SASA: una escala sencilla de mortalidad postoperatoria explorada en un centro de atención de tercer nivel en México / SASA: a simple scale of postoperative mortality explored in a third-level care center in Mexico

Resumen: Introducción: Las complicaciones postquirúrgicas han sido causa importante de muerte. Por lo tanto, el uso de predictores sencillos de mortalidad con una nueva escala llamada SASA podría indicar un riesgo postoperatorio de mortalidad a los 30 días aplicado en una muestra en población mexicana. Material y métodos: Exploramos una asociación entre la clasificación de estado físico de la Sociedad Americana de Anestesiólogos (ASA-PS), el Apgar quirúrgico (sAs) y la puntuación de SASA con un análisis univariado en 371 pacientes estimando la relación de probabilidades (OR) y graficando las curvas de operación característica del receptor (receiver-operating-characteristic [ROC]) para cada escala. Resultados: Obtuvimos los valores de dos; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 40.56% (IC del 95%: 35.44-45.83)], 6; [sensibilidad; 81.82% (IC del 95 %: 48.2-97.72), especificidad; 77.5% (IC del 95%: 72.83-81.71)] y 10; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 83.6% (IC del 95%: 78.77-86.78)] como los mejores puntos de corte para el ASA-PS, sAs y SASA respectivamente. Conclusiones: el cálculo de SASA obtuvo la misma sensibilidad, pero mejor especificidad y área bajo la curva cuando se comparó con el ASA-PS y el sAs.

Abstract: Introduction: Post-surgical complications have been a significant cause of death. Therefore, the use of easy preoperative mortality predictors is recommended. A new SASA score could indicate a perioperative risk more globally at 30-days of the postoperative period applied in a Mexican sample. Material and methods: 371 patients were analyzed. We explore an association between the American Society of Anesthesiologists physical status classification (ASA-PS), the surgical Apgar score (sAs), and the new SASA score to assess 30-days mortality after surgery using univariate analysis to estimate the odds ratio (OR). Receiver-operating-characteristic (ROC) curves were plotted for each scale. Results: We obtained values of two; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 40.56% (95% CI: 35.44-45.83)] 6; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 77.5% (95% CI: 72.83-81.71)] and 10; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 83.6% (95% CI: 78.77-86.78)] as the best cut-off points for ASA-PS, sAs and SASA respectively. Conclusions: To predict postoperative 30-days mortality, SASA calculation as a new score obtained the same sensitivity but better specificity and area under the curve (AUC) for the ROC compared with the ASA-PS and the sAs.

Analysis of early death and long-term reoperation after 11-year single-center arterial switch operation / 中华胸心血管外科杂志

Objective:To analyze the early postoperative mortality and long-term reoperation of ASO and to explore the surgical risk and the reasons of long-term reoperation.Methods:The clinical data and follow-up data of ASO children undergoing surgery in Shanghai Children Medical Center from January 2010 to December 2020 were analyzed retrospectively. Four groups were divided into transposition of the great vessels(TGA/IVS) , transposition of the great vessels with ventricular septal defect(TGA/VSD) , Taussig-bing anomaly(TBA) , and two stage ASO(Ⅱ-ASO) groups. χ2 test was used to analyze the early mortality and long-term reoperation rates of ASO in different groups. Results:A total of 861 ASO patients were included in this study and 108 died early(12.5%, 108/861) . Seven hundred and fifty three cases were followed up and 102 cases were lost(13.5%, 102/753) . The median follow-up time was 7.23 years and the quartile interval was 4.74-9.37 years old. Sixty six patients(10.1%, 66/651) underwent long-term reoperation. Four patients(6%, 4/66) died after reoperation. In 241 cases of TGA/IVS, 24 cases(10%) were performed reoperation. In 256 cases of TGA/VSD, 23 cases(9%) had reoperation. In 126 cases of TBA, 18 cases(14.3%) for reoperation. And in 28 cases of Ⅱ-ASO only 1 case(3.6%) had reoperation. Among all the reoperation cases, there were 36 cases(2 deaths) for pulmonary angioplasty, 2 cases for pulmonary stenting, 10 cases for right ventricular outflow tract obstruction(RVOTO) repair, 2 cases for aortic valvularplasty, 5 cases for aortic valve replacement(2 deaths), 4 cases for aortic anastomotic stenosis repair, 3 cases for left ventricular outflow tract obstruction(LVOTO) repair, 2 cases for VSD residual shunt repair and 2 cases for coarctation of the aorta(CoA) correction.Conclusion:The early mortality rate of ASO surgery is still higher than that of developed countries. Long-term follow-up after ASO surgery should focus on right ventricular outflow tract stenosis and aortic valve insufficiency.

Mortalidad quirúrgica durante pandemia de coronavirus en un centro universitario / Surgical mortality during a coronavirus pandemic in a university center

Resumen Introducción: La pandemia de coronavirus, iniciada en Wuhan el año 2019, ha trastocado al mundo y afectado profundamente a la actividad quirúrgica al restringir el número de intervenciones en forma dramática, después de los reportes iniciales de mortalidad posoperatoria sobre el 20% en pacientes operados portadores de COVID. El objetivo del presente estudio fue evaluar las cifras de mortalidad quirúrgica, en pacientes intervenidos quirúrgicamente durante la pandemia del COVID-19. Materiales y Método: Cohorte retrospectiva de pacientes operados entre el 15 de marzo de 2020 y el 31 de julio de 2020 en un centro universitario. Se evaluó variables clínicas asociadas a la intervención quirúrgica y coinfección por SARS-CoV-2. Resultados: Se analizaron 344 pacientes quienes presentaron una mortalidad global de 6,1%. Se realizó examen de PCR para COVID a 153 pacientes. Presentaron un riesgo de mortalidad significativo los pacientes: PCR COVID(+) (22,7%), p = 0,01, portadores de hipertensión arterial (11,6%) p = 0,03 y mayores de 60 años (12,4%) p < 0,001. No fueron factores estadísticamente significativos de mayor riesgo de mortalidad, las siguientes variables: género, obesidad, diabetes mellitus, patología oncológica, cirugía de urgencia y clasificación de ASA. Al analizar dos subgrupos se observó que los pacientes menores de 60 años COVID negativo presentaron una cifra de mortalidad de 1,26% versus 36,3% en los mayores de 60 años, COVID positivos (p = 0,01). Discusión: Los resultados del presente estudio sugieren que se deben realizar los mayores esfuerzos para descartar la infección por SARS-CoV-2 en la evaluación preoperatoria para disminuir los riesgos de mortalidad posoperatoria.

Background: The coronavirus pandemic, started in the city of Wuhan in 2019, has disrupted the world and deeply affected surgical activity. Restricting the number of interventions dramatically, after initial reports of postoperative mortality over 20% in patients with COVID. The purpose of this study is to evaluate the figures for surgical mortality, during the coronavirus pandemic. Materials and Method: Retrospective cohort of patients operated between March 15, 2020 and July 31, 2020 at a university center. Clinical variables associated with surgical intervention and coinfection by SARS-CoV-2 were evaluated. Results: 344 patients with an overall mortality of 6.1% were analyzed. PCR testing for COVID was performed on 153 patients. Only from the ninth week of the pandemic did routine preoperative testing begin. Patients who presented a higher risk of mortality were: PCR COVID(+) (22.7%), arterial hypertension (11.6%) and age over 60 years (12.4%). In the present series, the following variables were not statistically significant risk factors for mortality: gender, obesity, diabetes mellitus, oncological pathology, emergency surgery and ASA classification. When analyzing two subgroups, we observed that COVID negative patients under 60 had a mortality rate of 1.26%, versus 36.36% in those over 60 years of age, COVID positive. Discussion: The results of the present study lead us to make every effort to rule out COVID infection preoperatively to reduce the risks of postoperative mortality. Although this is a series of cases and the extrapolation of its results should be cautious, having national figures can be a useful element to make decisions in this stage of reactivation of surgical activity.

Relationship of age, pathological grade, and implants with perioperative mortality in patients with hip fracture / 中国组织工程研究

BACKGROUND: Up to now, the research on the mortality rate of hip fracture after operation mainly focuses on 30 days to 1 year and longer. However, there are few studies on early postoperative mortality of hip fracture. OBJECTIVE: To compare the differences between survived and dead patients at 72 hours after surgery, and to explore the risk factors associated with 72-hour postoperative mortality in hip fracture patients. METHODS: Clinical data of 2 811 hip fracture patients admitted to Zhujiang Hospital of Southern Medical University from January 2013 to December 2018 were retrospectively analyzed, including surgical treatment and conservative treatment. The patient's age ranged from 15 to 101 years old. This study compared the differences between the survival group and death group within 72 hours after surgery. According to the outcome, the patients were divided into survival group and death group. The patient's medical records were collected, including gender, age, preoperative ASA classification, preoperative walking ability score, preoperative cognitive level, whether to take anticoagulants orally, fracture classification, operation mode, internal plant species, operation time, blood transfusion volume, anesthesia mode, and postoperative complications. The diagnosis of each observation factor was based on the clinical diagnosis of medical records. The survival status, cause of death, intraoperative and postoperative complications were recorded within 72 hours after operation. The patients were followed up by telephone within half a year after operation. RESULTS AND CONCLUSION: (1) Forty-seven patients received conservative treatment, and 1 patient died 24 hours after admission; totally 2 764 patients were included in the study. (2) The average age was 72.5 years, including 2 035 females and 729 males. The mortality rate within 72 hours after operation was about 0.90% (25 patients). (3) In the 72-hour postoperatively death group, the proportion of patients with advanced age, ASA grade 3 or above, pre-traumatic walking ability limitation and cognitive impairment was higher (P 0.05). (6) In conclusion, great attention has been paid to the optimization of the management of patients undergoing hip fracture surgery and its concomitant effect on survival. Our study found that the increased risk of death within 72 hours after hip fracture surgery is associated with advanced age, ASA grade 3 or above, limited walking ability before injury, cognitive impairment and more than 48 hours after injury; however, it is not related to the type of implant of the patient. The information provided in this study can be used to assess patients with the highest risk of death within 72 hours after surgery. On the basis of this study, it may be necessary to further collect multi-center, more detailed data to assess the impact of various factors on the postoperative mortality of hip fracture patients, and to identify high-risk factors affecting the early postoperative mortality.

Efectos de la curva de aprendizaje en los resultados de la duodenopancreatectomía cefálica en un hospital de nivel II / Effects of the learning curve on the results of cephalic pancreaticoduodenectomy in a level II hospital

Resumen Introducción: La duodeno pancreatectomía cefálica es una operación compleja cuyos resultados a corto plazo son multifactoriales. Objetivo: Evaluar el impacto de la curva de aprendizaje en los resultados a corto plazo de la duodenopancreatectomía cefálica en un hospital de nivel II. Materiales y Método: Se analizaron los datos obtenidos a partir de una base de datos mantenida prospectivamente desde 2005. Se definieron dos periodos de tiempo: de 2005 a 2011 y de 2012 a 2017. Se compararon la morbilidad, mortalidad y estancia postoperatoria de ambos períodos. Resultados: Durante el período de tiempo estudiado se hicieron 126 duodenopancreatectomías cefálicas, 61 durante la primera etapa y 65 durante la segunda. La tasa de transfusión intraoperatoria se redujo de 33% a 15% (p = 0,011). La tasa de transfusión postoperatoria se redujo de 39 a 23% (p = 0,021). No hubo diferencias significativas con respecto a la incidencia global de complicaciones postoperatorias (59% y 52,3%). La incidencia de abscesos intraabdominales fue significativamente menor en el segundo período (18% y 4,6%, respectivamente; p = 0,038). La tasa de reintervenciones se redujo significativamente, de 22% a 9% (p = 0,049). También se redujo significativamente la tasa de mortalidad, de 6,56% a 0% (p = 0,032). La estancia media postoperatoria disminuyó significativamente en el segundo período, pasando de 19,6 a 15,8 días (p = 0,001), con una mayor proporción de pacientes dados de alta en los 8 primeros días de postoperatorio (11,5% y 38,5%, respectivamente; p = 0,001). Conclusión: La curva de aprendizaje es un factor que permite mejorar los resultados de la duodenopancreatectomía cefálica, en un hospital de nivel II, hasta alcanzar valores similares a los de un hospital de nivel III.

Introduction: The duodenum pancreatectomy cephalic is a complex operation whose short-term results are multifactorial. Aim: To assess the impact of the learning curve on the short-term outcomes of cephalic duodenopancreatectomy at a level II hospital. Materials Method: We analyze the data obtained from a database maintained prospectively since 2005. Two time periods were defined: from 2005 to 2011 and from 2012 to 2017. The morbidity, mortality and postoperative stay of both periods were compared. Results: 126 cephalic duodenopancreatectomies were performed, 61 during the first period and 65 during the second. The intraoperative transfusion rate was reduced from 33% to 15% (p = 0.011). The postoperative transfusion rate was reduced from 39 to 23% (p = 0.021). There were no significant differences with respect to the overall incidence of postoperative complications (59% and 52.3%, respectively). However, the incidence of intra-abdominal abscesses was significantly lower in the second period (18% and 4.6%, respectively, p = 0.038). The rate of reoperations was significantly reduced, from 22% to 9% (p = 0.049). The mortality rate was also significantly reduced, from 6.56% to 0% (p = 0.032). The mean postoperative stay decreased significantly in the second period, from 19.6 to 15.8 days (p = 0.001), with a higher proportion of patients discharged in the first 8 postoperative days (11.5% and 38.5%, respectively, p = 0.001). Conclusion: The learning curve is a factor allows improving the results of cephalic pancreaticoduodenectomy, in a level II hospital, until reaching values similar to those of a level III hospital.

Caracterización de los pacientes operados por adenocarcinoma gástrico en el Hospital "Dr. Carlos J Finlay". 2009-2016 / Characterization of patients operated on for gastric adenocarcinoma at "Dr. Carlos J. Finlay" Hospital from 2009 to 2016

RESUMEN Introducción: El cáncer gástrico ocupa hoy el cuarto lugar de incidencia mundial de cáncer y es la segunda causa de muerte por cáncer en el mundo. Objetivo: Caracterizar a los pacientes operados con adenocarcinoma gástrico en el Hospital "Dr. Carlos J. Finlay". 2009-2016. Material y Métodos: Se realizó un estudio descriptivo retrospectivo a los pacientes operados con adenocarcinoma gástrico en un periodo de 8 años. Resultados: Prevalecieron los pacientes geriátricos del sexo masculino. La forma más frecuente de presentación fue la úlcera gástrica en 54,7%. Predominaron los tumores del antro en 72,0%, moderadamente diferenciados en 61,3% de pacientes. La mayoría de los tumores se encontraban en estadio IIIA. De los procedimientos quirúrgicos predominó la gastrectomía distal en 56,0% y los procederes exeréticos en 68,0% de pacientes. La mortalidad operatoria fue de 6,0%, con prevalencia del shock hipovolémico. Conclusiones: Predominaron los pacientes geriátricos del sexo masculino cuya técnica quirúrgica fue la gastrectomía distal. Como forma clínica sobresalió la úlcera gástrica, así como los tumores del antro en estadio IIIA, moderadamente diferenciados. El estadio avanzado y los procedimientos paliativos se relacionaron de manera significativa con la mortalidad.

ABSTRACT Introduction: Gastric cancer is the fourth most common cancer at present and the second leading cause of cancer-related mortality worldwide. Objective: The aim of this study is to characterize the patients with gastric adenocarcinoma operated on at "Dr. Carlos J. Finlay" Hospital during the period between 2009 and 2016. Material and Methods: A descriptive retrospective study was conducted in patients operated on for gastric adenocarcinoma in an eight-year period. Results: Male geriatric patients prevailed in the study. Gastric ulcer was the most frequent form of presentation in 54,7 %. Tumors of the antrum predominated in 72,0 %, with moderate degree of differentiation in 61,3 % of patients. The majority of tumors were in stage IIIA. The most used surgical methods were distal gastrectomy which was performed in 56,0 % of patients and exeretic procedures that were carried out in 68,0 % of patients. Operative mortality was 6,0 % with prevalence of hypovolemic shock. Conclusion: There was a predominance of male geriatric patients who underwent the surgical technique of distal gastrectomy. Gastric ulceration was the most common clinical form of presentation as well as tumors of the antrum in stage IIIA, in which there was a moderate degree of differentiation. Advanced stage tumors and palliative procedures were significantly related to mortality.

Severity of disease scoring systems and mortality after non-cardiac surgery / Sistemas de classificação da gravidade da doença e mortalidade após cirurgia não cardíaca

Abstract Background: Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Methods: Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). Results: 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Conclusion: Some factors influenced both surgical intensive care unit and hospital mortality.

Resumo Justificativa: A mortalidade após cirurgia é frequente e os sistemas de classificação da gravidade da doença são usados para a previsão. Nosso objetivo foi avaliar os preditivos de mortalidade após cirurgia não cardíaca. Métodos: Os pacientes adultos admitidos em nossa unidade de terapia intensiva cirúrgica entre janeiro de 2006 e julho de 2013 foram incluídos. Análise univariada foi feita com o teste de Mann-Whitney, qui-quadrado ou exato de Fisher. Regressão logística foi feita para avaliar fatores independentes com cálculo de razão de chances (odds ratio - OR) e intervalo de confiança de 95% (IC 95%). Resultados: No total, 4.398 pacientes foram incluídos. A mortalidade foi de 1,4% na unidade de terapia intensiva cirúrgica e de 7,4% durante a internação hospitalar. Os preditivos independentes de mortalidade na unidade de terapia intensiva cirúrgica foram APACHE II (OR = 1,24); cirurgia de emergência (OR = 4,10), sódio sérico (OR = 1,06) e FiO2 na admissão (OR = 14,31). Bicarbonato sérico na admissão (OR = 0,89) foi considerado um fator protetor. Os preditivos independentes de mortalidade hospitalar foram idade (OR = 1,02), APACHE II (OR = 1,09), cirurgia de emergência (OR = 1,82), cirurgia de alto risco (OR = 1,61), FiO2 na admissão (OR = 1,02), insuficiência renal aguda no pós-operatório (OR = 1,96), frequência cardíaca (OR = 1,01) e sódio sérico (OR = 1,04). Os pacientes moribundos apresentaram escores mais altos de gravidade da doença nos sistemas de classificação e mais tempo de permanência em unidade de terapia intensiva cirúrgica. Conclusão: Alguns fatores tiveram influencia sobre a mortalidade tanto hospitalar quanto na unidade de terapia intensiva cirúrgica.

Estudio de pacientes ingresados por peritonitis en el Centro Nacional de Cirugía de Mínimo Acceso / Study of patients with peritonitis admitted to the National Center for Minimal Access Surgery

Introducción: La peritonitis postoperatoria es una de las complicaciones más frecuentes que se presenta tras procederes laparoscópicos. Objetivo: Caracterizar la evolución de los pacientes complicados con peritonitis después de un proceder laparoscópico. Material y método: Se realizó un estudio observacional descriptivo de los pacientes con peritonitis ingresados en la terapia intensiva, del Centro Nacional de Cirugía de Mínimo Acceso, desde septiembre de 2010 hasta diciembre de 2015. Se analizaron algunas variables demográficas, procederes laparoscópicos que se complicaron con este diagnóstico, complicaciones clínicas, antibioticoterapia utilizada, tipo de nutrición y la escala de evaluación fisiológica APACHE II como predictor de pronóstico. La información se obtuvo de las historias clínicas. Las variables cualitativas se resumieron utilizando frecuencias absolutas y porcentajes. Para las cuantitativas se utilizó la media y la desviación estándar. Resultados: Se complicaron con peritonitis 26 de 298 pacientes ingresados en el período (8,7 ), la edad media fue de 60 años, predominó el sexo femenino (57,7 por ciento). Se complicaron más con este diagnóstico los pacientes perforados postcolonoscopia (50 por ciento). El disbalance hidroelectrolítico (73,1 por ciento) fue la complicación asociada más frecuente. Se usó precozmente la nutrición enteral en 57,7 por ciento y los antibióticos más utilizados fueron ceftriaxone, amikacina y metronidazol. Predominó la evolución favorable a pesar que el score APACHE II se mantuvo en valores elevados. Conclusiones: Las perforaciones intestinales después de una colonoscopía tienen un alto riesgo de sufrir peritonitis secundaria, pero si se realiza un diagnóstico y tratamiento precoz su evolución es favorable(AU)

Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it. Objective:To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016. Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons. Results:The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7 percent). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively. Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 percent of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred. After the dilatations, dysphagia improved or disappeared in 93,2 percent of patients. Conclusions:Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia(AU)

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

PURPOSE: An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. METHODS: We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. RESULTS: The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. CONCLUSION: Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

Incidence and Predictors of Cardiovascular Complications and Death after Vascular Surgery / Incidência e Preditores de Complicações Cardiovasculares e Óbito após Cirurgia Vascular Arterial

AbstractBackground:Patients undergoing arterial vascular surgery are considered at increased risk for post-operative complications.Objective:To assess the incidence and predictors of complications and death, as well as the performance of two models of risk stratification, in vascular surgery.Methods:This study determined the incidence of cardiovascular complications and deaths within 30 days from surgery in adults. Univariate comparison and logistic regression assessed the risk factors associated with the outcomes, and the receiver operating characteristic (ROC) curve assessed the discriminatory capacity of the revised cardiac risk index (RCRI) and vascular study group of New England cardiac risk index (VSG-CRI).Results:141 patients (mean age, 66 years; 65% men) underwent the following surgeries: carotid (15); lower limbs (65); abdominal aorta (56); and others (5). Cardiovascular complications and death occurred within 30 days in 28 (19.9%) and 20 (14.2%) patients, respectively. The risk predictors were: age, obesity, stroke, poor functional capacity, altered scintigraphy, surgery of the aorta, and troponin change. The scores RCRI and VSG-CRI had area under the curve of 0.635 and 0.639 for early cardiovascular complications, and 0.562 and 0.610 for death in 30 days.Conclusion:In this small and selected group of patients undergoing arterial vascular surgery, the incidence of adverse events was elevated. The risk assessment indices RCRI and VSG-CRI did not perform well for complications within 30 days.

ResumoFundamento:Pacientes submetidos à cirurgia vascular arterial são considerados de risco aumentado para complicações no pós-operatório.Objetivo:Avaliar incidência e preditores de complicações e óbito, assim como o desempenho de dois modelos de estratificação de risco, em cirurgia vascular.Métodos:Em pacientes adultos, determinou-se a incidência de complicações cardiovasculares e óbitos em 30 dias. Comparações univariadas e regressão logística avaliaram os fatores de risco associados com os desfechos, e a curva ROC (receiver operating characteristic) examinou a capacidade discriminatória do índice de risco cardíaco revisado (RCRI) e do índice de risco cardíaco do grupo de cirurgia vascular da New England (VSG-CRI).Resultados:141 pacientes (idade média 66 anos, 65% homens) realizaram cirurgias de: carótida (15), membros inferiores (65), aorta abdominal (56) e outras (5). Complicações cardiovasculares e óbito em até 30 dias ocorreram em 28 (19,9%) e em 20 (14,2%) pacientes, respectivamente. Os preditores de risco foram: idade, obesidade, acidente vascular cerebral, capacidade funcional ruim, cintilografia alterada, cirurgia de aorta e alteração de troponina. Os escores RCRI e VSG-CRI apresentaram AUC (area under the curve) de 0,635 e 0,639 para complicações cardiovasculares precoces e 0,562 e 0,610 para óbito em 30 dias.Conclusões:Nesse grupo pequeno e selecionado submetido à cirurgia vascular arterial, a incidência de eventos adversos foi elevada. Para complicações em até 30 dias, os índices de avaliação de risco RCRI e VSG-CRI não apresentaram boa performance.

Mortality prediction using POSSUM scoring system for laparotomy patients in Mulago National Referral Hospital, Uganda

Prediction of serious complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of dying contributes significantly to the quality of surgical care and cost reduction. The postoperative mortality of patients who underwent laparotomy in Mulago Hospital was studied using Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM). Consecutive patients who underwent laparotomy in Mulago Hospital were recruited and consent obtained. Patients operated were followed up to the 30th postoperative day. Postoperative deaths were promptly investigated and findings recorded. Follow-up of patients was conducted by phone and surgical review once a week in outpatient. Ethical approval was obtained from the Institutional Review Board (IRB) of Makerere University Medical School. Seventy-six patients participated and the observed mortality was 14.5% and the predictive value of POSSUM using Receiver Operative Characteristics (ROC) curve was 0.817 (95% Confidence Interval 0.711, 0.924) and the Hosmer and Lemeshow test predicted 18.2% of mortality and survival 100%. Postoperative mortality can be predicted in the modern management of surgery using POSSUM. It is markedly influenced by the preoperative, operative and postoperative conditions of the patients.

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

PURPOSE: Despite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA. MATERIALS AND METHODS: From January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately. RESULTS: The 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant. CONCLUSION: To decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.

Causas, tratamiento y complicaciones de la peritonitis difusa en un hospital de la periferia de Luanda / Causes, treatment and complications of the diffuse peritonitis in a hospital of Luanda periphery

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 34 pacientes con peritonitis difusa secundaria, extendida a los 4 cuadrantes de la cavidad peritoneal, intervenidos quirúrgicamente en el Hospital General de Luanda durante el período comprendido desde agosto del 2008 hasta julio del 2009. Las afecciones causales más frecuentes fueron las perforaciones tíficas (en las cuales se utilizó la enterorrafia) y la apendicitis aguda, en tanto la complicación posoperatoria más común resultó ser la dehiscencia de sutura. En la casuística, 6 de sus integrantes experimentaron reintervenciones y 5 fallecieron. La perforación intestinal es una complicación grave de la fiebre tifoidea, cuya frecuencia se incrementa en áreas endémicas y puede ser la primera causa de peritonitis generalizada o difusa aguda

A descriptive, longitudinal and retrospective study of 34 patients with secondary diffuse peritonitis, extended to the 4 quadrants of the peritoneal cavity, surgically treated in the General Hospital of Luanda was carried out from August, 2008 to July, 2009. The most frequent causal affections were the typhic perforations (in which enterorrhaphy was used) and the acute appendicitis, the most common postoperative complication turned out to be the suture dehiscence. In the case material, 6 of its members experienced reinterventions and 5 died. The intestinal perforation is a serious complication of the typhoid fever whose frequency is increased in endemic areas and it can be the first cause of acute diffuse or sistemic peritonitis

Risk factors for mortality after surgery in patients with cirrhosis / 대한간학회지

No abstract available.

Clinical Factors Affecting Postoperative Mortality in Necrotizing Enterocolitis

PURPOSE: Necrotizing enterocolitis (NEC) is one of the most common surgical emergencies during the neonatal period. The aim of this study was to identify and assess the factors affecting the postoperative mortality in infants with NEC that require surgical treatment. METHODS: The authors retrospectively reviewed 37 infants surgically treated, at the Department of Surgery, Pusan National University Hospital, between Jan. 2000 and Dec. 2004. The patients were divided two groups according to the clinical outcomes; the survival and non-survival groups. Eight variables, i.e., sex, gestational age, weight at birth and at the time of the first operation, weight change between birth and the time of the first operation, degree of clinical manifestations (as a modified Bell's stage), interval between the onset of symptoms and the time of the first operation, the extent of necrotic intestine and associated anomalies, were analyzed. RESULTS: Among 37 infants, 6 expired (a mortality rate of 16.2%). The postoperative mortality was not affected by sex, gestational age, and the weight at birth and at the time of the first operation, weight change between birth and at the time of the first operation, degree of clinical manifestations and the interval between the onset of symptoms and the time of the first operation. However, the extent of necrotic intestine was associated with a significantly increased mortality (P=0.046). CONCLUSION: These data suggest that the extent of necrotic intestine is the only statistically significant factor affecting the postoperative mortality in infants with NEC that require surgical treatment.

Risk Factors Associated with Mortality in Emergency Surgery for Perforated Peptic Ulcer

PURPOSE: Despite modern medication, peptic ulcer, patients often require emergency surgery for complications of peptic ulcer disease, and the mortality due to a perforated peptic ulcer still remains high. This retrospective study was conducted to evaluate the risk factors associated with mortality in patients undergoing surgery for a perforated peptic ulcer. METHODS: Two hundred and four consecutive patients (mean age: 45.8 years; range: 15~0 years) who underwent emergency surgery for a perforated peptic ulcer at the National Medical Center, between January 1991 and December 2000, were reviewed. RESULTS: The overall mortality rate was 5.9%. A univariate analysis of multiple clinical variables revealed old age (> or =65 years), duration of symptoms (> or =24 hours), NSAIDs or steroid use, comorbid disease, shock on admission, low hemoglobin ( or =20 mg%), higher creatinine (> or =1.5 mg%), gastric ulcer and simple closure to be significantly associated with mortality. However, a multivariate analysis showed that shock on admission, comorbid disease and old age (> or =65 years) were independent predictors of mortality. CONCLUSION: Shock on admission, comorbid disease and old age should be considered as significant prognostic factors of emergency surgery for a perforated peptic ulcer, and a comorbid disease and age as non modifiable factors. For that reason, prompt resuscitation is considered as the most effective therapy for reducing the mortality due to peptic ulcer perforation.

A comparison of outcome after general anesthesia versus regional anesthesia in geriatric patients / 대한마취과학회지

To reduce postoperative mortality in elderly patient, between January 1988 and March 1993, in a retrospective study we compared 388 patients with general anesthesia (GA) and regional anesthesia (RA) over 70 years of age. The patients whose anesthetic methods could be decided by anesthesiologists arbitrarily were selected undergoing orthopedic surgery, gynecologic surgery and urosurgery. The groups were compared for postoperative hospital death within one month. The overall postoprative mortality was 3.9% and 6.6% in GA group, 2.6% in RA group respectively. There was no significance between GA group and RA group. We conclude that there are no signifcant differences postoperative survival or mortality attributable specifically to anesthetic methods selected, either GA or RA.

A Clinical Analysis of Surgically Treated 286 Intracranial Aneurysms

We have studied 286 cases of intracranial aneurysm patients, who were admitted, surgically treated and registered at Korea University Medical Center between January, 1980 and February, 1989. This report resents an analysis of 286 cases of surgically treated intracranial aneurysms. The following results were obtained; 1) Intracranial aneurysm was the most common in the 6th decade(100 cases, 35.0%) and the next order was in the 5th decade(82 cases, 28.7%). 2) The male to female ratio was 1 : 1.53, but male predominant below 4th decade. 3) Aneurysmal size was the most common between 3mm and 10mm(264 cases, 85.2%). 4) The most frequent site was anterior communicating artery(102 cases, 32.9%) and the next order was posterior communicating artery(90 cases, 29.0%). 5) The incidence of multiple aneurysm was 6.6%(19 cases). 6) The incidence of single unruptured aneurysm was 7.6%(19 cases), its most common initial symptom was 3rd cranial nerve palsy. 7) The initial clinical status of patients seems to parallel the postoperative prognosis. 8) The degree of cerebral vasospasm on angiography seems to parallel the postoperative prognosis. 9) Postoperative mortality was 10.8%, but it was 3.8% in operation cases after January, 1986. 10) The most common cause of postoperative mortality was cerebral vasospasm(38.7%), and the next order was rebleeding(19.4%).

Clinical Features of Craniocerebral Injury in Children

The present study involves 667 patients of craniocerebral injury under 15 year old who were admitted to the Department of Neurosurgery, Yonsei Medical College and Wonju Christian Hospital from January, 1982 to December, 1983. The results of which were analyzed and evaluated as follows. 1) The proportion of male to female was 2 to 1, and one third of patients was from 2 to 7 years of age. 2) The most frequent cause of injury was traffic accident : crash injury by truck and taxi and the next was fall from height and which were the causes of three quaters of all the craniocerebral injury of children. 3) Accidents were most frequent in May, and their frequent hour was from 3 P.M. to 4 P.M. 4) In 546 cases(81.9%), the consciousness was lost at the moment of the accident, and the duration was considered to be correlated with the clinical severity. Vomiting was observed in 353 cases(52.9%), and the early seizure attack accured in 31 cases(4.6%). 5) On admission, 631 patients were G.C.S. 8 and over, 25 patients were G.C.S. between 5 and 7,11 patients were G.C.S. 3 or 4. Two thirds of mortality cases were observed in G.C.S. under 7. 6) On plain skull films, skull fracture was observed in 292(43.8%) cases. Among those, depressed skull fracture was observed in 57 cases, and compound comminuted depressed fracture in 21 cases. By brain CT scan, abnormal hemorrhagic density was observed in 126 cases(18.9%), which involves 65 cases of epidural hematoma and 14 cases of subdural hematoma. In 47 cases, the hemorrhagic density was observed in intracerebral, intraventricular or intracerebellar region. 7) Associated injury accompanied by head injury was observed in 102(15.3%) cases, and mandible fracture, with or without tooth fracture, clavicle fracture, femur fracture, tibia fracture in order of frequency. It is considered that associated injury was one of the major causes of long term hospitalization and complication. 8) Total mortality rate was 3.1%, and the postoperative mortality was 6.9%.