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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.
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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
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Humanos , Feminino , Adulto , Fibroma Desmoplásico/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Fibroma Desmoplásico/cirurgia , Parede Torácica/patologia , Fibromatose Agressiva/diagnóstico por imagemRESUMO
No disponible
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Humanos , Feminino , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Torácicos/classificação , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/tendências , Próteses e Implantes/classificação , Parede Torácica/lesões , Próteses e Implantes/tendências , Próteses e ImplantesAssuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Procedimentos de Cirurgia Plástica/instrumentação , Parede Torácica/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Politetrafluoretileno/uso terapêutico , Procedimentos de Cirurgia Plástica/métodos , Costelas/cirurgia , Esterno/cirurgiaRESUMO
Introducción La mediastinitis necrosante descendente (MND) consiste en una infección grave que aparece como complicación de una infección orofaríngea. Aún existe controversia a propósito del tratamiento quirúrgico y si está indicado un abordaje transtorácico rutinario. En este artículo presentamos nuestra experiencia en el tratamiento de la mediastinitis necrosante descendente y revisamos en la bibliografía las diferentes opciones de abordaje propuestas. Material y métodos Estudio observacional retrospectivo de los pacientes con mediastinitis necrosante descendente intervenidos entre 1988 y 2009. Se analizan variables demográficas, origen de la infección, estadio de la enfermedad según la clasificación de Endo, técnica quirúrgica realizada y evolución. Resultados En dicho periodo se intervino a 29 pacientes. El tratamiento quirúrgico consistió en el drenaje y desbridamiento radical a nivel cervical y mediastínico. El drenaje mediastínico se realizó por vía transcervical en 10 casos y transtorácica en 19, en función de la extensión de la mediastinitis. De ellos, 24 presentaron buena evolución y 5 fallecieron (mortalidad 17,2%).Conclusiones De acuerdo con nuestros resultados y las conclusiones de los principales autores, se debe realizar un tratamiento quirúrgico precoz y agresivo que incluya un abordaje transtorácico en casos de mediastinitis extendida (AU)
Introduction Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature. Material and methods A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome. Results Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%).Conclusions According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM (AU)
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Humanos , Mediastinite/cirurgia , Faringite/complicações , Infecções Respiratórias/complicações , Toracostomia/métodos , Orofaringe/microbiologia , Estudos RetrospectivosRESUMO
INTRODUCTION: Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature. MATERIAL AND METHODS: A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome. RESULTS: Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%). CONCLUSIONS: According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM.