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1.
Medicine (Baltimore) ; 99(19): e19982, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384450

RESUMO

Unplanned reoperations have not been studied extensively in pediatric patients, especially concerning risk factors. We aim to estimate the rate of unplanned reoperations and to determine the associated factors in pediatric general surgical specialties.This analysis included a retrospective case-control study of unplanned reoperations from July 1, 2010 to June 30, 2017 in the general surgical specialties. For each case, we identified approximately 2 randomly selected controls who underwent the same type of operation. The factors involved in the unplanned reoperations were investigated using univariate and multivariate analysis.Of the 3263 patients who underwent surgery, unplanned reoperations were performed in 139 patients (4.3%). The main indications for unplanned reoperations were wound complications (n = 52, 42.6%), followed by postoperative ileus (n = 12, 9.8%), postoperative bleeding (n = 8, 6.6%), and intraabdominal infection (n = 13, 10.7%). Following multivariate analysis, 2 factors remained significantly associated with unplanned reoperation: higher initial surgery-related risk level (P = .007, risk ratio (RR) = 0.48; 95% confidence interval (CI) = 0.27-0.82) and operation performed outside working hours (P = .031, RR = 0.52; 95% CI = 0.30-0.89).Various patient- and procedure-related factors were associated with unplanned reoperations. This information might be helpful for the optimization of treatment planning and resource allocation.


Assuntos
Complicações Pós-Operatórias/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Reoperação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estudos de Casos e Controles , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Reoperação/métodos , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
2.
Medicine (Baltimore) ; 99(8): e19250, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080131

RESUMO

Stenotrophomonas maltophilia (S. maltophilia) is an important nosocomial bacterial pathogen. However, the clinical features of children with S. maltophilia infection, the predisposing factors, and the antibiotic susceptibility of the bacteria have not been fully evaluated.In this study, the data of children with S. maltophilia infection from the West China Second University Hospital of Sichuan University (Chengdu, China) between July 2010 and October 2017 were collected and analyzed. The clinical features of enrolled children, the predisposing factors, and the antibiotic susceptibility were reported.In total, infection of S. maltophilia was identified in 128 patients. Most of these patients were under 1 year old (67.2%) and were mainly diagnosed as pneumonia (69%). A large proportion had underlying diseases (45.3%), received immunosuppressive therapy (53.1%), had undergone invasive operations (41.4%), had a history of carbapenem antibiotics use within 7 days before culture acquisition (54.7%), history of intensive care unit (ICU) hospitalization within previous 30 days (34.4%), and other risk factors. In particular, invasive operation (95% confidence interval [CI]: 1.125-14.324, P = .032), especially mechanical ventilation (95% CI: 1.277-20.469, P = .021), and ICU admission (95% CI: 1.743-22.956, P = .005) were independent risk factors for the children to develop severe S. maltophilia infection. As for antibiotic susceptibility, trimethoprim sulfamethoxazole (TMP-SMX), piperacillin tazobactam, ticarcillin clavulanate, and ceftazidime exhibited strong antibacterial activities against S. maltophilia, the susceptibility rates were 97.5%, 86.7%, 92.9%, and 81.5%, respectively.We report the clinical features of children with S. maltophilia infection, the predisposing factors and the antibiotic susceptibility. TMP-SMX can continue to be the first choice for the treatment of S. maltophilia infection. Piperacillin tazobactam, ticarcillin clavulanate, and the third generation cephalosporins can be used as alternative drugs.


Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Stenotrophomonas maltophilia , Distribuição por Idade , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Ceftazidima/uso terapêutico , Pré-Escolar , China/epidemiologia , Ácidos Clavulânicos/uso terapêutico , Comorbidade , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Humanos , Imunossupressores/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Masculino , Combinação Piperacilina e Tazobactam/uso terapêutico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ticarcilina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
3.
J Surg Res ; 246: 236-242, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610351

RESUMO

BACKGROUND: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.


Assuntos
Medicina Tradicional Africana/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Peritonite/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Gastos em Saúde/estatística & dados numéricos , Hospitais Universitários/economia , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Medicina Tradicional Africana/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Peritonite/economia , Ruanda , Fatores Socioeconômicos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/psicologia , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
4.
J Surg Res ; 246: 93-99, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562991

RESUMO

BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS: A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS: For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS: Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Doenças do Recém-Nascido/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Pediátricos/economia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/epidemiologia , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/economia , Taxa de Sobrevida , Uganda/epidemiologia
5.
J Surg Res ; 246: 106-112, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31563830

RESUMO

BACKGROUND: Nongovernmental organizations conduct short-term surgical outreach to lessen the substantial global burden of surgical disease. Long-term outcomes of short-term surgical missions (STSMs) are underreported, raising concern for clinical sequelae and patient satisfaction with essential general surgeries. This study aims to describe long-term follow-up results of one general surgical nongovernmental organization's provision of care in rural Ghana with focus on patient-related outcomes and satisfaction. METHODS: From 2013 to 2018, Tetteh Quarshie Memorial Hospital in Mampong, Ghana, was the host site of annual 1-wk International Surgical Health Initiative (ISHI) STSMs. Beginning in 2016, an ISHI provider-hosted follow-up clinics augmented by mobile telephone support. Surgical patients from 2013 to 2016 were contacted by the local nursing staff and evaluated for long-term outcomes and self-reported satisfaction. RESULTS: Sixty-nine of 256 patients (27%) responded; 39 patients (57%) were interviewed and examined by an ISHI physician, whereas 30 patients (43%) received mobile telephone follow-up. Mean age was 47 (±18) y, with 44% female patients, and mean duration of follow-up was 1.5 (±1) y. Eleven patients (16%) had surgical and anesthesia complications. All patients reported improvement in symptoms and activity level. Eighty-six patients reported complete satisfaction (5/5). Factors associated with reduced patient satisfaction (<5/5) included increased age and complications. CONCLUSIONS: To our knowledge, this is one of the first studies focusing on patient-reported outcomes for the evaluation of long-term follow-up of general surgery STSMs. With mobile technology, long-term follow-up is achievable toward obtaining meaningful outcomes. Complications in this series are within an acceptable range, whereas symptom improvement and overall satisfaction are high.


Assuntos
Altruísmo , Missões Médicas/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Feminino , Seguimentos , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , População Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Resultado do Tratamento
6.
J Surg Res ; 246: 231-235, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31606513

RESUMO

BACKGROUND: An estimated 800,000 dog bites require medical attention every year. The purpose of this study is to review the characteristics of dog bite injuries in children and examine temporal trends. METHODS: The Kids' Inpatient Database was used to identify pediatric patients with dog bite injuries over a 10-y period. Demographic data, primary payer, injury characteristics, length of hospitalization, and treatments were recorded. Statistical analysis was performed in SAS 9.3 (SAS Institute Inc, Cary, NC). RESULTS: A total of 6308 patients were identified. Average age at time of injury was 6.4 ± 4.3 y. Children under age 5 y were the most affected subgroup (39.3% in 2000 versus 44.7% in 2009, P < 0.001). Most bites were to the head/neck and significantly increased from 53.9% in 2000 to 60.1% in 2009. Cellulitis complicated many injuries (33.7% in 2000 versus 44.8% in 2009, P < 0.001). Overall, 50% of patients underwent a procedure; 31% had an invasive surgical procedure; and 5.1% of patients required skin grafts or flaps. CONCLUSIONS: Dog bites are a common cause of pediatric injuries and are a significant burden on families and the health care system. Evaluating the characteristics of these injuries can guide educational efforts.


Assuntos
Mordeduras e Picadas/epidemiologia , Celulite (Flegmão)/epidemiologia , Efeitos Psicossociais da Doença , Cães , Fatores Etários , Animais , Mordeduras e Picadas/complicações , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/cirurgia , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/cirurgia , Criança , Pré-Escolar , Feminino , Cabeça , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pescoço , Estudos Retrospectivos , Transplante de Pele/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
7.
J Surg Res ; 245: 629-635, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522036

RESUMO

BACKGROUND: Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions annually. Low-income EGS patients have higher rates of postoperative adverse events (AEs) than high-income patients. This may be related to health care segregation (a disparity in access to high-quality centers). The emergent nature of EGS conditions and the limited number of EGS providers in rural areas may result in less health care segregation and thereby less variability in EGS outcomes in rural areas. The objective of this study was to assess the impact of income on AEs for both rural and urban EGS patients. MATERIALS AND METHODS: The National Inpatient Sample (2007-2014) was queried for patients receiving one of 10 common EGS procedures. Multivariate regression models stratified by income quartiles in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based factors were used to determine the rates of surgical AEs (mortality, complications, and failure to rescue [FTR]). RESULTS: 1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52). CONCLUSIONS: Lower income is associated with higher postoperative AEs in the urban setting but not in a rural environment. This socioeconomic disparity in EGS outcomes in urban settings may reflect health care segregation, a differential access to high-quality health care for low-income patients.


Assuntos
Tratamento de Emergência/efeitos adversos , Disparidades em Assistência à Saúde/economia , Renda/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
8.
J Surg Res ; 245: 315-320, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421379

RESUMO

BACKGROUND: Transplant patients are at the risk of serious sequelae from medical and surgical intervention. The incidence and burden of emergency general surgery (EGS) in transplant patients are scarcely known. This study aims to identify predictors of outcomes in transplant patients with EGS needs. METHODS: The Nationwide Inpatient Sample (2007-2011) was queried for adult patients (aged ≥16 y) who underwent abdominal visceral transplantation. These were further queried for a secondary diagnosis of an American Association for the Surgery of Trauma-defined EGS condition. Outcome measures included mortality, complications, length of stay, and cost of care. Propensity scores were used to match patients across baseline characteristics. Multivariate analysis was used to further adjust propensity score quintiles and hospital-level characteristics. RESULTS: A total of 35,573 transplant patients were identified. Of these, 30% (n = 10,676) developed an EGS condition. Most common EGS conditions were resuscitation (7.7%), intestinal obstruction (7.3%), biliary conditions (3.9%), and hernias (3.2%). Patients with public insurance, those in the highest income quartile, and those treated at larger hospitals had a lower likelihood of developing an EGS condition (P < 0.05). Patients with an EGS condition had a ninefold higher likelihood of mortality and a threefold higher likelihood of developing complications (odds ratio [95% confidence interval (CI)]: 9.21 [1.80-10.89] and 3.17 [3.02-3.34], respectively). Transplant patients after EGS had a longer risk-adjusted length of stay and cost of index hospitalization (Absolute difference [95% CI]: 12.70 [12.14-13.26] and $57,797 [55,415-60,179], respectively]). CONCLUSIONS: Transplant patients fare poorly after developing an EGS condition. The results of this study will help in identifying at-risk patients and determining outcomes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estados Unidos
9.
Khirurgiia (Mosk) ; (12): 60-65, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825344

RESUMO

Meta-analysis is a leading methodology used in systematic secondary researches. Review Manager software is the main tool used by leading world expert groups for meta-analysis. The authors analyzed the features of meta-analyzes evaluating the results of surgeries. It is shown that the majority of baseline clinical parameters correspond to normal distribution (in accordance with central limit theorem) considering the fact that surgical outcomes depend on various and often unpredictable factors. Moreover, multiple heterogeneous variables are compared in the meta-analysis due to the differences in diagnostic scales and methods of evaluating the results in primary researches. Therefore, both absolute and standardized measurements are required for these purposes. The authors describe the features of meta-analysis for dichotomous, continuous and skewed data, as well as for ordinal outcomes, time-to-event, counts and ratios. These data are useful to interpret numerical values, objectively evaluate the majority of surgical outcomes and predict the effectiveness of interventions.


Assuntos
Interpretação Estatística de Dados , Metanálise como Assunto , Procedimentos Cirúrgicos Operatórios , Humanos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
11.
Dis Colon Rectum ; 62(11): 1390-1400, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31596764

RESUMO

BACKGROUND: Few data are published on perianal tuberculosis. OBJECTIVE: This study aimed to determine the best method to diagnose tuberculosis in patients with fistula-in-ano and to conduct a systematic review to determine the incidence and characteristics of tuberculosis fistula-in-ano. DATA SOURCES: The prospective study data and existing literature were derived from PubMed, Google scholar, and Scopus STUDY SELECTION:: Prospective analysis of patients with tuberculous fistula-in-ano treated between 2014 and 2018 was conducted, and a systematic review of studies describing ≥3 patients with tuberculosis fistula-in-ano was completed. INTERVENTION: Testing of tuberculosis was performed by histopathology or polymerase chain reaction of tissue or pus from the fistula tract. MAIN OUTCOME MEASURES: The primary outcomes measured were the detection rate of various tests to detect tuberculosis in fistula-in-ano and the prevalence rate of tuberculosis in simple versus complex fistulas. RESULTS: In 637 samples (410 patients) tested, tuberculosis was detected in 49 samples (43 patients). Additional samples (n = 106) sent in patients with a high index of suspicion tested positive in 14 more patients. Thus, overall, 63 samples tested positive in 57 patients (total: 743 samples in 410 patients were tested). Tuberculosis was detected in 2 of 181 patients (1.1%) in tissue (histopathology), in 28 of 341 patients (8.2%) in tissue (polymerase chain reaction), and in 19 of 115 patients (16.5%) in pus (polymerase chain reaction) samples. To detect tuberculosis, tissue (polymerase chain reaction) was significantly better than tissue (histopathology) (28/341 vs 2/181, p < 0.00001) and pus (polymerase chain reaction) was significantly better than tissue (polymerase chain reaction) (19/115 vs 28/341, p < 0.0009). Tuberculosis was significantly more common in complex fistulas than in simple fistulas (20.3% vs 7.2%, p = 0.0002). The systematic review (n = 199) highlighted that tubercular fistulas are more common in recurrent and complex fistulas and in tuberculosis endemic regions. LIMITATIONS: The true sensitivity and specificity of each testing modality could not be determined because not all patients with tuberculosis fistula-in-ano were tested by every diagnostic modality studied. CONCLUSIONS: The tuberculosis detection rate of polymerase chain reaction was significantly higher than histopathology. Among polymerase chain reaction, pus had higher detection rate than tissue. Tuberculosis was associated with more complex and recurrent fistulas.


Assuntos
Fissura Anal , Mycobacterium tuberculosis , Fístula Retal , Estreptomicina/administração & dosagem , Tuberculose Gastrointestinal , Assistência ao Convalescente/métodos , Antituberculosos/administração & dosagem , Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/estatística & dados numéricos , Feminino , Fissura Anal/diagnóstico , Fissura Anal/epidemiologia , Fissura Anal/microbiologia , Fissura Anal/terapia , Humanos , Incidência , Índia/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/estatística & dados numéricos , Fístula Retal/diagnóstico , Fístula Retal/epidemiologia , Fístula Retal/microbiologia , Fístula Retal/terapia , Recidiva , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/epidemiologia , Tuberculose Gastrointestinal/fisiopatologia , Tuberculose Gastrointestinal/terapia
12.
Med Care ; 57(12): 949-959, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31568164

RESUMO

BACKGROUND: There is evidence suggesting higher rates of negative surgical outcomes for patients with lower socioeconomic status. OBJECTIVE: The objective of this study was to evaluate the effects of different geographic measures of socioeconomic status and deprivation on surgical outcomes in the United States. RESEARCH DESIGN: We extracted county-level, zip code-level, census block group-level and census tract-level measures of geographic risk. We evaluated associations between geographic area inequity and surgical outcomes using linear, logistic, and Poisson regression with generalized estimating equations to account for clustering by hospital. SUBJECTS: Hospital discharges (n=1,573,740) after major surgery in Arizona, Florida, Iowa, Michigan, New Jersey, New York, North Carolina, and Vermont as extracted from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database between the years 2010-2012. MEASURES: Inpatient mortality, length of stay, hospital costs, discharge status, and 30-day all-cause readmission. RESULTS: After adjusting for patient, hospital, and discharge factors, the odds of inpatient mortality significantly increased as geographic distress increased across all measures of geographic risk. Odds of routine discharge increased and the odds of 30-day all-cause readmission decreased with geographic distress for select measures of geographic inequity. The choice of measure generally did not affect the findings; the results did not conclusively support the use of measures from larger or smaller geographic units. CONCLUSIONS: There is a consistent, strong association between geographic indicators for socioeconomic status and distress with important surgical outcomes. Further work is needed to understand the source of these associations and to develop interventions and effective policies to address them.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
13.
Health Serv Res ; 54(6): 1223-1232, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31576566

RESUMO

OBJECTIVE: To develop and validate a claims-based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores. DATA SOURCE: Five percent Medicare data from 2007 to 2014. STUDY DESIGN: Retrospective cohort study of patients aged ≥65 years undergoing six major operations (N = 99 250). DATA COLLECTION: One-year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30-day mortality, 30-day readmission, and length of stay. The comorbidity score was developed in the derivation cohort (70 percent sample) using logistic regression model. The comorbidity score was calibrated and validated in the validation cohort (30 percent sample), and compared against the Charlson, Elixhauser, and Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) comorbidity scores using c-statistic, net reclassification improvement, and integrated discrimination improvement. PRINCIPAL FINDINGS: In the validation cohort, the surgery-specific comorbidity score was well calibrated and performed better than the Charlson, Elixhauser, and CMS-HCC comorbidity scores for all outcomes; the performance was comparable to the CMS-HCC for 30-day readmission. For example, the surgery-specific comorbidity score (c-statistic = 0.792; 95% CI, 0.785-0.799) had greater discrimination than the Charlson (c-statistic = 0.747; 95% CI, 0.739-0.755), Elixhauser (c-statistic = 0.747; 95% CI, 0.735-0.755), or CMS-HCC (c-statistic = 0.755; 95% CI, 0.747-0.763) scores in predicting 1-year mortality. The net reclassification improvement and integrated discrimination improvement were greater for surgery-specific comorbidity score compared to the Charlson, Elixhauser, and CMS-HCC scores. CONCLUSIONS: Compared to commonly used comorbidity measures, a surgery-specific comorbidity score better predicted outcomes in the surgical population.


Assuntos
Comorbidade , Guias como Assunto , Mortalidade Hospitalar , Classificação Internacional de Doenças/normas , Risco Ajustado/normas , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos
14.
N Z Med J ; 132(1503): 13-24, 2019 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581178

RESUMO

AIM: To assess the incidence of pre-operative anaemia in patients presenting for general surgery and determine the relationship between pre-operative anaemia, transfusion and post-operative metrics including length of stay (LOS) and infectious complications. METHOD: A retrospective cohort of 1,186 patients. Stratification into two groups with and without pre-operative anaemia through propensity score matching. Logistic regression was used to determine the relationship between pre-operative anaemia, blood transfusion and infectious complications. RESULTS: The incidence of pre-operative anaemia was 17.4%. Red blood cell (RBC) transfusion was greater in those with PA than those without, 13.1% versus 0.7% (OR 21.7 (2.9-166.7, p<0.001)). In the propensity matched cohort, pre-operative anaemia was associated with an increase in LOS from 2.1 to 3.0 days (p=0.006) and increased infectious complications from 6.4% to 18.4%, (OR 3.3 (1.4-7.7), p=0.004). The risk of infectious complications was amplified in the patients receiving RBC transfusion. After adjustment for transfusion, in patients with pre-operative anaemia the OR for infectious complications became 2.3 (0.95-5.7, p=0.06) for those not transfused and 5.5 (2.0-15.3, p=0.001) for those transfused. CONCLUSION: Pre-operative anaemia is associated with an increase in hospital LOS and infectious complications. When adjusted for transfusion the effect of pre-operative anaemia alone on hospital LOS and infectious complications is not statistically significant. Expeditious investigation and treatment of PA could reduce complications and save resources.


Assuntos
Anemia , Transfusão de Sangue , Assistência Perioperatória , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Adulto , Anemia/diagnóstico , Anemia/epidemiologia , Anemia/etiologia , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Feminino , Cirurgia Geral , Hemoglobinas/análise , Humanos , Tempo de Internação , Masculino , Nova Zelândia/epidemiologia , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
15.
S Afr Med J ; 109(10): 765-770, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635575

RESUMO

BACKGROUND: Operating theatres account for a significant proportion of hospital costs. There is a paucity of data evaluating utilisation of South African (SA) state operating theatres. OBJECTIVES: To measure operating theatre utilisation and the rate of day-of-surgery cancellations (DOSCs) in a state hospital theatre complex. METHODS: A prospective audit of a state operating theatre complex at a Durban regional hospital was performed between 26 February and 26 April 2018. Times were collected for each theatre case from the entry of the patient into theatre to their departure to the post-anaesthetic care unit. This was done on weekdays between 08h00 and 16h00. The factors causing any delays and DOSCs were identified and recorded. RESULTS: Over the study period, 125 220 operative minutes were available for both elective and emergency operating theatres; 655 elective cases and 359 emergency cases were performed. Overall theatre utilisation was 55.2%, with actual operating time comprising only 36.9% of all available time. Non-operative time occupied 63.1% of all available time, split between late starts (9.3%), early list finishes (16.1%), changeover times (19.4%) and anaesthetic time (18.3%). The DOSC rate was 26.2%, with 232 cases cancelled on the day of surgery. Just under half of the DOSCs were avoidable. The most common reason for cancellation was lack of operative time. CONCLUSIONS: Measured theatre utilisation was higher than previously quoted figures for SA state hospitals, but below international benchmarks. A significant amount of time was wasted as a result of delayed first-case starts, prolonged changeovers and early terminations of lists, all of which contributed to a high DOSC rate. Before more theatre time can be made available, theatre users must first optimise use of currently available time. Further studies quantifying the effect of staff shortages in state operating theatres on inefficient use of time are required.


Assuntos
Custos Hospitalares , Hospitais Estaduais/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Hospitais Estaduais/economia , Humanos , Auditoria Médica , Salas Cirúrgicas/economia , Duração da Cirurgia , Estudos Prospectivos , África do Sul , Procedimentos Cirúrgicos Operatórios/economia
17.
Am Surg ; 85(10): 1094-1098, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657301

RESUMO

On January 9, 2018, a catastrophic debris flow devastated Montecito, California. A 30-foot wall of boulders, mud, and debris ran down the hillsides at 15 miles per hour injuring dozens and causing 21 prehospital deaths. A retrospective review was conducted of the victims from the debris flow presenting to Cottage Health. Injury patterns, procedures performed, complications, length of stay, and outcomes were analyzed. Twenty-four patients were evaluated; 15 were admitted. Of the patients admitted, the most common presenting symptoms were soft tissue injuries (100%), hypothermia (67%), craniofacial injuries (67%), corneal abrasions (53%), and orthopedic injuries (47%), as well as loss of an immediate family member during the incident (73%). Procedures included skin irrigation (93%), operative soft tissue debridement (47%), body orifice irrigation due to mud impaction (40%), and orthopedic repair of fractures and ligaments (40%). All survived to discharge. "Debris flow syndrome" can be defined as a pattern of injuries, including soft tissue injuries, hypothermia, craniofacial trauma, corneal abrasions, orthopedic injuries, and mud impaction. Managing the debris flow syndrome requires co-ordinated and specialized care.


Assuntos
Osso e Ossos/lesões , Lesões da Córnea/epidemiologia , Desastres/estatística & dados numéricos , Traumatismos Faciais/epidemiologia , Inundações/estatística & dados numéricos , Hipotermia/epidemiologia , Deslizamentos de Terra/estatística & dados numéricos , Lesões dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Idoso , California/epidemiologia , Criança , Pré-Escolar , Lesões da Córnea/etiologia , Lesões da Córnea/cirurgia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Feminino , Humanos , Hipotermia/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Síndrome , Adulto Jovem
18.
Prof Inferm ; 72(2): 100-110, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31550426

RESUMO

AIM: Currently more than 40% of surgical procedures are performed on subjects over65 years. this event has brought to the fore the concept of frailty. The aim of this work is to summarize the knowledge available in the literature in order to better understand what are the essential aspects of frailty, which impact it has on surgical outcomes of the elderly and what action we need to apply to prevent it. METHODS: A narrative literature review was conducted using the principal bibliographic biome- dical and nursing databases. RESULTS: Literature analysis revealed that frailty is a medical syndrome with multiple causes characterized by reduced physiological functions and decreased stress resistance, resulting in several adverse outcome following surgery. In the selected studies, frailty has emerged as a reliable indi- cator of increased morbidity and mortality, long-term hospital stay, post-discharge institutionali- zation, and increased healthcare costs. For frailty prevention and treatment, the most important clinical intervention is physical exercise. CONCLUSION: Identifying a patient like frail in the preoperative period allows the health profes- sional to adequately transmit information about individual perioperative risks. It should provide an opportunity to discuss the expectations and wishes of the patient for whom an adverse posto- perative outcome is expected. In addition, for high risk subjects, a clinical pathway with a well- structured discharge program can be anticipated in order to avoid hospital prolongations, thus reducing hospitalization costs.


Assuntos
Idoso Fragilizado , Fragilidade/complicações , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Humanos , Tempo de Internação , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Resultado do Tratamento
19.
Rev Col Bras Cir ; 46(4): e2211, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508734

RESUMO

OBJECTIVE: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. METHODS: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. RESULTS: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. CONCLUSION: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Assuntos
Tratamento de Emergência/classificação , Triagem/métodos , Brasil , Cor , Emergências , Tratamento de Emergência/estatística & dados numéricos , Humanos , Estudos Longitudinais , Sistemas de Informação em Salas Cirúrgicas , Salas Cirúrgicas , Estudos Retrospectivos , Especialidades Cirúrgicas/classificação , Especialidades Cirúrgicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Atenção Terciária , Fatores de Tempo
20.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-31502796

RESUMO

BACKGROUND: It is a policy objective to increase the percentage of journeys made by bicycle in Norway from the current 5 % to 10 %. Kristiansand is one of the most active cities in Norway in terms of cycling. We wished to identify the extent of injuries among cyclists admitted to the hospital. MATERIAL AND METHOD: We reviewed the medical records of patients with cycling-related injuries who were admitted to Sørlandet Hospital, Kristiansand in the period 1 January 2012 to 31 December 2015. Patient, accident, injury and treatment characteristics were recorded, as well as any sequelae after 12 months. RESULTS: Altogether 224 adults and 53 children (<16 years) were registered with cycling-related injuries, most of which (n=192, 69 %) were mild/moderate. Very severe and critical injuries were recorded in 6 (11 %) children and 22 (10 %) adults. Fractures (n=179, 65 %) and minor head injuries (n= 78, 28 %) dominated the injury panorama. Surgical treatment was undertaken in 107 (48 %) adults and 19 (36 %) children. A total of 12 (4 %) patients were transferred to the trauma centre at Oslo University Hospital Ullevål. Four adults had significant sequelae after 12 months, all related to severe head/neck injury. INTERPRETATION: A considerable proportion of serious and complex injuries require that the national guidelines for use of a trauma team be followed. Systematic and ongoing registration of cyclists' injuries in the form of a national registry could help increase our insight into the circumstances surrounding accidents and the extent of injuries related to these.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Adolescente , Adulto , Ciclismo/estatística & dados numéricos , Criança , Traumatismos Craniocerebrais/epidemiologia , Serviços Médicos de Emergência , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Tempo de Internação , Masculino , Registros Médicos , Pessoa de Meia-Idade , Noruega/epidemiologia , Estações do Ano , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores de Tempo , Transporte de Pacientes , Índices de Gravidade do Trauma
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