RESUMO
Anastomotic leakage (AL) is a defect of the intestinal wall at the anastomotic site and is one of the most severe complications in colorectal surgery. Previous studies have shown that the immune system response plays a significant role in the development of AL. In recent years, DAMPs (damage-associated molecular patterns) have been identified as cellular compounds with the ability to activate the immune system. The NLRP3 inflammasome plays an important role in the inflammatory responses which are mediated by DAMPs such as ATP, HSP proteins or uric acid crystals, when found in extracellular environments. Recent publications suggest that systemic concentration of DAMPs in patients with colorectal surgery may determine the inflammatory process and have a role in the occurrence of AL and other post-surgery complications. This review provides valuable knowledge about the current evidence supporting this hypothesis and highlights the possible role of these compounds in postoperative processes, which could open a new path to explore new strategies to prevent possible post-surgical complications.
Assuntos
Anastomose Cirúrgica , Fístula Anastomótica , Cirurgia Colorretal , Humanos , Alarminas , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-OperatórioRESUMO
BACKGROUND: Failure-to-rescue measures a hospital's response capacity to avoid the death of a patient after a complication. The aim of this study was to validate the use of prolonged length of stay to calculate failure-to-rescue rates as a substitute for traditional coding of complications in colorectal cancer surgery. METHOD: We performed a cross-sectional between-instruments agreement study. Our study population was comprised of 204 colorectal cancer surgical patients from a public academic hospital during 2017 and 2018. We obtained two failure-to-rescue indicators from administrative data: an indicator using International Classification of Diseases, tenth edition, (ICD-10) codes; and another one using a cut-off point of prolonged length of stay as a predictor of patients with complications. Then, they were compared with a reference indicator from clinical records. RESULTS: Failure-to-rescue rates were between 10 and 13.64 for the study site depending on which indicator was used. A hospital stay ≥10 days had the maximum Youden's index (0.6) and an area under the ROC curve of 0.87. This was used in the failure-to-rescue indicator using prolonged length, which obtained the highest agreement (any coefficient >0.75). CONCLUSION: ICD-10 codes identified complications poorly. Prolonged length of stay could be a valid replacement of ICD-10 codes when measuring failure-to-rescue in administrative databases for colorectal surgical patients.
Assuntos
Neoplasias Colorretais , Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Tempo de Internação , Estudos Transversais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Fibromatose Agressiva/complicações , Fibromatose Agressiva/diagnóstico por imagem , Cavidade Abdominal/diagnóstico por imagem , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Imageamento por Ressonância Magnética , Doença CrônicaRESUMO
We present the case of a patient with an inflammatory bowel disease to whom a pelvic desmoid tumor is discovered during an infertility study.
