.27-18.85, P = 0.021); a history of stroke (OR 8.2, 95%CI 1.08-62.37, P = 0.04); postoperative atelectasis (OR 4.7, 95%CI 1.21-18.64, P = 0.026); and air leaks (OR 12.6, 95%CI 4.10-38.91, P = 0.001).The prediction multivariable model for readmission represents an area under the curve (ROC) of 0.90. Mortality at 90 postoperative days in the group of readmitted patients was 13% versus 1.5 for the group of patients who did not require readmission (P < 0.001). CONCLUSIONS: The factors predictive for readmission can help design individualized outpatient follow-up plans and programs for the reduction of readmissions.
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Neoplasias Pulmonares/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Alta do Paciente , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: The objective of this study was to investigate the impact of a program of major video-assisted surgery on care quality in a Unit of Thoracic Surgery. METHODS: A descriptive comparative study was conducted of 793 major thoracic procedures performed between 2009 and 2012. Quality indicators and hospital performance before [2009-2010] and after (2011 and 2012) the implementation of the program. RESULTS: The incidence of surgical complications decreased significantly from 6.32%/7.88% (2009/2010, respectively) to 1.87%/1.67% (2011/2012, respectively) [95% CI for 7.08% (4.20-9.96%); 95% CI for 1.76% (0.44-3.08%) P<0.001, respectively]. The mean hospital stay was reduced from 8.5/7.8 days in 2009/2010, respectively, to 6.3/5.8 days in 2011/2012, respectively. Mortality rates were 0.57%, 0.60%, 0.93% and 0.43% in 2009, 2010, 2011, and 2012, respectively (P=0.624, 95% CI: -0.6, 0.7). The percentages of emergency readmissions in 2009/2010 were 1.16%/1.23%, respectively vs. 2.80%/0.84% in 2011/2012. CONCLUSIONS: The implementation of the video-assisted thoracic surgery (VATS) program in the unit of Thoracic Surgery Care resulted in a significant improvement in care quality, with a reduction of length of hospital stay, but without any changes in mortality or the percentage of readmissions at 30 post-operative days.
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No disponible
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Humanos , Neoplasias Pulmonares/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Estadiamento de Neoplasias , Pneumonectomia/métodos , Técnicas Estereotáxicas , Quimioterapia AdjuvanteRESUMO
No disponible
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Humanos , Neoplasias Pulmonares/classificação , Carcinoma Pulmonar de Células não Pequenas/classificação , Estadiamento de Neoplasias/métodos , Neoplasias Pleurais/secundário , Neoplasias Pulmonares/terapia , Metástase Neoplásica/terapia , Carcinoma Pulmonar de Células não Pequenas/terapiaRESUMO
No disponible
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Humanos , Masculino , Feminino , Hemotórax/complicações , Hemotórax/diagnóstico , Exostose/complicações , Exostose/cirurgia , Exostose , Osteocondroma/complicações , Hemotórax/fisiopatologia , Hemotórax , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão , Visualização de DadosAssuntos
Doenças dos Trabalhadores Agrícolas/microbiologia , Brucella melitensis , Brucelose/complicações , Pneumopatias/microbiologia , Adulto , Doenças dos Trabalhadores Agrícolas/diagnóstico por imagem , Brucelose/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , RadiografiaRESUMO
Spontaneous hemomediastinum is a rare pathological event due to bleeding disorders, mediastinal organ hemorrhage or idiopathic causes. It usually presents with chest pain and dyspnea, which can lead to confusion with other clinical conditions. The election diagnostic method is computed tomography and treatment depends on underlying etiology, aimed on controlling hemorrhages, if present. In this paper, we present a case of spontaneous hemomediastinum and hemothorax after bronchial artery aneurysm dissection treated with endovascular embolization and chest drainage.