Análisis ajustado de la mortalidad operatoria en cirugía cardíaca de adultos en Uruguay; 14 años de aplicación y validación del EuroSCORE I ajustado por el Fondo Nacional de Recursos / Adjusted analysis of operative mortality in cardiac surgery of adults in Uruguay, 14 years of application and validation of EuroSCORE I by the Fondo Nacional de Recursos / Análise ajustada da mortalidade operatória em cirurgia cardíaca de adultos no Uruguai, 14 anos de aplicação e validação do EuroSCORE I pelo Fondo Nacional de Recursos

Introducción: la mortalidad posoperatoria ha sido el indicador principal de los resultados a corto y mediano plazo en la evaluación de la cirugía cardíaca. Una forma de analizar dicho evento es mediante los modelos de ajuste del riesgo que identifican variables que predicen su ocurrencia. Uno de los más utilizados es el EuroSCORE I que pro-porciona la probabilidad de morir de cada individuo y que está constituido por 18 variables de riesgo. Objetivos: presentar los resultados de la aplicación y la validación del modelo EuroSCORE I en Uruguay entre los años 2003 y 2020. Metodología: inicialmente se desarrolló una validación externa del EuroSCORE I en la población uruguaya adulta tomando como población de referencia la intervenida entre los años 2003 y 2006. Una vez que se validó el EuroSCORE I, este se aplicó prospectivamente durante los años 2007 al 2020 en su versión original y con el ajuste desarrollado con población del período 2003-2006. Resultados: la aplicación del modelo original encontró que hubo 5 años en los que la razón de mortalidad observada y esperada (MO/ME) fue significativamente mayor que 1. En el período 2007-2020 el EuroScore I no calibró en 6 oca-siones, y fue aplicada la versión ajustada en la evaluación de las instituciones de medicina altamente especializada. La aplicación del modelo ajustado mostró una buena calibración para el período 2007-2020, salvo en el año 2013, y mostró una buena discriminación (área bajo la curva ROC) en todo el período evaluado. Conclusiones: las escalas de riesgo son herramientas metodológicas y estadísticas que tienen gran utilidad para la toma de decisiones en salud. Este trabajo tiene como fortaleza el de presentar datos nacionales aplicando un modelo de riesgo ampliamente utilizado en todo el mundo, lo que nos permite comparar nuestros resultados con los obte-nidos a nivel internacional (EuroSCORE I logístico original) y, por otro lado, evaluar la performance comparativa interna a lo largo de un largo período de tiempo (EuroSCORE I logístico ajustado). Para el futuro resta el desafío de comparar estos resultados, ya sea con un modelo propio o con otros internacionales de elaboración más reciente.

Introduction: postoperative mortality has been the main indicator of short- and medium-term results in the eva luation of cardiac surgery. One way to analyze such outcomes is through risk adjustment models that identify varia bles that predict the occurrence. One of the most used is the EuroSCORE I, which provides the probability of death for each individual and is made up of 18 risk variables. Objectives: present the results of the application and validation of the EuroSCORE I model in Uruguay between 2003 and 2020. Methodology: initially, an external validation of the EuroSCORE I was developed in the Uruguayan adult popula tion, taking as reference population the intervened population between 2003 and 2006. Once the EuroSCORE I was validated, it was applied prospectively during the years 2007 to 2020 in its original version and with the adjustment developed with the population of the period 2003 to 2006. Results: the application of the original model found that there were 5 years during which the observed versus ex pected mortality ratio (OM/ME) was significantly greater than 1. In the period 2007 to 2020, the EuroScore I did not calibrate on 6 occasions, the adjusted version being applied in the evaluation of highly specialized medicine institu tions. The application of the adjusted model showed a good calibration for the period 2007-2020 except in the year 2013 and showed good discrimination (area under the ROC curve) throughout the evaluated period. Conclusions: risk scales are methodological and statistical tools that are very useful for decision-making in health care. This work has the strength of presenting national data applying a risk model widely used across the world, which allows it to be compare with results at an international level (original logistical Euroscore I) and, on the other hand, to evaluate the internal comparative performance over long period of time (adjusted logistic Euroscore I). Up next is the challenge of comparing these results either with our own model or with other more recent international ones.

Introdução: a mortalidade pós-operatória tem sido o principal indicador de resultados a curto e médio prazo na avaliação da cirurgia cardíaca. Uma forma de analisar esse evento é por meio de modelos de ajuste de risco que identificam variáveis que predizem a ocorrência do evento. Um dos mais utilizados é o EuroSCORE I, que fornece a probabilidade de morrer para cada indivíduo e é composto por 18 variáveis de risco. Objetivos: apresentar os resultados da aplicação e validação do modelo EuroSCORE I no Uruguai entre os anos de 2003 e 2020. Metodologia: inicialmente, foi realizada uma validação externa do EuroSCORE I na população uruguaia adulta, tomando como referência a população operada entre 2003 e 2006. Uma vez validado o EuroSCORE I, foi aplicado prospectivamente durante os anos de 2007 a 2020 em sua versão original e com o ajuste desenvolvido com a popu lação do período de 2003 a 2006. Resultados: a aplicação do modelo original constatou que houve 5 anos em que a razão de mortalidade observada versus esperada (MO/ME) foi significativamente maior que 1. No período de 2007 a 2020, o EuroScore I não calibrou em 6 ocasiões, sendo a versão ajustada aplicada na avaliação de instituições médicas altamente especializadas. A aplicação do modelo ajustado mostrou uma boa calibração para o período 2007-2020 exceto no ano de 2013 e apre sentou boa discriminação (área sob a curva ROC) em todo o período avaliado. Conclusões: as escalas de risco são ferramentas metodológicas e estatísticas muito úteis para a tomada de decisões em saúde. O ponto forte deste trabalho é apresentar dados nacionais aplicando um modelo de risco amplamente uti lizado em todo o mundo, que permite comparar com resultados a nível internacional (original Logistic Euroscore I) e, por outro lado, avaliar o comparativo interno desempenho durante um longo período de tempo (Euroscore Logístico I ajustado). Para o futuro, fica o desafio de comparar esses resultados, seja com um modelo próprio ou com outros internacionais de elaboração mais recente.

Clinical outcomes of arterial switch operation in infants with transposition of the great arteries--A single center clinical experience / 中华胸心血管外科杂志

Objective:To retrospectively analyze the efficacy of arterial switch operation in infants with transposition of the great arteries and to explore the prognostic related factors.Methods:The clinical data of 381 children with transposition of the great arteries from October 2001 to December 2017 were collected, including anatomical diagnosis, age of surgery, preoperative status, coronary artery malformation, aortic arch disease, etc. The relevant factors of postoperative mortality and reintervention were analyzed.Results:The overall mortality rate is about 4.5%, and the reintervention rate is about 3.7%. The postoperative mortality of every 100 cases droped significantly ( P<0.05), early surgery did not increase the risk of surgical death, but the mortality rate in the emergency surgery group was higher than that in the non-emergency surgery group. The mortality in the combined coronary artery abnormality group was significantly higher than that in the normal coronary artery group. Patients with Taussig-Bing anomaly and abnormal aortic arch were significantly more likely to get worse outcomes than those without aortic arch abnormality. In the whole group, 14 patients were re-intervened due to pulmonary valve or supra-valvular stenosis, aortic arch constriction, left ventricular outflow obstruction, and new aortic valve regurgitation. One patient died after operation. There was no coronary reintervention in the middle and long-term follow-up. Conclusion:The clinical outcome of early diagnosis and treatment of transposition of great arteries was good, preoperative status affects the outcome of surgery, coronary artery malformation, Taussig-Bing combined with aortic arch abnormalities were associated with increased operative mortality.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil / Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

Clinical Analysis of Abdominal Aortic Aneurysm

PURPOSE: In patients with small or large aneurysms, the decision for surgical treatment is not so simple. The mortality of ruptured abdominal aortic aneurysm (AAA) is high. This study was designed to retrospectively analyse the clinical characteristics of patients with AAA. METHODS: Ninety-one cases of AAA were surgically treated between January 1991 and January 2003 at the Department of Surgery, Chonnam National University Hospital. Patients were divided into 49 elective cases and 42 emergency cases, and retrospective analysed on the basis of age, sex, chief complaints, physical examination, associated diseases, size of aneurysm, diagnostic modalities, operative mortality and causes of death. RESULTS: The initial presentations were mainly palpable masses in the elective cases. On the other hand, in the emergency cases which were ruptured, many patients complained of abdominal or back pain. There was a positive relationship between the size of AAA and the incidence of the rupture in our study, especially in the case of transverse diameters above 10 cm (P<0.001). There was no death in the elective cases, but there were 22 surgical mortalities in the 42 emergency cases (52.3%, P<0.001). Overall surgical mortality was 24.1%. The causes of death were intraoperative and postoperative bleeding (11), myocardial infarction (5), acute renal failure (4), and sepsis (2). CONCLUSION: Surgical mortality in ruptured AAA was high. Consequently, surgical intervention is recommended and the operation must be performed. In that way we can reduce the operative mortality and improve the treatment outcome.

The Analysis of Operative Mortality for Patients Requiring Arterial Surgery

PURPOSE: The purpose of this study is to investigate the frequencies and causes of operative mortalities in patients who underwent arterial operations for various arterial diseases. METHOD: The preregistered data base of 604 patients (533 men and 71 women, mean age 65 11.9 years ranging 10~88 years) who underwent arterial operations at Department of Surgery, Kyungpook National University Hospital was retrospectively reviewed. Operative mortality included patient death within 30 days after operation or during the same admission period. Frequencies and their causes of operative mortality were analyzed according to the arterial disease, location of the arterial lesion, surgical procedure, timing of their occurrence and associated risk factors. RESULT: Patients with arterial disease comprised of 399 chronic occlusive, 126 acute occlusive and 79 aneurysmal disease. Overall operative mortality rate was 4.5% including 0.8% with chronic arterial occlusive disease, 7.6% with aneurysmal disease, and 14.3% with acute arterial occlusive disease. In the chronic occlusive disease, there was no statistically significant differences in the operative mortality rates by the location of disease, surgical procedures, age or other associated risk factors. Cause of operative mortality in this group was all cardiac origin. Operative mortality rates in the patients with acute arterial occlusive disease were 40% and 10.8% in mesenteric and limb artery occlusive disease respectively, and 16.2% and 11.5% in acute embolism and acute thrombosis, respectively. Preoperative renal dysfunction (serum creatinine> or =1.5 mg/dL) was an independent risk factor for operative mortality in acute arterial occlusive disease (80% vs 11.6% in embolism, p=0.002, 100% vs 8% in thrombosis, p=0.011). The main causes of death were organ failure (55.6%) and cardiac (33.3%). In aneurysmal disease, all mortalities occurred in ruptured aneurysm. Operative mortality rate of ruptured abdominal aortic aneurysm was 20.8%. The main causes of death were exanguination (50%) and later development of organ failure(50%). CONCLLUSION: To reduce operative mortalities after arterial surgery, disease-specific and surgery-specific causes of death should be considered.

Differences Between Gallstone Patients Over and Under 65 Years of Age

BACKGROUND: Recently the number of elderly gallstone patients has increased, in Korea. The aim of this study is to analyze and to measure the risk factors associated with operation on elderly gallstone patients. METHODS: We reviewed the medical records of 206 gallstone patients who had been admitted and operated on in the department of general surgery. Konkuk University Hospital, between January, 1993 and December, 1999. The patients were divided into 2 groups, over and under age 65. In each group, analysis was done on sex distribution, the ratio according to location of gallstone, duration of hospital stay, duration of general anesthesia and operative mortality, and then the above factors of each group were compared. RESULTS: 1) The ratio of common bile duct stones in patients over age 65 was two times of that in patients under age 65(48%,24%) 2) The overall operative mortality was 1.9% and has no correlation with old age. 3) Severe coexisting disease may seem the risk factor for operative mortality. CONCLUSION: In the diagnosis and management of gallstones in the elderly, the possibility of common bile duct stone should be suspected. And in order to reduce the operative mortality, careful preoperative evaluation and treatment of coexisting disease should be done.

Factors Which Influence Mortality Following Operation on Patients over 65 Years of Age

BACKGROUND: There is a continuing increase in geriatric population. Many workers have reported an increased mortality rate after operation on patients over 65 years of age. The aim of this study is to analyze and to measure the risk factors associated with geriatric surgery. METHODS: We reviewed the medical records of 467 patients over 65 years of age who had been admitted and operated on in the department of General Surgery, Konkuk University Hospital, between January, 1993 and December, 1999. An analysis was done on age and sex distribution, duration of admission, type of anesthesia, duration of general anesthesia, number of benign and malignant disease, number of coexistent disease, number of emergency and elective operation, and then, we analyzed the above factors to know whether they influence mortality rate or not. RESULTS: 1) Overall operative mortality rate was 4.3%, and the factors influencing mortality rate were, malignant disease, coexisting disease, emergency operation and long duration of general anesthesia. 2) Old age in itself did not affect the mortality. CONCLUSION: In order to reduce the operative mortality in geriatric surgery, careful preoperative evaluation and elective surgery rather than emergency operation must be done, and the operation chosen should be the one of less magnitude, not very radical operations to achieve permanent cures.

Comparison of Admission Pattern and Management of Subarachnoid Hemorrhage Patients Over a 5-year Interval

Aneurysmal subarachnoid hemorrhage is a neurosurgical emergency. Early and intensive medical intervention is important for minimizing the occurrence of rebleeding and vasospasm. The purpose of this study was to document and compare the admission or referral pattern, management outcome and attitude of the general public of subarachnoid hemorrhage(SAH) patients over a five year interval of 1987 and 1992. The authors analysed 229 SAH cases diagnosed by computerized tomography(CT) or lumbar puncture;106 cases diagnosed in 1987 were compared to 123 cases diagnosed in 1992. The results of the study showed that 1) the performance rate of angiography and operation have increased in 1992 as compared to 1987. 2) Early admission rate(within 0~1 day after the onset of SAH) have increased in 1992(84%) as compared to 1987(38%), and delayed admission rate(more than 2 days after the onset of SAH) have decreased in 1992 as compared to 1987. 3) Overall management mortality have decreased from 34% to 20% and operative mortality, from 12% to 4% in 1987 and in 1992, respectirely, It is concluded that the rate of early admission and operation of SAH patients have improved in 1992 as compared to 1987.

Analysis of 5,653 cases with congenital heart disease catheterized at Yonsei Medical Center: a 28-Year review

No abstract available.