ABSTRACT
Resumen Introducción: Las consultas en el servicio de urgencia (CU) y el reingreso (RI) hospitalario después de una cirugía bariátrica (CB) son importantes indicadores de calidad y seguridad. Sin embargo, existe escasa información de estos indicadores en nuestro medio nacional. En este trabajo analizamos las CU y RI de pacientes sometidos a una CB primaria en un centro universitario de alto volumen, y buscamos variables asociadas a estos indicadores. Materiales y Método: Estudio observacional retrospectivo que incluyó a todos los pacientes sometidos a bypass gástrico (BPG) o gastrectomía en manga (GM) laparoscópica primaria realizados de forma consecutiva en nuestra institución durante el período 2006-2007 y 2012-2013. Utilizando nuestros registros clínicos y base de seguimiento prospectivo, identificamos aquellos pacientes con CU o RI en nuestro hospital durante los primeros 30 días después del alta. Resultados: Se incluyeron 1.146 CB primarias, 53% (n = 613) fueron BPG y 47% (n = 533) GM. Un 8,03% (n = 92) de los pacientes tuvo al menos una CU y un 3,7% (n = 42) un RI. Las variables independientes asociadas tanto a CU como RI fueron el tiempo operatorio e índice de masa corporal (IMC) preoperatorio. No se encontró asociación estadística, en el periodo estudiado, para el tipo de CB realizada con la CU ni con el RI. Conclusión: Existe una baja proporción de pacientes que requieren CU y RI posterior a la CB, lo que demuestra la seguridad de estas intervenciones.
Introduction: Emergency department visits (EDV) and hospital readmission (HR) after bariatric surgery (BS) are important indicators of quality and safety in surgery, however there is little information on their characteristics in our national environment. Aim: In this work we analyze EDV and HR in patients undergoing a primary BS in a high-volume university center, and identify variables that could be associated with these indicators. Materials and Method: A retrospective observational study where we identified all patients undergoing Roux-in-Y gastric bypass (RYGBP) or primary laparoscopic sleeve gastrectomy (SG) performed consecutively at our institution during the period 2006-2007 and 2012-2013. Using our clinical records and prospective follow-up database, we identify those patients with EDV and/or HR in our hospital during the first 30 days after discharge. Results: 1146 primary BS were included, of these 53% (n = 613) were RYGBP and 47% (n = 533) SG. 8,03% (n = 92) of the patients had at least one EDV, of these 3,7% (n = 42) had an HR. The independent variables associated with EDV and HR were the operative time and preoperative body mass index (BMI). No statistical association was found, in the period studied, for the type of BS performed with EDV or HR. Conclusion: There is a low proportion of patients who require EDV and HR after BS, which demonstrates the safety of these interventions.
Subject(s)
Humans , Male , Female , Child , Adult , Gastric Bypass/methods , Bariatric Surgery/statistics & numerical data , Patient Readmission , Postoperative Complications , Multivariate Analysis , Risk Factors , Emergency Service, Hospital/statistics & numerical data , GastrectomyABSTRACT
Background: Chile has the highest gallbladder cancer (GBC) death rate world-wide, affecting mainly Southern areas of the country. Aim: To compare the survival of GBC patients treated in hospitals located in areas with low and high risk for GBC. Material and Methods: Medical records of all patients with GBC admitted to one public hospital located in southern Chile, a public hospital and a private clinic, both located in Metropolitan Santiago, were reviewed. Cases were analyzed by age, sex, stage at diagnosis, ethnicity, socioeconomic status (SES) and rural residence. Survival was calculated using Kaplan Meier method. Results: A total of 598 cases (469 women), were analyzed. No differences in age or sex among hospitals were detected. At the moment of diagnosis, 75, 50 and 44 percent of cases from the hospital in southern Chile, the public hospital in Santiago and the private clinic in Santiago, were in stage IV, respectively. Five years survival was lower in the public hospital in southern Chile than in the public hospital in Santiago (10.7 and 14.4 percent respectively, p < 0.05) but not statistically different from the figure at the private clinic in Santiago (13.0 percent). However, when adjusting for stage at the moment of diagnosis, no difference in survival between the three hospitals, was found. The median days of survival were 1,559, 188, 70 and 69 for stages I, II, III and IV respectively. Conclusions: GBC mortality is high. The stage at the moment of diagnosis is only significant predictor of survival.