Sistematização da assistência de enfermagem ao paciente com fratura de colo de fêmur: relato de experiência / Systematization of nursing care for patients with femoral neck fracture: experience report

Objetivo: descrever a aplicação da Sistematização da Assistência de Enfermagem a um paciente com Fratura de Colo de Fêmur no período perioperatório. Metodologia: Relato de experiência realizado no centro cirúrgico de um hospital geral, o qual atende demanda espontânea da capital e do interior do estado da Bahia. O período de realização do estudo foi em agosto de 2019, na cidade de Feira de Santana- BA. Esta experiência foi fruto da vivência de acadêmicos de enfermagem do sexto semestre da Universidade Estadual de Feira de Santana. Foram respeitados os aspectos éticos da Resolução 466/2012. Resultados: Foi aplicada a Sistematização da Assistência de Enfermagem no Perioperatório a paciente idoso com fratura de colo de fêmur, conforme cinco fases do processo de enfermagem: Histórico, Diagnóstico, Planejamento, Implementação e Avaliação. Ressalta-se que o referido caso foi analisado de acordo com as Diretrizes Terapêuticas para Fratura de Colo de Fêmur, que demostraram a importância da aplicação da sistematização para um cuidado diferenciado ao paciente idoso com diagnóstico de fratura de fêmur, considerando que a população idosa cada vez mais vem alcançando a longevidade e as quedas são um dos eventos adversos que mais acometem essa população, seguido pela fratura. Conclusão: Este estudo pretende contribuir como instrumento gerencial e de cuidado relevante para a instituição no centro cirúrgico que visem acelerar o tempo de alta, minimizar o risco de complicações, reduzir os custos e favorecer a qualidade de vida dos pacientes idosos com fratura de fêmur a partir da sistematização da assistência de enfermagem perioperatória.

Objective: Describe the application of Nursing Care Systematization to a patient with a femoral neck fracture during the perioperative period. Methodology: Report of an experience carried out in the operating room of a general hospital, which cares for the spontaneous demand of the capital city and the interior of the state of Bahia. The study was held in August 2019 in the city of Feira de Santana, in the state of Bahia. This was the result of the academic experience of nursing students in the sixth semester at the State University of Feira de Santana. The ethical aspects of Resolution 466/2012 were respected. Results: Perioperative Nursing Care Systematization was applied to an elderly patient with a femoral neck fracture, according to five phases of the nursing process: History, Diagnosis, Planning, Implementation, and Evaluation. It emphasizes whether the case was analyzed according to the Therapeutic Guidelines for Femoral Neck Fractures, which demonstrated the importance of applying systematization for differentiated care for elderly patients diagnosed with femoral fractures, considering that the elderly population is living longer, and falls are one of the adverse events most frequently affecting such population, followed by fracture. Conclusion: This study aims at contributing as a relevant management and care instrument for the institution of any surgical center that aims at speeding up discharge time, minimizing the risk of complications, reducing costs, and favoring the quality of life of elderly patients with femur fracture from the systematization of perioperative nursing care.

Baja incidencia y alta mortalidad por COVID-19 en Cirugía General durante la primera ola de la pandemia / Low incidence and high COVID-19 mortality in a General Surgery during the first wave of the pandemia

Resumen Introducción y objetivo: La infección por coronavirus (COVID-19) en pacientes intervenidos es causa de importante mortalidad posoperatoria, aunque su incidencia es variable. El objetivo primario fue evaluar la incidencia de COVID-19 en los pacientes intervenidos en nuestro Servicio de Cirugía General y Digestiva, durante el máximo impacto de la pandemia en España. El objetivo secundario fue evaluar la mortalidad perioperatoria y determinar los factores de riesgo para la infección por COVID-19. Materiales y Método: Estudio observacional retrospectivo de pacientes consecutivos sometidos a Cirugía General y Digestiva con ingreso superior a 24 h, del 1 de febrero de 2020 al 30 de abril de 2020 en un hospital terciario de Madrid, España. Resultados: Se analizaron 441 pacientes: 423 sin COVID-19 y 18 con COVID-19. Las características preoperatorias y operatorias fueron similares para ambos grupos, salvo por el grado ASA (American Society of Anesthesiologists). La incidencia de COVID-19 en los pacientes intervenidos fue del 4,1%. La mortalidad posoperatoria fue elevada, del 22,2% en pacientes con COVID-19, frente a un 2,8% en pacientes no COVID-19 (p: 0,003). Los factores de riesgo para la infección por COVID-19 en los pacientes intervenidos fueron una estancia hospitalaria prolongada (OR: 1,035 [95% CI: 1,007-1,065]) y la reintervención quirúrgica (OR: 5,025 [95% CI: 1,650-15,311]). Conclusión: Las intervenciones durante la pandemia de COVID-19 causaron una baja tasa de infección con elevada mortalidad posoperatoria. La intervención quirúrgica debe valorarse frente al riesgo adicional para el paciente en contextos de alta transmisión.

The impact of coronavirus disease (COVID-19) in intervened patients seems to cause large postoperative mortality, although its incidence varies among centres. Primary aim was to evaluate the incidence of COVID-19 on the patients intervened in our General and Digestive Surgery Department, during the maximum impact of the pandemia in Spain. Secondary outcomes were evaluating perioperative mortality, and determining the risk factors for COVID-19 infection. Materials and Method: Retrospective single centre study of consecutive patients undergoing general and gastrointestinal surgical procedures with more than 24 hours of inhospital stay, from February 1, 2020 to April 30, 2020 in a tertiary referral centre in Madrid, Spain. Results: A total of 441 patients were analysed: 423 were non-COVID-19 patients while 18 of them had COVID-19. Preoperative and operative characteristics were similar for both groups, unless for the American Society of Anesthesiologists grade. The incidence of COVID-19 in our intervened patients was 4.1%. Postoperative mortality was high among surgical patients with COVID-19, with a mortality rate of 22.2% compared to a 2.8% in non COVID-19 patients. The risk factors for COVID-19 infection were a prolonged postoperative stay (OR: 1.035 [95% CI: 1.007-1.065]) and the need of a reintervention (OR: 5.025 [95% CI: 1.650-15.311]). Conclusion: Surgical interventions during the COVID-19 pandemia resulted in a low infection rate but a high postoperative COVID-19 mortality. The decision to intervene must be carefully balanced against the additional risk for patients in a high transmission setting.

Mortalidad perioperatoria / Perioperative mortality

Introducción: La tasa de mortalidad perioperatoria representa un indicador global del acceso seguro a la atención quirúrgica y anestesiológica. Objetivo: Caracterizar los pacientes fallecidos durante el perioperatorio en intervenciones quirúrgicas. Métodos: Se realizó un estudio descriptivo transversal en el servicio de Anestesiología del Hospital Clínico Quirúrgico Arnaldo Milián Castro, provincia Villa Clara, en el periodo período de enero de 2015 a diciembre de 2018. La población estuvo constituida por los pacientes intervenidos quirúrgicamente en dicho hospital (N: 133 724). La muestra fueron los pacientes fallecidos durante el período intraoperatorio y primeras 24 h tras la intervención quirúrgica (n: 77). Resultados: La tasa de mortalidad perioperatoria general fue de 5,76/10 000. Incidencia de mortalidad mayor en hombres (59,7 por ciento), ancianos (75,3 por ciento), con varias comorbilidades asociadas (51,9 por ciento), clase 4 de la ASA (41,5 por ciento), riesgo quirúrgico grupo II (62,3 por ciento), cirugía abdominal (63,6 por ciento), intervenciones de urgencia (88,3 por ciento), bajo una técnica anestésica general (84,4 por ciento) y en el período postoperatorio 24 h (68,8 por ciento). El shock séptico constituyó la principal causa de mortalidad (48,1 por ciento). Conclusiones: Predominaron las defunciones en ancianos con comorbilidades asociadas, alto riesgo anestésico y quirúrgico, intervenidos de urgencia bajo anestesia general, con el shock séptico como principal causa de muerte. La tasa de mortalidad perioperatoria fue similar a naciones de desarrollo socioeconómico equivalente(AU)

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care. Objective: To characterize patients who deceased during the perioperative period in surgical interventions. Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77). Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7 percent), elderlies (75.3 percent), patients with several associated comorbidities (51.9 percent), those classified as ASA-IV (41.5 percent), those belonging to group II for surgical risk (62.3 percent), cases of abdominal surgery (63.6 percent), emergency interventions (88.3 percent), patients under general anesthetic technique (84.4 percent), and at 24 hours after the postoperative period (68.8 percent). Septic shock was the main cause of mortality (48.1 percent). Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development(AU)

Fístula aorto-duodenal primaria: caso clínico / Primary aorto-duodenal fistula: clinical case

Resumen Introducción Las fístulas aorto-entéricas (FAE) son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Caso clínico Reportamos el caso de una mujer de 66 años intervenida por un aneurisma sacular aórtico abdominal (AAA) yuxtarrenal, con rotura contenida, fistulizado al duodeno. Presentó una hemorragia digestiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio. La paciente fue sometida a reparación quirúrgica urgente con instalación de una prótesis aórtica bifemoral y resección duodenal. En el postoperatorio inmediato presentó una trombosis parcial de las ramas de la prótesis aórtica e isquemia de extremidades, siendo reintervenida exitosamente. Discusión La FAE es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación de la fístula. Es preferible la resección duodenal ante la simple duodenorrafia.

Introduction Aorto-enteric fistulae (AEF) are a rare cause of gastrointestinal bleeding. The prognosis tends to be ominous, depending greatly in a high level of clinical suspicion and prompt diagnosis. Clinical case We report a case of a 66-year-old female with a saccular juxta-renal abdominal aortic aneurysm (AAA), with a contained rupture. The patient was urgently submitted to surgical repair using an bifemoral aortic prosthesis. A duodenal partial resection was performed. During the immediate postoperative time she presented partial thrombosis of prosthesis and ischemia of lower extremities so she was reoperated successfully. Discussion AEF is a potentially fatal cause of gastrointestinal bleeding. Diagnosis is still troublesome due to its vague presentation and it should always be considered when facing gastrointestinal haemorrhage with no apparent cause. There are several surgical approaches that should be pondered case to case without delaying the repair of the defect.

Intervenção educativa e indicadores de obesidade de candidatos à gastroplastia: estudo quase-experimental / Intervención educativa e indicadores de obesidad de candidatos a gastroplastía: estudio cuasi experimental / Educational intervention and obesity indicators of gastroplasty candidates: a quasi-experimental study

Resumo Objetivo Avaliar o efeito de intervenção educativa nos indicadores de obesidade de pacientes em pré-operatório da cirurgia bariátrica. Métodos Estudo quase-experimental realizado de junho a agosto de 2017, em hospital de referência na realização de cirurgias bariátricas no Ceará, com 55 participantes (28 no Grupo Controle e 27 no Grupo Intervenção). O Grupo Controle foi submetido às orientações verbais sobre o procedimento cirúrgico, de rotina da instituição. O Grupo Intervenção, além de tal rotina, foi submetido à intervenção educativa realizada por enfermeira, semanalmente, a partir de leitura de cartilha educativa com informações e esclarecimentos acerca do perioperatório, durante três semanas. Para análise foram utilizados o teste de Wilcoxon para comparar os indicadores de obesidade entre os momentos de coleta e o teste de Mann-Whithey para comparar as variáveis entre os grupos. Resultados As variáveis redução de peso, índice de massa corporal, circunferência abdominal, relação cintura estatura e percentual do excesso de peso tiveram aumento no Grupo Controle e redução, com significância estatística, no Grupo Intervenção. Conclusão O acesso às informações no material impresso foi eficaz para aprendizagem e contribui significativamente para redução de indicadores de obesidade, os quais são clinicamente importantes para realização da cirurgia bariátrica. O uso de tecnologias educacionais deve ser estimulado no preparo pré-operatório de candidatos à gastroplastia.

Resumen Objetivo Evaluar los efectos de la intervención educativa en los indicadores de obesidad de pacientes en preoperatorio de cirugía bariátrica. Métodos Estudio cuasi experimental realizado de junio a agosto de 2017, en hospital de referencia en realización de cirugías bariátricas en el estado de Ceará, con 55 participantes (28 en el Grupo de Control y 27 en el Grupo Experimental). Al Grupo de Control se le dieron instrucciones verbales sobre el procedimiento quirúrgico, de rutina de la institución. El Grupo Experimental, además de recibir dicha rutina, recibió una intervención educativa realizada por enfermera, semanalmente, a partir de la lectura de manual educativo con información y explicaciones sobre el perioperatorio, durante tres semanas. Para el análisis se utilizó la Prueba de Wilcoxon para comparar los indicadores de obesidad entre los momentos de recolección y la prueba de Mann-Whitney para comparar las variables entre los grupos. Resultados Las variables reducción de peso, índice de masa corporal, circunferencia abdominal, relación cintura/estatura y porcentaje de exceso de peso aumentaron en el Grupo de Control y se redujeron, con significación estadística, en el Grupo Experimental. Conclusión El acceso a la información del material impreso fue eficaz para el aprendizaje y contribuyó significativamente para la reducción de indicadores de obesidad, los cuales son clínicamente importantes para la realización de la cirugía bariátrica. El uso de tecnologías educativas debe ser estimulado en la preparación preoperatoria de candidatos a gastroplastía.

Abstract Objective To assess the effect of educational intervention on obesity indicators in preoperative bariatric surgery patients. Methods A quasi-experimental study conducted from June to August 2017 at a referral hospital for bariatric surgery in Ceará, with 55 participants (28 in the Control Group and 27 in the Intervention Group). The Control Group was submitted to verbal instructions on the surgical procedure, routine of the institution. The Intervention Group, in addition to this routine, underwent an educational intervention performed by a nurse, weekly, from reading an educational booklet with information and clarifications about the perioperative period for three weeks. The Wilcoxon test was used for analysis to compare obesity indicators between collection times and the Mann-Whitney test to compare variables among groups. Results The variables weight reduction, body mass index, waist circumference, waist-to-height ratio and percentage of overweight increased in the Control Group and statistically significantly reduced in the Intervention Group. Conclusion Access to information in the printed material was effective for learning and significantly contributes to the reduction of obesity indicators, which are clinically important for bariatric surgery. The use of educational technologies should be encouraged in the preoperative preparation of gastroplasty candidates.

Prospective evaluation of the effect of adherent perinephric fat on outcomes of robotic assisted partial nephrectomy following elimination of the learning curve

ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.

Avaliação da capacidade funcional de pacientes atendidos em um ambulatório perioperatório do Distrito Federal / Evaluation of the functional capacity of patients attended in a perioperative outpatient clinic of the Federal District / Evaluación de la capacidad funcional de pacientes atendidos en un ambulatorio perioperatorio del Distrito Federal

Objetivo: Identificar a capacidade funcional de pacientes atendidos no ambulatório de avaliação perioperatória do Hospital Regional do Gama (APA-HRG), no Distrito Federal, bem como estabelecer relação com as estratificações cardíacas utilizadas. Método: Estudo observacional, descritivo, retrospectivo, com coleta de dados dos registros nos prontuários das consultas pré-operatórias de 292 pacientes triados como alto risco, executadas por equipe de médicos anestesiologistas e enfermeiros, realizadas no APA-HRG no período de junho de 2014 a junho de 2016. Resultados: O perfil da amostra constituiu-se, em sua maioria, por indivíduos do gênero feminino (78,77%), maiores de 60 anos (48,35%), não obesos (69,44%), encaminhados principalmente pela clínica ginecológica (39,79%), diagnosticados com hipertensão arterial sistêmica (44,17%) e tabagistas (12,67%). A capacidade funcional foi classificada como excelente em 63,18% (>10 equivalentes metabólicos) dos pacientes. Foi constatada associação significativa entre os equivalentes metabólicos e as estratificações da American Society of Anesthesiologists, do Índice de Risco Cardíaco Revisado e da Classificação Funcional da New York Heart Association. Conclusão: A maioria dos prontuários analisados era de pacientes com excelente capacidade funcional, apresentando associação significativa com as estratificações estudadas.

Objective: To identify the functional capacity of patients attended at the perioperative evaluation outpatient clinic of the Regional Hospital of Gama (APA-HRG), Federal District, as well as establish relationship with the cardiac stratifications employed. Method: Observational, descriptive, retrospective study with data collection of records from preoperative consultations of 292 patients screened as high risk, performed by a team of medical anesthesiologists and nurses, performed in the APA-HRG in the period from June 2014 to June 2016. Results: The sample profile consisted, for the most part, of female subjects (78.77%), of over 60 years of age (48.35%), not obese (69.44%), referred mainly by the gynecological clinic (39.79%), diagnosed with systemic arterial hypertension (44.17%) and smokers (12.67%). Functional capacity was classified as excellent in 63.18% (>10 metabolic equivalents) of patients. There was a significant association between the metabolic equivalents and the stratification of the American Society of Anesthesiologists, the Revised Cardiac Risk Index and the Functional Classification of the New York Heart Association. Conclusion: Most of the charts analyzed were of patients with excellent functional capacity, presenting a significant association with the stratifications studied.

Objetivo: Identificar la capacidad funcional de pacientes atendidos en el ambulatorio de evaluación perioperatoria del Hospital Regional do Gama (APA-HRG), en el Distrito Federal, así como establecer relación con las estratificaciones cardíacas utilizadas. Método: Estudio observacional, descriptivo, retrospectivo, con colecta de datos de los registros en los historiales médicos de las consultas preoperatorias de 292 pacientes seleccionados como alto riesgo, ejecutadas por equipo de médicos anestesistas y enfermeros, realizadas en el APA-HRG en el período de junio de 2014 a junio de 2016. Resultados: El perfil de la muestra se constituye, en su mayoría, por individuos del género femenino (78,77%), mayores de 60 años (48,35%), no obesos (69,44%), encaminados principalmente por la clínica ginecológica (39,79%), diagnosticados con hipertensión arterial sistémica (44,17%) y tabaquistas (12,67%). La capacidad funcional fue clasificada como excelente en un 63,18% (>10 equivalentes metabólicos) de los pacientes. Fue constatada asociación significativa entre los equivalentes metabólicos y las estratificaciones de la American Society of Anesthesiologists, del Índice de Riesgo Cardíaco Revisado y de la Clasificación Funcional de la New York Heart Association. Conclusión: La mayoría de los historiales médicos analizados era de pacientes con excelente capacidad funcional, presentando asociación significativa con las estratificaciones estudiadas.

Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases

ABSTRACT Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution

ABSTRACT Purpose To compare perioperative and pathological results in different approaches of robotic or laparoscopic radical prostatectomy. Materials and Methods We retrospectively reviewed 206 patients diagnosed with prostate cancer (PC) from June 2016 to October 2017 in the First Affiliated Hospital of Nanjing Medical University. A total of 132 cases underwent robot-assisted laparoscopic radical prostatectomy (RLRP) including 54 patients on transperitoneal robot-assisted laparoscopic radical prostatectomy (Tp-RLRP) and 78 on extraperitoneal robot-assisted laparoscopic radical prostatectomy (Ep-RLRP). Meanwhile, 74 patients performed with extraperitoneal laparoscopic radical prostatectomy (Ep-LPR) were also included. Perioperative and pathological data were compared among these groups. Results All operations were completed without conversion. There was no significant difference in basic and pathological characteristics of patients between each two groups. In Tp-RLRP vs. Ep-RLRP: Significant differences were found in the comparison in total operation time [235.98 ± 59.16 vs. 180.45 ± 50.27 min, P = 0.00], estimated blood loss (EBL) [399.07 ± 519.57 vs. 254.49 ± 308.05 mL, P = 0.0473], postoperative pelvic drainage time [5.37 ± 2.33 vs. 4.24 ± 3.08 d, P = 0.0237] and postoperative length of stay [8.15 ± 3.30 vs. 6.49 ± 3.49 d, P = 0.0068] while no significant differences were detected in other variables. In Ep-RLRP vs. Ep-LPR: Longer total operation time was observed in Ep-RLRP when compared to Ep-LPR [180.45 ± 50.27 vs. 143.80 ± 33.13 min, P = 0.000]. No significant differences were observed in other variables. Conclusion In RLRP, Ep-RLRP was proved a safe and effective approach based on the perioperative results compared to Tp-RLRP. Ep-RLRP and Ep-LPR provides equivalent perioperative and pathological outcomes.

Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during cabg: a double-blind controlled randomized trial

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Potentially modifiable predictors for renal replacement therapy in patients with cardiac surgery associated-acute kidney injury: a propensity score-matched case-control study

Abstract Objective: To discover potentially modifiable perioperative predictors for renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: A cohort of 1773 consecutive cardiac surgery patients with postoperative acute kidney injury (AKI) from January 2013 to December 2015 were included retrospectively. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was CSA-AKI requiring renal replacement therapy (AKI-RRT). The initiation of RRT was based on clinical judgment regarding severe volume overload, metabolic abnormality (e.g., acidosis, hyperkalemia), and oliguria. Patients with AKI-RRT were matched 1:1 with patients without AKI-RRT by a propensity score, to exclude the influence of patients' demographics, comorbidities, and baseline renal function. Multivariable regression was performed to identify the predictors in the matched sample. Results: AKI-RRT occurred in 4.4% of the entire cohort (n=78/1773), with 28.2% of in-hospital mortality (n=22/78). With the propensity score, 78 pairs of patients were matched 1:1 and the variables found to be predictors of AKI-RRT included the contrast exposure within 3 days before surgery (odds ratio [OR]=2.932), central venous pressure (CVP) >10 mmHg on intensive care unit (ICU) admission (OR=1.646 per mmHg increase), and erythrocyte transfusions on the 1st day of surgery (OR=1.742 per unit increase). Conclusion: AKI-RRT is associated with high mortality. The potentially modifiable predictors found in this study require concern and interventions to prevent CSA-AKI patients from worsening prognosis.

Survival and perioperative morbidity of totally laparoscopic versus open gastrectomy for early gastric cancer: analysis from a single latin american centre / Comparação da sobrevida e morbidade perioperatória da gastrectomia totalmente laparoscópica vs. laparotômica para tratamento do câncer gástrico precoce em um centro latino-americano

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

Comparative evaluation of magnetic resonance cholangiopancreatography and perioperative cholangiography in patients with suspect choledocholithiasis / Avaliação comparativa da colangiopancreatografia por ressonância magnética e da colangiografia peroperatória na suspeita de coledocolitíase

ABSTRACT Background: Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. Aim: To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. Methods: This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. Results: It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. Conclusions: The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.

RESUMO Racional: A colelitíase é afecção de alta prevalência, sendo a coledocolitíase complicação de elevada morbidade e que necessita de métodos acurados para seu diagnóstico. Objetivo: Avaliar o perfil populacional de pacientes com suspeita de coledocolitíase e verificar o valor estatístico da colangiopancreatografia por ressonância magnética, da ultrassonografia, dos exames laboratoriais e da clínica desses pacientes e compará-los aos resultados obtidos pela colangiografia peroperatória. Métodos: Trata-se de estudo longitudinal, de coorte, retrospectivo, no qual foram avaliados 76 pacientes com diagnóstico de colelitíase e suspeita de coledocolitíase. Resultados: Observou-se que na presença de dilatação das vias biliares ou coledocolitíase na ultrassonografia havia risco quatro e oito vezes maior, respectivamente, de colangiografia peroperatória positiva para coledocolitíase. Para cada unidade de aumento na fosfatase alcalina sérica houve aumento em 0,3% no risco de colangiografia peroperatória positiva para coledocolitíase. Na presença de dilatação das vias biliares na ultrassonografia ou clínica de pancreatite havia risco quatro e cinco vezes maior, respectivamente, de colangiopancreatografia por ressonância magnética positiva para coledocolitíase. Na presença de colangiopancreatografia por ressonância magnética positiva para coledocolitíase o risco foi 104 vezes maior de colangiografia peroperatória positiva para coledocolitíase. Conclusão: A colangiopancreatografia por ressonância magnética para seguimento propedêutico tem boa acurácia para o diagnóstico de coledocolitíase, e concordante com os resultados obtidos na colangiografia peroperatória. O método é menos invasivo, com menores riscos ao paciente e com diminuição do tempo cirúrgico dispendido para realização da colangiografia peroperatória.

Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

ABSTRACT Purpose: Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors. Materials and Methods: We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups. Results: We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02). Conclusions: The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN.

Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs

OBJECTIVE: The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS: In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS: The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS: Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.

Nylon, fibrin glue and Vicryl®- the graft fixation techniques in the conjunctival autotransplant for the treatment of primary pterygium / Nylon, cola de fibrina e Vicryl® - Avaliação da fixação do enxerto no autotransplante conjuntival para tratamento do pterígio primário

Abstract Objective: to compare nylon, fibrin glue and Vicryl® in the conjunctival autograft for treatment of primary pterygium. Methods: Prospective study approved by the Ethics Committee following the Declaration of Helsinki. 89 eyes were underwent pterygium excision and conjunctival autograft. They were grouped according to the technique: fibrin glue, nylon 10-0 and 8-0 Vicryl® and followed up for 3 months. Surgical Time, intra and postoperative symptoms, biomicroscopic signs, ocular discomfort ( by Visual Analogue Scale), aesthetic appearance and recurrences (day 21, 90 and 3 years) were evaluated. Results: The operative time was shorter with the fibrin glue (p<0.001). As to intraoperative symptomatology, burning sensation predominated with Vicryl® (p=0,012). The postoperative symptoms and signs: on day 1- secretion with fibrin glue (p=0.02), foreign body sensation (p=0.017) and subconjunctival hemorrhage (p=0.022) with Vycril®; on day 7- chemosis (p=0.035), hyperemia (p<0.001) and eyelid edema (p=0.011) with Vicryl®; on day 21-foreign body sensation (p=0.001) and conjunctival hyperemia (p<0.001) with nylon; on day 90- dry eye (p=0.005) with Vicryl®. Ocular discomfort was greater with Vycril® (p=0.015) on day 7. Final aesthetic appearance was superior with fibrin glue (p=0.003). The recurrences was greater on day 90: 20,7%(nylon), 10%(fibrin glue) and 19%(Vicryl®) (p=0.496) and after 3 years: 4.8% in NG, 0% in FGG, and 5.3% in VG (p=0.536). Conclusion: Fibrin glue showed efficacy, rapidity, less postoperative discomfort and better final aesthetic appearance. Vicryl® showed significant intraoperative and early postoperative symptoms and obvious signs of inflammation, beside ocular discomfort on day 7. Nylon caused more foreign body sensation and conjunctival hyperemia until its removal. The signs of recurrence were similar among the groups.

Resumo Objetivo: comparar o nylon, a cola de fibrina e o Vicryl® no autotransplante conjuntival para o tratamento do pterígio primário. Métodos: estudo prospectivo aprovado pelo Comitê de Ética seguindo a Declaração de Helsinque. 89 olhos foram submetidos à excisão de pterígio e autotransplante conjuntival, agrupados conforme as técnicas: nylon 10-0, cola de fibrina, e Vicryl® 8-0, acompanhados por 3 meses. Tempo cirúrgico, sintomas intra e pós-operatórios, sinais biomicroscópicos, desconforto ocular (Escala Analógica Visual), aspecto estético, recorrências no 21º e 90º dia pós-operatório e aos 3 anos. Resultados: O tempo operatório foi menor com a cola de fibrina e maior com Vicryl® (p<0,001). Sintomatologia intra-operatória: a ardência predominou com Vicryl® (p=0,012). Sintomas e sinais pós-operatórios significativos: no 1º dia, secreção com cola de fibrina (p=0,02), sensação de corpo estranho (p=0,017) e hemorragia subconjuntival (p=0,022) com Vycril®; No 7º dia - quemose (p=0,035), hiperemia (p<0,001) e edema da pálpebra (p=0,011) com Vicryl®; No 21º dia - sensação de corpo estranho (p=0,001) e hiperemia conjuntival (p<0,001) com nylon; No 90º dia - olho seco (p=0,005) com Vicryl®. Desconforto ocular: maior com Vycril® (p=0,015) no 7º dia. Aparência estética final: melhor com a cola (p=0,003). Sinais de recidiva: maior no 90º dia: 20,7%(nylon), 10%(cola) e 19%(Vicryl®) e após 3 anos: 4,8%(nylon), 0%(cola) e 5.3%(Vicryl®) (p=0,536). Conclusão: A cola de fibrina mostrou eficácia, rapidez, menor desconforto pós-operatório e melhor aspecto estético; o Vicryl®, maiores sintomas intraoperatórios, pós-operatórios iniciais e sinais evidentes de inflamação, aliados ao desconforto ocular no 7º dia; o nylon, mais sensação de corpo estranho e hiperemia conjuntival até sua remoção. Os sinais de recidiva foram semelhantes entre os grupos.

Blood transfusion and increased perioperative risk in coronary artery bypass grafts

Abstract Objective: To correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG). Methods: Transfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results. Results: The transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively]. Conclusion: The use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.

Predicting outcomes in partial nephrectomy: is the renal score useful?

ABSTRACT Introduction and Objective The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Materials and Methods Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). Results No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin. Conclusion R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin.

Impact of surgeon experience during carotid endarterectomy operation and effects on perioperative outcomes

Abstract Objective: We evaluated the effect of surgeon experience on complication and mortality rates of carotid endarterectomy operation. Methods: Fifty-nine consecutive patients who underwent carotid endarterectomy between January 2013 and February 2016 were divided into two groups. Patients who had been operated by surgeons performing carotid endarterectomy for more than 10 years were allocated to group 1 (experienced surgeons; n=34). Group 2 (younger surgeons; n=25) consisted of patients operated by surgeons independently performing carotid endarterectomy for less than 2 years. Both groups were compared in respect of operative results and postoperative complications. Results: No intergroup difference was found for laterality of the lesion or concomitant coronary artery disease. In group 1, signs of local nerve damage (n=2; 5.9%) were detected, whereas in group 2 no evidence of local nerve damage was observed. Surgeons in group 1 used local and general anesthesia in 3 (8.8%) and 31 (91.2%) patients, respectively, while surgeons in group 2 preferred to use local and general anesthesia in 1 (4%) and 24 (96%) patients, respectively. Postoperative stroke was observed in group 1 (n=2; 5.9%) and group 2 (n=2; 5.8%). Conclusion: Younger surgeons perform carotid endarterectomy with similar techniques and have similar results compared to experienced surgeons. Younger surgeons rarely prefer using shunt during carotid endarterectomy. The experience and the skills gained by these surgeons during their training, under the supervision of experienced surgeons, will enable them to perform successful carotid endarterectomy operations independently after completion of their training period.

Assistência de enfermagem segura e qualificada: avaliação do risco cirúrgico no cuidado perioperatório ao idoso / Safe and effective nursing care: assessment of surgical risks in perioperative care of elderly patients / Asistencia de enfermería segura y cualificada: evaluación del riesgo quirúrgico en el cuidado perioperatorio al anciano

Objetivou-se discutir o uso de escalas para avaliar o risco cirúrgico de idosos no período perioperatório. Trata-se de comentário crítico fundamentado nos princípios da segurança do paciente e no cuidado à pessoa idosa submetida a procedimento cirúrgico uma vez que o enfermeiro realiza avaliação global, identificando os fatores de risco e prevenindo complicações cirúrgicas. A busca na literatura científica foi realizada entre os meses de julho e agosto de 2015. Os resultados evidenciam que escalas preditoras são tecnologias de cuidado que devem ser utilizadas pelos enfermeiros no cuidado ao idoso no período perioperatório com foco na cirurgia segura. Conclui-se que as escalas para avaliação de risco cirúrgico apresentadas podem ser incorporadas à prática cotidiana de cuidado dos enfermeiros, mediante o estabelecimento de plano de cuidados individualizado. A Enfermagem precisa instrumentalizar-se nesse processo e contribuir para a produção do conhecimento nesta perspectiva, a fim de fundamentar e implementar intervenções baseadas em evidências científicas (AU).

The present study aimed to examine the use of scales for assessment of surgical risks for elderly patients in the perioperative period. It involves a critical analysis of the principles of patient safety and care provided to elderly individuals undergoing surgical procedures, since nurses perform a comprehensive assessment in order to identify risk factors and prevent surgical complications. Search of scientific literature was performed in July and August 2015. The results obtained indicated that scales for predicting risks are patient care technologies that should be used by nurses in the perioperative period, in order to ensure a safe surgery. It is concluded that these scales can be used in the daily practice of nurses, through the establishment of an individualized care plan. Nursing should use this approach and contribute to the production of knowledge under this perspective, in order to implement interventions based on scientific evidence (AU).

Fue objetivo del estudio discutir el uso de escalas para evaluar el riesgo quirúrgico de ancianos en el periodo perioperatorio. Es un comentario crítico fundamentado en los principios de la seguridad del paciente y en el cuidado a la persona mayor sometida a procedimiento quirúrgico, considerando que el enfermero realiza evaluación global, identificando los factores de riesgo y previniendo complicaciones quirúrgicas. La búsqueda en la literatura científica fue realizada entre los meses de julio y agosto de 2015. Los resultados muestran que escalas predictoras son tecnologías de cuidado que deben ser utilizadas por los enfermeros en el cuidado al anciano en el periodo perioperatorio con foco en la cirugía segura. Se concluye que las escalas para evaluación de riesgo quirúrgico presentadas pueden ser incorporadas a la práctica cotidiana de cuidado de los enfermeros, por medio del establecimiento de planes de cuidados individualizados. La Enfermería necesita de instrumentalización en ese proceso, así como contribuir para la producción del conocimiento en esta perspectiva, para fundamentar y implementar intervenciones basadas en evidencias científicas (AU).