RESUMO
OBJECTIVE: Bull-horn injuries (BHI) are unique and there is reduced published literature about it. We present an analysis of a 11-year BHI case series. METHOD: Study of 138 cases developed during a 11-year period with hospitalization admission greater than 24 hours with diagnosis of BHI/contusion. We classified patients in two groups: group A, patients undergoing procedures under general anaesthesia and group B undergoing procedures under local anaesthesia. Variables: age, sex, date, hospitalization length, main region affected, Comprehensive complication index (CCI, ISS, intensive care unit (ICU) admission, stay and mortality. Statistical analysis: t-Student test, ANOVA, χ2 and linear or logistic regression. RESULTS AND CONCLUSIONS: ISS was related to hospital stay, CCI, ICU admission and type of treatment applied. The comparative statistical analysis of variables between both groups determined a significant difference in age, ISS and hospitalization length, being greater in those belonging to group A. There is a more risk of undergoing surgery by increasing age, ISS and presenting the wounds in thorax-abdomen-pelvis area. CCI may be a good method of quantifying postoperatory morbidity in polytraumatized patients or in other areas besides the abdomen.
OBJETIVO: Las heridas por asta de toro (HAT) poseen características únicas y existe literatura escasa en esta área. Presentamos un análisis de 11 años de pacientes con HAT. MÉTODO: Estudio retrospectivo y analítico de 138 casos durante un periodo de 11 años, de pacientes ingresados durante más de 24 horas por HAT. Clasificamos a los pacientes en dos grupos: grupo A, sometidos a procedimientos bajo anestesia general, y grupo B, sometidos a procedimientos bajo anestesia local. Variables recogidas: edad, sexo, mes del suceso, hospitalización (días), región afectada, Comprehensive Complication Index (CCI), Injury Severity Score (ISS), ingreso y estancia en la unidad de cuidados intensivos (UCI) y mortalidad. Análisis estadístico: t de Student, ANOVA, χ2, regresión lineal y logística. RESULTADOS Y CONCLUSIONES: El ISS se relaciona directamente con la estancia hospitalaria, el CCI, el ingreso en UCI y el tratamiento recibido. Entre ambos grupos se evidenció una diferencia significativa en edad, ISS y estancia hospitalaria, siendo mayores en el grupo A. Existe un mayor riesgo de necesitar cirugía conforme aumentan la edad, el ISS y las heridas en tórax, abdomen o pelvis. El CCI puede ser un buen método para cuantificar la morbilidad posoperatoria en pacientes politraumatizados o con lesiones en otras áreas distintas del abdomen.
Assuntos
Unidades de Terapia Intensiva , Animais , Bovinos , Humanos , Tempo de Internação , Modelos Logísticos , MasculinoAssuntos
COVID-19/terapia , Pneumoperitônio/diagnóstico por imagem , Doenças Assintomáticas , COVID-19/complicações , COVID-19/diagnóstico por imagem , Tratamento Conservador , Humanos , Unidades de Terapia Intensiva , Ventilação com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Pneumoperitônio/complicações , Pneumoperitônio/terapia , Respiração Artificial , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , TraqueostomiaRESUMO
OBJECTIVE: To validate the Comprehensive Complication Index (CCI) via an assessment of its relation to postoperative costs. BACKGROUND: The CCI summarizes all the postoperative complications graded by the Clavien-Dindo classification (CDC) on a numerical scale. Its relation to hospital costs has not been validated to date. METHODS: Prospective observational cohort study, including all patients undergoing surgery at a general surgery service during the 1-year study period. All complications graded with the CDC and CCI and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. The surgeries were classified according to their Operative Severity Score (OSS) and in 4 groups of homogeneous surgeries. All postoperative costs were recorded. RESULTS: In all, 1850 patients were included, of whom 513 presented complications (27.7%). The CDC and the CCI were moderately to strongly correlated with overall postoperative costs (OPCs) in all OSS groups (rs = 0.444-0.810 vs 0.445-0.820; P < 0.001), homogeneous surgeries (rs = 0.364-0.802 vs 0.364-0.813; P < 0.001), prolongation of postoperative stay (rs = 0.802 vs 0.830; P < 0.001), and initial operating room costs (rs = 0.448 vs 0.451; P < 0.001). This correlation was higher in emergency surgery. With higher CDC grades, the OPC tended to increase an upward trend. In the multivariate analysis, CDC, CCI, age, and duration of surgery were all associated with OPC (P < 0.001). CONCLUSIONS: In our environment, the CCI presented associations with OPC. This demonstration of its economic validity enhances its clinical validity.
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Efeitos Psicossociais da Doença , Complicações Pós-Operatórias/economia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. METHODS: A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. RESULTS: A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. CONCLUSION: This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
