Complicaciones tempranas de la artroplastia total de cadera por vía anterolateral transglútea directa: estudio comparativo / Early complications in direct transgluteal anterolateral total hip arthroplasty. A comparative study

Introducción: En los últimos años, la introducción de diversas técnicas, el instrumental quirúrgico y las competencias del cirujano han contribuido a disminuir las complicaciones tempranas que pueden sobrevenir luego de una artroplastia de cadera. Las complicaciones más frecuentes son: el aflojamiento femoral, la trombosis venosa profunda y la luxación. Objetivos: Evaluar la tasa de complicaciones intraoperatorias y durante los primeros 12 meses luego de una artroplastia de cadera por vía anterolateral directa; y comparar los resultados con la serie publicada en 2007. Materiales y métodos: Estudio de cohorte retrospectivo que incluyó a pacientes operados por artrosis primaria de cadera en 2 instituciones, divididos en: grupo I (468 pacientes operados entre junio de 1999 y junio de 2003) y grupo II (344 pacientes operados entre enero de 2018 y enero de 2020). Resultados:La tasa global de complicaciones en la nueva serie fue del 4,7%. La trombosis venosa profunda fue la complicación que más se repitió, no hubo episodios de luxación. El empleo de cabezas de 22 mm de diámetro se asoció con un riesgo de luxación más alto que con cabezas más grandes (OR = 6,7; IC95% 1,2-78,2). Conclusiones: La artroplastia total de cadera con abordaje anterolateral transglúteo directo causó una baja tasa global de complicaciones dentro del primer año de la cirugía. Las complicaciones se redujeron casi a la mitad en las cirugías realizadas entre 2018 y 2020, con respecto a la serie anterior, fundamentalmente a expensas de la luxación. Nivel de Evidencia: IV

Introduction: In recent years, the advent of new procedures, surgical instruments, and surgeon skills has contributed to a reduction in the number of early complications that can arise after hip arthroplasty. Among the most frequent are femoral loosening, deep vein thrombosis, and dislocation. Objective: To evaluate the rate of intraoperative complications and complications within the first 12 months after a hip arthroplasty performed utilizing the direct anterolateral approach; and to compare the results to a series published in 2007. materials and methods: Retrospective cohort study, which included patients who underwent surgery for primary hip osteoarthritis at two institutions, divided into: group I (468 patients who were operated between June 1999 and June 2003) and group II (344 patients who were operated between January 2018 and January 2020). Results: The global rate of complications in group II was 4.7%. Deep vein thrombosis was the most frequent event, and there were no episodes of dislocation. The use of 22 mm diameter heads was associated with a higher risk of dislocation compared to surgeries in which larger heads were used (OR= 6.7 - 95% CI 1.2 - 78.2). Conclusions: Total hip replacement through a direct transgluteal anterolateral approach had a low global rate of complications within the first postoperative year. Complications were reduced by almost half in surgeries performed between 2018 and 2020, compared to the previous series, mainly in regards to dislocation. Level of Evidence: IV

Eventos adversos em pacientes cirúrgicos: incidência, características e fatores associados / Adverse events in surgical patients: incidence, characteristics and associated factors

Objetivo: Estimar a incidência de eventos adversos e identificar os fatores associados à sua ocorrência em pacientes cirúrgicos de um hospital geral de referência do interior de Minas Gerais, Brasil. Método: Estudo retrospectivo e documental realizado em 851 prontuários de pacientes submetidos a procedimentos cirúrgicos. Para rastrear e identificar o evento adverso, utilizou-se uma adaptação do método Global Trigger Tool, adotou-se a dupla revi-são dos documentos de forma independente e a análise de dados por estatística descritiva, teste χ2, t de Student e regressão logística. Resultados: Foram identificados 145 eventos adversos em 108 prontuários, mais da metade relacionada a complicações no local da cirurgia, como sangramento e infecções de sítio cirúrgico. O tempo de internação prolongado, a duração da cirurgia superior a quatro horas e procedimentos cirúrgicos classificados como con-taminados mostraram-se associados a maiores chances de ocorrência do evento adverso (p<0,001). Conclusão: Os eventos adversos na assistência cirúr-gica possuem elevada frequência e impacto de danos causados, reforçando a importância das estratégias voltadas para a segurança do paciente cirúrgico

Objective: To estimate the incidence of adverse events and identify the factors associated with their occurrence in surgical patients at a general reference hospital in the interior of Minas Gerais, Brazil. Method: Retrospective and documentary study carried out in 851 medical records of patients undergoing surgical procedures. To track and identify the adverse event, an adaptation of the Global Trigger Tool method was used, with double review of documents independently and data analysis using descriptive statistics, χ2 test, Student's t-test and logistic regression. Results: 145 adverse events were identified in 108 medical records, more than half related to complications at the surgical site, such as bleeding and surgical site infections. Prolonged hos-pital stay, duration of surgery longer than four hours and surgical procedures classified as contaminated were associated with greater chances of adverse event occurrence (p<0.001). Conclusion: Adverse events in surgical care have a high frequency and impact of damage caused, reinforcing the importance of strategies aimed at the safety of surgical patients

Objetivo: Estimar la incidencia de eventos adversos e identificar los factores asociados a su ocurrencia en pacientes quirúrgicos en un hospital general de referencia en el interior de Minas Gerais, Brasil. Método: Estudio retrospectivo y documental realizado en 851 historias clínicas de pacientes sometidos a procedimientos quirúrgicos. Para el seguimiento e identificación del evento adverso se utilizó una adaptación del método Global Trigger Tool. Se adoptó el procedimiento de doble revisión de documentos de forma independiente y el análisis de datos se realizó mediante estadística descriptiva, prueba de chi-cuadrado, prueba t de Student y regresión logística. Resultados: Se identificaron 145 eventos adversos en 108 historias clínicas. Más de la mitad se relacionaron con complicaciones en el sitio quirúrgico, como sangrado e infecciones del sitio quirúrgico. La estancia hospitalaria prolongada, la duración de la cirugía mayor a cuatro horas y la realización de procedimientos quirúrgicos clasificados como contaminados se asociaron con mayo-res posibilidades de ocurrencia de eventos adversos (p<0,001). Conclusión: Los eventos adversos en la atención quirúrgica tienen una alta frecuencia e impacto del daño causado, reforzando la importancia de las estrategias dirigidas a la seguridad de los pacientes quirúrgicos

Resultados del tratamiento quirúrgico del cáncer de recto y ano en el Hospital Español / Results of the surgical treatment of rectal and anal cancer in the Hospital Español / Resultados do tratamento cirúrgico do câncer de reto e ânus no Hospital Español

La cirugía del cáncer de recto y ano se ha desarrollado considerablemente en las últimas décadas. En función de dichos avances, se ha observado una disminución en la morbimortalidad operatoria, así como también una mejoría en el pronóstico de estos pacientes. El objetivo del presente estudio es exponer y analizar los resultados del tratamiento quirúrgico del cáncer de recto y ano en un servicio universitario. Se realizó un estudio observacional, descriptivo y retrospectivo de todos los pacientes intervenidos por cáncer de recto y ano en el Hospital Español entre 2016 y 2020. Las variables registradas fueron: variables demográficas, clínico-oncológicas, relacionadas a la morbimortalidad operatoria y a la recidiva locorregional, y la sobrevida a 5 años. El procedimiento más realizado fue la resección anterior de recto (RAR) en 11 intervenciones (58%), mientras que las 8 restantes correspondieron a amputaciones abdominoperineales (AAP) (42%). Se diagnosticaron un total de 6 complicaciones intraoperatorias en 5 pacientes, siendo la perforación del tumor la más frecuente, y un total de 18 complicaciones postoperatorias en 11 pacientes, siendo la más frecuente la infección de la herida quirúrgica abdominal. La morbilidad operatoria mayor fue de 31,6% y la mortalidad operatoria a 90 días fue de 0%. La sobrevida global a 5 años fue de 63,2%. Los resultados quirúrgicos en la presente casuística fueron comparables con los de la bibliografía consultada. Destacamos la nula mortalidad a 90 días, con resultados oncológicos similares a los reportados en la literatura.

Rectal and anus surgery have been developed considerably in the last decades. Based on these advancements, it has been observed a decrease in the surgical morbidity and mortality, as well as an improved prognosis of these patients. The aim of the present study is to expose and analyze the results of the anus and rectal surgical treatment in a university service. An observational, descriptive and retrospective study was performed of all the intervened patients for rectum and anus cancer in the Hospital Español between 2016 and 2020. We recorded data about demographic, clinical-oncologic, related to the surgical morbidity and mortality, locoregional relapse and overall 5 year survival. The most performed procedure was the rectum anterior resection in 11 interventions (58%), while the 8 left corresponded to abdominoperineal resection (42%). There was a total of 6 intraoperative complications diagnosed in 5 patients, being the tumor perforation the most frequent one, and a total of 18 postoperative complications diagnosed in 11 patients, being the surgical wound infection the most frequent one. The serious surgical morbidity was 31,6%, while the surgical mortality rate at 90 days was 0%. Overall 5 year survival was 63,2%. The surgical results in the present study about the rectum and anal cancer were comparable with the results reported on the consulted bibliography. We highlight the null mortality within 90 days, with oncologic results similar to the ones reported in the literature.

A cirurgia do câncer retal e anal desenvolveu-se consideravelmente nas últimas décadas. Com base nesses avanços, observou-se diminuição da morbimortalidade operatória, bem como melhora no prognóstico desses pacientes. O objetivo deste estudo é apresentar e analisar os resultados do tratamento cirúrgico do câncer de reto e anal em um serviço universitário. Foi realizado um estudo observacional, descritivo e retrospectivo de todos os pacientes operados por câncer de reto e ânus no Hospital Espanhol entre 2016 e 2020. As variáveis ​​registradas foram: variáveis ​​demográficas, clínico-oncológicas, relacionadas à morbidade e mortalidade operatórias e recorrência locorregional. , e sobrevida em 5 anos. O procedimento mais realizado foi a ressecção anterior do reto (RAR) em 11 intervenções (58%) e as 8 restantes corresponderam a amputações abdominoperineais (AAP) (42%). Foram diagnosticadas 6 complicações intraoperatórias em 5 pacientes, sendo a perfuração tumoral a mais frequente, e um total de 18 complicações pós-operatórias em 11 pacientes, sendo a infecção da ferida operatória abdominal a mais frequente. A morbidade operatória maior foi de 31,6% e a mortalidade operatória em 90 dias foi de 0%. A sobrevida global em 5 anos foi de 63,2%. Os resultados cirúrgicos da presente casuística foram comparáveis ​​aos da bibliografia consultada. Destacamos a mortalidade nula em 90 dias, com resultados oncológicos semelhantes aos relatados na literatura.

Risco para lesões por posicionamento cirúrgico decorrentes da posição supina / Riesgo de lesiones de posicionamiento quirúrgicoderivadas de la posición supina / Risk for surgical position injuries arising from the supine position

Objetivo: relacionar o escore de risco de lesões por posicionamento cirúrgico decorrentes da posição supina com aspectos sociodemográficos, clínicos, cirúrgicos e ocorrência de complicações. Método: estudo observacional longitudinal realizado com 89 pacientes em decúbito dorsal. Aplicadas variáveis ​​sociodemográficas e clínicas e a Escala de Risco para Desenvolvimento de Lesões por Posicionamento Cirúrgico. Adotadas análises descritivas, bivariadas e de regressão logística, considerando-se um nível de significância de α=0,05. Resultados: a idade aumentou em 1,11 vezes (p<0,001) e a obesidade em 13,77 vezes (p=0,01) a chance de aumento do risco de lesões. A proporção de dor (34,1%) e lesão por pressão na região sacrococcígea (91,7%) destacou-se nos pacientes de maior risco (p=0,05). Conclusão: obesos e idosos apresentaram maior risco de lesões. Dor e ocorrência de lesão por pressão na região sacrococcígea foram as complicações predominantes nos pacientes de maior risco (AU)

Objective:to relate the risk score for injuries due to surgical positioning resulting from the supine position with sociodemographic, clinical, surgical aspects and the occurrence of complications. Method: longitudinal observational study carried out with 89 patientsin the supine position. Sociodemographic and clinical variables and the Risk Scale for the Development of Surgical Positioning Injuries were applied. Descriptive, bivariate and logistic regression analyzes were adopted, considering a significance level ofα=0.05. Results: age increased by 1.11 times (p<0.001) and obesity by 13.77 times (p=0.01) the chance of increased risk of injury. The proportion of pain (34.1%) and pressure injury in the sacrococcygeal region (91.7%) stood out in patients at higher risk(p=0.05). Conclusion:obese and elderly people had a higher risk of injury. Pain and occurrence of pressure injury in the sacrococcygeal region were the predominant complications in patients at higher risk (AU)

Objetivo:relacionar el puntaje de riesgo de lesiones por posicionamiento quirúrgico derivado de la posición supina con aspectos sociodemográficos, clínicos, quirúrgicos y la ocurrencia de complicaciones. Método:estudio observacional longitudinal realizado con 89 pacientes en decúbito supino. Se aplicaron variables sociodemográficas, clínicas y la Escala de Riesgo para el Desarrollo de Lesiones de Posicionamiento Quirúrgico. Fueron adoptados análisis descriptivos, bivariados y de regresión logística, considerando un nivel de significancia de α=0,05. Resultados:La edad aumentó en 1,11 veces (p<0,001) y la obesidad en 13,77 veces (p=0,01) la probabilidad de mayor riesgo de lesión. La proporción de dolor (34,1%) y lesión por presión en la región sacrococcígea (91,7%) sedestacó en los pacientes de mayor riesgo (p=0,05).Conclusión:Las personas obesas y ancianas tenían mayor riesgo de lesiones. El dolor y la aparición de lesión por presión en la región sacrococcígea fueron las complicaciones predominantes en los pacientes de mayor riesgo (AU)

Abordaje quirúrgico y evolución posoperatoria en reintervenciones de complicaciones en cirugía colorrectal laparoscópica, 15 años de experiencia / Surgical approach and postoperative clinical course in reinterventions for complications following laparoscopic colorectal surgery: 15 years of experience

Resumen Objetivo: Comparar tres abordajes quirúrgicos (abierto, laparoscópico y laparoscópico convertido) para el manejo de complicaciones posoperatorias en cirugía colorrectal electiva realizadas primariamente por vía laparoscópica. Materiales y Método: Este estudio de cohorte retrospectivo incluyó pacientes reoperados después de una cirugía colorrectal laparoscópica electiva, agrupándose según la vía de abordaje de reoperación: abierta (RVA), laparoscópica (RVL) y laparoscópica convertida (RVLC). Las variables estudiadas fueron: preoperatorias (edad, sexo, puntuación ASA, IMC, comorbilidades e historia quirúrgica); operatorias (causa de reoperación, latencia para reoperación, tiempo operatorio, cirugía realizada y causa de conversión); y posoperatorias (tránsito intestinal, días de hospitalización, días de UCI, complicaciones médicas, infección del sitio quirúrgico, evisceración, transfusión y mortalidad a los 30 días). Resultados: Sin diferencias significativas para las variables preoperatorias y operatorias. En cuanto a las variables posoperatorias, el grupo de reoperaciones por vía laparoscópica, tuvo menos días de hospitalización (p = 0,012), menos días de UCI (p = 0,001) y un tránsito intestinal más rápido para reaparición de gases, heces y retorno a dieta sólida (p = 0,008, p = 0,029, p = 0,030, respectivamente). No hubo diferencias significativas en la infección del sitio quirúrgico, la evisceración, las complicaciones médicas, la transfusión y la mortalidad. Discusión y Conclusión: Este estudio reveló una mejor evolución clínica posoperatoria en el grupo de reoperación laparoscópica, con menor estancia hospitalaria y en UCI, y reducción del íleo posoperatorio, sin aumento de la morbimortalidad. Por lo tanto, la reoperación laparoscópica en cirugía colorrectal podría ser el abordaje más adecuado en pacientes debidamente seleccionados.

Aim: To compare three approaches (laparoscopic, open, and conversion of laparoscopic approach) for the management of intra-abdominal surgical complications after elective laparoscopic colorectal surgery. Materials and Method: This was a retrospective cohort study including patients who required reoperation due to an intra-abdominal surgical complication after initial elective laparoscopic colorectal surgery. Patients were grouped according to the reoperation approach-laparoscopic reoperation, laparoscopic reoperation that required conversion to open surgery, and open reoperation. Pre-operative variables (age, gender, ASA score, BMI, comorbidities, and surgical history), operative variables (cause of reoperation, latency for reoperation, operative time, surgery performed, and cause of conversion), and post-operative variables (intestinal transit, hospital days, ICU days, medical complications, surgical site infection, evisceration, transfusion and 30-day mortality), were compared between groups. Results: There were no significant differences between groups among the pre-operative and operative variables. In terms of post-operative variables, the laparoscopic reoperation group, had fewer hospital days (p = 0.012), fewer ICU days (p = 0.001), and faster intestinal transit regarding gas, stool and return to solid diet (p = 0.008, p = 0.029 and p = 0.030, respectively). However, there were no significant differences in surgical site infection, evisceration, medical complications, transfusion, and mortality. Discussion and Conclusión: This study revealed better post-operative clinical course in the laparoscopic reoperation group, with shorter hospital and ICU stay, and reduced postoperative ileus, without increased morbidity or mortality. Laparoscopic reoperation for complications after elective laparoscopic colorectal surgery may therefore be the preferred approach.

Mortalidad operatoria en cirugía mayor. Análisis retrospectivo en un Servicio de Cirugía / Operative mortality in major surgery. Retrospective analysis in a Surgery Service

RESUMEN Introducción: la propia asistencia médica provoca, en determinadas situaciones, problemas de salud que pueden llegar a ser importantes para el enfermo. El análisis de la mortalidad es uno de los parámetros utilizados para investigar la seguridad en la realización de procederes de cirugía mayor. Objetivo: determinar los factores asociados a la mortalidad operatoria en cirugías mayores. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo, de los pacientes que fallecieron tras la realización de una cirugía mayor, en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, en el período comprendido de enero de 2011 a diciembre de 2019. Resultados: la tercera edad aportó 77,3 % de los fallecidos. La hipertensión arterial, diabetes mellitus y cardiopatía isquémica fueron las principales comorbilidades. El abdomen agudo fue el diagnóstico operatorio más frecuente con 98 (58,3 %). Las complicaciones aportaron el 11,9 % de los fallecidos; los eventos adversos, 29,7 %, y por el curso natural de la enfermedad, murió un 58,3 %. El síndrome de disfunción múltiple de órganos y el shock séptico resultaron las principales causas de muerte (62 %). Conclusiones: la mortalidad operatoria estuvo asociada a factores de riesgo como edad avanzada, enfermedades crónicas y cirugía de urgencia. Los eventos adversos elevan la incidencia de mortalidad en cirugía mayor. Las infecciones son la principal causa de mortalidad operatoria (AU).

ABSTRACT Introduction: medical care itself causes, in certain situations, health problems that could be very important for the patient. The mortality analysis is one of the parameters used to study safety performing procedures of major surgery. Objective: to determine the factors associated to operatory mortality in major surgeries. Materials and methods: a retrospective, descriptive and observational study was carried out of the patients who passed away after undergoing a major surgery in the Military Hospital Dr. Mario Munoz Monroy in the period between January 2011 and December 2019. Results: 77.3 % of the deceased were elder people. The main co-morbidities were arterial hypertension, diabetes mellitus and ischemic heart disease. The most frequent surgery diagnosis was acute abdomen with 98 patients (58.3 %). Complications yielded 11.9 % of the deceases, adverse events 29.7 % and 58.3 % died due to the natural course of the disease. The organs multiple dysfunction syndrome and septic shock were the main causes of dead (62 %). Conclusions: operatory mortality was associated to risk factors like advanced age, chronic diseases and emergency surgery. The adverse events increase mortality incidence in major surgery. Infections are the main causes of operatory mortality (AU).

Delay in hip fracture surgery and its outcomes. A reflection / Retraso en cirugía de fractura de cadera y sus desenlaces. Una reflexión

Abstract Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 hours after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.

Resumen La fractura de cadera representa uno de los problemas de salud pública más grandes en los pacientes ancianos en todo el mundo, principalmente, por el riesgo de caídas y la osteoporosis típicos en esta etapa de la vida, que puede causar la muerte de hasta el 36 % de los afectados; su manejo es en principio quirúrgico y los mejores resultados se presentan cuando se interviene en las primeras 24 a 72 horas después de la fractura. El retraso en la corrección quirúrgica está asociado principalmente a factores patológicos personales no compensados, demora en la valoración perioperatoria o en los estudios complementarios prequirúrgicos, o por trámites administrativos de las empresas prestadoras de servicios de salud. Estos determinantes pueden afectar la morbimortalidad y contribuir a un deterioro funcional, incapacidad y pérdida de la calidad de vida de estos pacientes. Se hace necesaria una intervención por parte de terceros para mejorar los factores prevenibles que retrasan la osteosíntesis de este tipo de fracturas; además, asegurar educación, infraestructura, insumos, talento humano capacitado y remisión rápida de pacientes desde el primer nivel de atención. Investigar en este escenario y evaluar los efectos en la calidad de vida de estos pacientes debería ser una prioridad.

Resultados clínicos del reemplazo valvular aórtico percutáneo con dispositivo balón expandible MyVal en estenosis aórtica severa de alto riesgo / Clinical results of percutaneous aortic valve replacement using the MyVal prosthesis in patients with severe aortice stenosis and hisgh surgical risk

INTRODUCCIÓN: El dispositivo MyVal balón-expandible (Meril Life Sciences, India) fue recientemente aprobado en Chile y la Unión Europea para uso comercial. El objetivo del presente estudio fue proveer datos de eficacia y seguridad temprana y de mediano plazo en pacientes portadores de estenosis aórtica (EA) severa de alto riesgo quirúrgico sometidos a reemplazo valvular aórtico percutáneo (RVAP) con dispositivo MyVal. MATERIAL Y MÉTODOS: Se enrolaron retrospectivamente todos los pacientes con EA severa sintomática de alto riesgo según criterio del ´heart team´ local, sometidos a RVAP usando prótesis MyVal en Hospital San Borja Arriarán. RESULTADOS: La población quedó compuesta por 14 sujetos tratados entre Octubre 2018 y Noviembre 2019. La población tuvo una edad media de 82,5±7,8 años y elevado perfil de riesgo (puntaje STS promedio 11,6±5,1% de mortalidad a 30 días). Se logró éxito de dispositivo y procedimiento en 12 pacientes (86%) con caída sustancial de la gradiente aórtica media, persistente a 6 meses de seguimiento sin insuficiencia aórtica más que leve. Ocurrió falla de dispositivo en 2 pacientes, una debida a falla de entrega y otra por embolización a ventrículo, esta última con resultado de muerte. En términos de complicaciones, ocurrió una muerte precoz atribuida a disección/ruptura de aorta y 2 hemorragias mayores. La tasa de marcapasos ascendió a 3 pacientes, 23% considerando todos quienes recibieron implante. CONCLUSIÓN: El presente registro cuestiona la seguridad de MyVal en el tratamiento percutáneo de la EA severa de alto riesgo. Sin embargo, una vez logrado un implante exitoso MyVal muestra adecuados parámetros de funcionamiento, persistentes a un plazo mediano de seguimiento.

BACKGROUND: The recently approved balloon expandable MyVal (Meril Life Sciences, India) transcatheter aortic valve replacement (TAVR) prosthesis is available for commercial use in Chile and the European Union. The aim of this study is to provide early and mid-term data on the safety and efficacy of patients with severe aortic stenosis (AS) at high surgical risk undergoing TAVR using the MyVal device. METHODS: All patients with symptomatic severe AS at high surgical risk undergoing intended TAVR with MyVal prosthesis at San Borja-Arriarán Hospital entered to a retrospective registry. RESULTS: Between October 2018 and November 2019, 14 patients entered to the registry. The mean age was 82.5±7.8 years-old with a high-surgical riskprofile (mean STS score of 11.6±5.1% for 30-day mortality). Device and procedural success were achieved in 12 patients (86%) with substantial decrease in the mean aortic gradient, persistent at 6 months follow-up, all with mild or trace aortic regurgitation. Device failure occurred in 2 patients, one due to failed delivery and other due to device embolization into the left ventricle, which resulted in patient death. There were one death attributed aortic dissection/rupture and two major bleeding episodes. Three patients receiving MyVal implant required the implantation of a permanent pacemaker (23%). CONCLUSION: The present registry rises a question upon the safety of the MyVal TAVR device in high-risk AS. However, once a successfully implant was achieved the MyVal prosthesis showed an adequate performance to mid-term follow-up.

Impact of intraoperative hypotension and blood loss on acute kidney injury after pancreas surgery / Impacto da hipotensão e perda sanguínea intraoperatórias na lesão renal aguda após cirurgia de pâncreas

Abstract Purpose: This study aimed to investigate factors associated with postoperative Acute Kidney Injury (AKI) focusing on intraoperative hypotension and blood loss volume. Methods: This was a retrospective cohort study of patients undergoing pancreas surgery between January 2013 and December 2018. The primary outcome was AKI within 7 days after surgery and the secondary outcome was the length of hospital stay. Multivariate analysis was used to determine explanatory factors associated with AKI; the interaction between the integrated value of hypotension and blood loss volume was evaluated. The differences in length of hospital stay were compared using the Mann-WhitneyU-test. Results: Of 274 patients, 22 patients had experienced AKI. The cube root of the area under intraoperative mean arterial pressure of < 65 mmHg (Odds Ratio = 1.21; 95% Confidence Interval 1.01-1.45; p = 0.038) and blood loss volume of > 500 mL (Odds Ratio = 3.81; 95% Confidence Interval 1.51-9.58; p = 0.005) were independently associated with acute kidney injury. The interaction between mean arterial hypotension and the blood loss volume in relation to acute kidney injury indicated that the model was significant (p < 0.0001) with an interaction effect (p = 0.0003). AKI was not significantly related with the length of hospital stay (19 vs. 28 days, p = 0.09). Conclusion: The area under intraoperative hypotension and blood loss volume of > 500 mL was associated with postoperative AKI. However, if the mean arterial pressure is maintained even in patients with large blood loss volume, the risk of developing postoperative AKI is comparable with that in patients with small blood loss volume.

Resumo Justificativa: O presente estudo teve como objetivo examinar os fatores associados à Lesão Renal Aguda (LRA) no pós-operatório, centrando-se na hipotensão e perda de sangue intraoperatórias. Método: Estudo de coorte retrospectivo de pacientes submetidos a cirurgia de pâncreas entre Janeiro de 2013 e Dezembro de 2018. O desfecho primário foi ocorrência de LRA em até 7 dias após a cirurgia e o secundário, o tempo de hospitalização. A análise multivariada foi usada para determinar os fatores explicativos associados à LRA; a interação entre o valor integrado da hipotensão e volume de perda de sangue foi avaliada. As diferenças no tempo de hospitalização foram comparadas pelo teste U de Mann-Whitney. Resultados: Dos 274 pacientes, 22 pacientes apresentaram LRA. A raiz cúbica da área sob a pressão arterial média intraoperatória < 65 mmHg (Odds Ratio = 1,21; Intervalo de Confiança de 95% 1,01-1,45; p = 0,038) e volume de perda sanguínea > 500 mL (Odds Ratio = 3,81; Intervalo de Confiança de 95% 1,51-9,58; p = 0,005) estavam independentemente associados à lesão renal aguda. A interação entre hipotensão arterial média e volume de perda sanguínea em relação à lesão renal aguda apontou o modelo como significante (p < 0,0001) com efeito de interação (p = 0,0003). A LRA não apresentou relação significante com o tempo de hospitalização (19 vs. 28 dias, p = 0,09). Conclusões: A área sob hipotensão arterial e o volume de perda sanguínea > 500 mL no intraoperatório apresentaram associação com LRA no pós-operatório. Entretanto, se a pressão arterial média se mantém, mesmo em pacientes com grande volume de perda sanguínea, o risco de desenvolver LRA no pós-operatório é comparável ao risco dos pacientes com pequeno volume de perda sanguínea.

Fogo em campo cirúrgico - Medidas preventivas para cirurgia palpebral segura / Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.

Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain / A prevalência de complicações de catarata em pacientes com síndrome pseudoesfoliativa no noroeste da Espanha

ABSTRACT Purpose: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. Methods: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. Results: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Conclusion: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

RESUMO Objetivo: Avaliar a relação entre a síndrome de pseudoexfoliação e a prevalência de complicações e fatores clínicos relacionados em pacientes submetidos à cirurgia de catarata. Métodos: Foi realizado um estudo retrospectivo de coorte de 503 de 551 pacientes que se submeteram à cirurgia de facoemulsificação durante 2 anos em um distrito de saúde no noroeste da Espanha. No total, 120 dos 681 olhos submetidos ao procedimento apresentavam síndrome de pseudoexfoliação. Dados sobre o procedimento cirúrgico e complicações associadas foram obtidos dos prontuários médicos. As complicações incluíram qualquer combinação de ruptura da cápsula posterior, perda de humor vítreo, diálise zonular e luxação do núcleo ou do cristalino. Resultados: Encontramos uma associação significativa entre síndrome de pseudoexfoliação e diálise zonular (razão de probabilidade [RP]: 6,89; IC 95%, 2,27-20,93), a miose perioperatória (RP: 2,15; IC 95%, 1,10-4,22) e luxação do cristalino >1,5 mm (RP: 9,49; IC 95%, 0,85-105,54). Porém, ao ajustar para o risco global de complicações em pacientes com síndrome de pseudoexfolição em consideração à miopia, uso de anticoagulantes ou α-agonistas, midríase prévia e comprimento da câmara anterior, a RP diminuiu para 1,02 (IC 95%, 0,47-2,21) e não foi, portanto, significativo. Conclusão: A diálise zonular e a miose intraoperatória foram complicações intraoperatórias em pacientes submetidos à cirurgia de catarata com síndrome de pseudoexfoliação quando comparados aos controles.

Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study / Fatores de risco para hipoxemia intraoperatória durante ventilação monopulmonar: estudo observacional

Abstract Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. Methods We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. Result Patients with a left main bronchus length of less than 40 mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). Conclusions We identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.

Resumo Justificativa Os tubos endotraqueais de duplo lúmen (Double-lumen tubes - DLTs) para intubação seletiva esquerda têm sido amplamente utilizados em procedimentos torácicos, esofágicos, vasculares e mediastinais para proporcionar a separação dos pulmões. Com a falta de diretrizes claras, os anestesiologistas geralmente selecionam os tubos com base em sua experiência com os tubos endotraqueais de duplo lúmen de 35 e 37 Fr, os mais comumente usados. Nossa hipótese foi que os pacientes com um brônquio principal esquerdo de menor comprimento (< 40 mm) apresentavam uma chance maior de sofrer dessaturação durante a ventilação monopulmonar, devido à obstrução do orifício do lobo superior esquerdo com o tubo brônquico. Métodos No total, 360 pacientes submetidos à intubação seletiva esquerda mediante o uso de tubo de duplo lúmen foram incluídos no estudo entre setembro de 2014 e agosto de 2015. Idade, sexo, altura, peso e doença de base foram registrados, junto do tipo de procedimento cirúrgico e os episódios de dessaturação. Além disso, a largura da traqueia e a largura e comprimento do brônquio esquerdo foram medidos por meio de tomografia computadorizada. Resultados Os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm, submetidos à intubação seletiva esquerda com tubos endotraqueais de duplo lúmen, tiveram incidência significativamente maior de dessaturação (Odds Ratio - OR: 8,087) durante a ventilação monopulmonar. Outros fatores relacionados aos pacientes e identificados como risco de desenvolver hipoxemia foram diabetes mellitus (OR: 5,368), cirurgia de colapso direito (OR: 4,933) e IMC (OR: 1,105). Conclusões Identificamos que os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm apresentam grande chance de dessaturação, principalmente se outros fatores de risco para dessaturação estiverem presentes.

Predictors of complication after adrenalectomy

ABSTRACT Purpose: To investigate risk factors for complications in patients undergoing adrenalectomy. Materials and Methods: A retrospective search of our institutional database was performed of patients who underwent adrenalectomy, between 2014 and 2018. Clinical parameters and adrenal disorder characteristics were assessed and correlated to intra and post-operative course. Complications were analyzed within 30-days after surgery. A logistic regression was performed in order to identify independent predictors of morbidity in patients after adrenalectomy. Results: The files of 154 patients were reviewed. Median age and Body Mass Index (BMI) were 52-years and 27.8kg/m2, respectively. Mean tumor size was 4.9±4cm. Median surgery duration and estimated blood loss were 140min and 50mL, respectively. There were six conversions to open surgery. Minor and major post-operative complications occurred in 17.5% and 8.4% of the patients. Intra-operative complications occurred in 26.6% of the patients. Four patients died. Mean hospitalization duration was 4-days (Interquartile Range: 3-8). Patients age (p=0.004), comorbidities (p=0.003) and pathological diagnosis (p=0.003) were independent predictors of post-operative complications. Tumor size (p<0.001) and BMI (p=0.009) were independent predictors of intra-operative complications. Pathological diagnosis (p<0.001) and Charlson score (p=0.013) were independent predictors of death. Conclusion: Diligent care is needed with older patients, with multiple comorbidities and harboring unfavorable adrenal disorders (adrenocortical carcinoma and pheocromocytoma), who have greater risk of post-operative complications. Patients with elevated BMI and larger tumors have higher risk of intra, but not of post-operative complications.

Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy

ABSTRACT Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown. Material and methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks. Oncologic outcomes were stratified by NCCN disease risk for comparison. The associations of time interval with clinicopathologic features and survival were evaluated using multivariate logistic and Cox regression analyses. Results: Median time from biopsy to surgery was 61 days (IQR 37, 84). Median follow-up after RP was 7.1 years (IQR 4.2, 11.7) while the overall perioperative complication rate was 19.7% (1,448/7,350). Adjusting for pre-operative variables, men waiting 12-26 weeks until RP had the highest likelihood of nerve sparing (OR: 1.45, p = 0.02) while those in the 4-6 week group had higher overall complications (OR: 1.33, p = 0.01). High risk men waiting more than 6 months had higher rates of biochemical recurrence (HR: 3.38, p = 0.05). Limitations include the retrospective design. Conclusions: Surgery in the 4-6 week time period after biopsy is associated with higher complications. There appears to be increased biochemical recurrence rates in delaying RP after biopsy, for men with both low and high risk disease.

Avaliação pré-operatória por imagem da hidradenite supurativa / Preoperative imaging assessment of hidradenitis suppurativa

A hidradenite supurativa (HS) é uma doença inflamatória crônica da pele caracterizada por apresentar nodulações subcutâneas, dolorosas e com sinais flogísticos, inicialmente enrijecidas e que evoluem para consistência amolecida. Ocorre em 1 a 4% da população mundial. A sua etiologia ainda é pouco conhecida, sugere-se que aconteça devido à oclusão do ducto apócrino dos folículos pilosos por fatores precipitantes como fricção de tecido adiposo, higiene precária, entre outras. Seu diagnóstico é eminentemente clínico, pela identificação de lesões típicas recorrentes em forma de nodularidades, abcessos, tratos fistulosos ou cicatrizes. Não há testes patognomônicos. Sua evolução é variável e de difícil manejo, o qual pode ser feito com terapia tópica, sistêmica ou por exérese cirúrgica. Este trabalho revisa a avaliação por imagem da hidroadenite supurativa e demonstra imagens de um caso avaliado por ressonância magnética. A avaliação por exames de imagem, apesar de pouco específica para firmar diagnóstico, é muito útil na determinação da extensão da doença, assim como na exclusão de diagnósticos diferenciais, destacando-se o papel da ressonância magnética na avaliação das lesões anogenitais, com potencial de reduzir recorrências.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful deep-seated skin nodules with phlogistic signs, which are initially hard and progress to have a soft consistency. It occurs in 1­4% of the world population. Etiology of HS is still poorly understood and is suggested to occur due to occlusion of the apocrine duct of the hair follicles by triggering factors such as friction of the adipose tissue and poor hygiene, among others. Diagnosis is eminently clinical, through the identification of typical recurrent lesions that include nodules, abscesses, sinus tracts, or scars. There are no pathognomonic tests used to confirm its presence. Progression is variable and difficult to manage, which can be done with topical or systemic therapy or surgical excision. This work reviews the imaging assessment of HS and shows images of a case assessed by magnetic resonance imaging. Imaging assessment, although not specific enough for a diagnosis, is useful to determine the extent of the disease and to exclude differential diagnoses. Moreover, magnetic resonance imaging has an important role in the assessment of anogenital lesions and a potential to reduce recurrences.

Coronary artery bypass surgery in Brazil: analysis of the national reality through the bypass registry

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

Tratamiento endoscópico subcutáneo de la diastasis de músculos rectos y de otros defectos de línea media / Subcutaneous endoscopic repair of diastasis recti and other midline defects

Antecedentes: la diastasis de rectos constituye la separación de la línea media o línea alba, originada en una laxitud de las fibras entrecruzadas de la aponeurosis de ambos músculos rectos. En la actualidad se discute su corrección quirúrgica, existiendo una multiplicidad de factores que lo justifican. Objetivo: analizar la factibilidad y la seguridad del abordaje endoscópico subcutáneo para efectuar la plicatura de músculos rectos, y la corrección de otros defectos de la línea media, en pacientes sin lipodistrofia abdominal. Material y métodos: entre marzo de 2014 y febrero de 2017 fueron abordados por esta vía 42 pacientes con diastasis asociada a otros defectos de línea media. Se analizaron datos demográficos, características de la diastasis, tamaño de los defectos, tiempo operatorio, estadía hospitalaria y complicaciones. El dolor posoperatorio se midió mediante una escala visual análoga, y se valoró la morbilidad y recurrencia mediante ultrasonografía. Resultados: 42 pacientes fueron intervenidos por vía endoscópica. Un 76% fueron de sexo femenino, con una edad promedio de 39 años. En el 93% de los casos, la diastasis fue supraumbilical e infraumbilical, y su tamaño promedio fue de 5,5 cm. Los defectos asociados en su mayoría fueron hernia umbilicales. No se registraron complicaciones intraoperatorias, con un tiempo quirúrgico promedio de 80 minutos. La intensidad de dolor posoperatorio fue de 4,1 puntos. La morbilidad más asociada fue el seroma. Conclusiones: la reparación endoscópica subcutánea de la diastasis de rectos, asociada a otros defectos de la línea media, es factible y segura de realizar. Aporta ventajas estéticas considerables, permitiendo su corrección con complicaciones mínimas.

Background: Diastasis recti is the separation of the midline or linea alba due to laxity of the intercrossed fibers of both aponeurosis of the rectus abdominis muscles. Although the surgical correction of this condition is still under debate, many factors justify it. Objective: The aim of this study was to analyze the feasibility and safety of the endoscopic subcutaneous approach for plication of the rectus muscles associated with other midline defects repair in patients without abdominal lipodystrophy. Material and methods: Between March 2014 and February 2017, 42 patients underwent subcutaneous endoscopic repair of diastasis recti and other midline defects. The demographic data, the characteristics and size of the defects, the surgical time, hospital stay and complications were analyzed. Postoperative pain was measured using a visual analogue scale. Ultrasound was used to evaluate morbidity and recurrence. Results: A total of 42 patients underwent the endoscopic approach; 76% were women and mean age was 39 years. In 93% of the cases, diastasis was supraumbilical and infraumbilical, with a mean size of 5.5 cm. Umbilical hernias were the most common associated defects. No intraoperative complications were reported. Mean surgical time was 80 minutes; the intensity of posoperative pain was 4.1 points and seroma was the most common complications. Conclusions: Subcutaneous endoscopic repair of diastasis recti and other midline defects is a feasible and safe procedure that allows the simultaneous correction of both conditions with minimal complications and esthetic benefits.

Risk of bleeding complications in percutaneous biliary drainage: the paradox of the normal hemostasis / Risco de complicações de sangramento na drenagem biliar percutânea: o paradoxo da hemostase normal

ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.

Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017 / Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017

Background: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. Aim: To describe PCA events at a Clinical Hospital in Santiago, Chile. Material and Methods: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. Results: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. Conclusions: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.