ABSTRACT
Introducción Los reemplazos articulares son calificados como procedimientos seguros y exitosos para el tratamiento de la osteoartrosis severa de cadera y rodilla alrededor del mundo. Las tasas de reingreso en los primeros 30 días y las complicaciones se han descrito como una medida para evaluar estándares de calidad. En Colombia no se conoce el comportamiento de éstos estándares. Este estudio pretende aportar información de un centro especializado en reemplazos articulares en Bogotá DC, Colombia, Suramérica. Materiales & Métodos Se realizó un estudio observacional prospectivo de una cohorte de 1.126 pacientes con 626 reemplazos totales de cadera (RTC) y 500 de rodilla (RTR), operados entre los años 2011-2015 en el Hospital Universitario San Ignacio de Bogotá DC, Colombia. Se reportan las tasas de reingreso a 30 días y las complicaciones. Se analiza mediante un modelo de regresión las asociaciones entre variables sociodemográficas y clínicas con el reingreso y las complicaciones. Resultados El 71% de los pacientes fueron mujeres, el promedio de edad de 63 años en los hombres y 65 años en mujeres. La estancia hospitalaria promedio fue de 3,5 días (DE:0,81-6,29). La tasa de reingreso a 30 días por cualquier causa fue 10,8% y la tasa de complicaciones asociadas al procedimiento fue 5,8%, se requirió reintervención quirúrgica en 1,5% de los pacientes. Se encontró asociación estadísticamente significativa entre el índice de Charlson mayor a 2 (OR=2,33[IC95% 1,3-4,18], p=0.004) y el reingreso a 30 días. La principal complicación en RTC fue luxación (1,4%) y en RTR infección de sitio quirúrgico (4%). Se encontró una asociación significativa entre complicaciones a 30 días con los días de hospitalización (OR=1,17[IC95% 1,09-1,25], p=0,00); y con el cirujano 4 en RTR (OR=2,28[IC95% 1,29-4,01], p=0,04); las demás variables no mostraron diferencias significativas. No se aprecian grandes diferencias con lo reportado en la literatura, asociación con estancia hospitalaria y experiencia del cirujano. Discusión La experiencia del cirujano y la aplicación de guías clínicas que optimicen los procesos intrahospitalarios y regulen los días de estancia hospitalaria, se relacionan con un mejor desenlace en la evolución de los pacientes en cuanto al número de complicaciones y reingresos a 30 días.
Background Joint replacements are always defined as safe and successful procedures for the treatment of severe osteoarthritis of the hip and knee around the world. Rates of readmission within initial post surgical 30 days and complications are described as a measure to assess quality standards. In Colombia the behavior of the standards are mainly unknown. Aim of study is to provide information from a specialized in joint replacements center in Colombia. Methods A prospective observational study was carried out on a cohort of 1,126 patients with 626 total hip replacements (THR) and 500 knee replacements (TKR), who underwent surgery between 2011-2015 at a University Hospital in Bogotá, Colombia. 30-day readmission rates and complications were reported. The associations between sociodemographic and clinical variables with readmission and complications were analyzed using a regression model. Results 71% of the patients were women, the average age was 63 years for men and 65 years for women. The mean hospital stay was 3.5 days (SD: 0.81-6.29). The 30-day readmission rate for any cause was 10.8% and the rate of complications associated with the procedure was 5.8%. Additional surgical procedures were required in 1.5% of the patients. A statistically significant association was found between the Charlson index greater than 2 (OR=2.33 [95% CI 1.3-4.18], p=0.004) and readmission at 30 days. The main complication in THR was dislocation (1.4%) and surgical site infection (4%) in TKR. A significant association was found between complications at 30 days and days of hospitalization (OR=1.17 [95% CI 1.09-1.25], p=0.00); and with surgeon 4 in TKR (OR=2.28 [95% CI 1.29-4.01], p=0.04); the other variables did not show significant differences. No differences were found with what is reported in the literature, association with hospital stay and experience of the surgeon. Discussion The surgeon's experience and the application of clinical guidelines that optimize in-hospital processes and regulate the days of hospital stay are related to a better outcome in the evolution of patients in terms of the number of complications and readmissions after 30 days.
Subject(s)
Humans , Patient Readmission , Arthroplasty , Risk FactorsABSTRACT
Objetivos: Analisar histologicamente e histometricamente o efeito do RTR® em defeitos ósseos cirúrgicos críticos em tíbias de ratos no processo de reparo ósseo. Materiais e Métodos: Defeitos ósseos críticos foram criados nas tíbias de 32 ratos Wistar divididos em dois grupos: Grupo Coágulo e Grupo RTR®. Após o período experimental de 30 e 90 dias, os animais foram sacrificados e as peças incluídas em parafina, cortadas e coradas com hematoxilina e eosina. Dois parâmetros foram analisados: a área óssea total neoformada (AON) e a área óssea da cortical neoformada (ACN). A análise estatística foi realizada nos dois períodos de observação pela análise de variância (ANOVA) e pelo Teste de Tukey. Resultados: Todos os grupos demonstraram reparo ósseo superior quando comparados ao Grupo Coágulo 30 dias nos dois parâmetros analisados. O Grupo RTR®, em 30 e 90 dias, apresentou reparo da cortical óssea e formações de tecido ósseo na região central do defeito maior do que no Grupo Coágulo de 90 dias, que apresentou reparo parcial da cortical óssea e poucas formações de tecido ósseo na região do defeito (p<0,05). Conclusões: O RTR® favoreceu a neoformação óssea no modelo experimental adotado podendo ser indicado em casos de cavidades ósseas de tamanho crítico(AU)
Objectives: To analyze histologically and histometrically the effect of RTR® on critical surgical bone defects in rat tibiae in the bone repair process. Materials and Methods: Critical bone defects were created in the tibia of 32 Wistar rats divided into two groups: Clot Group and RTR® Group. After the experimental period of 30 and 90 days, the animals were sacrificed and the paraffin embedded pieces were cut and stained with hematoxylin and eosin. Two parameters were analyzed: total neoformed bone area (AON) and bone area of neoformed cortical (ACN). Statistical analysis was performed in the two observation periods by analysis of variance (ANOVA) and Tukey's test. Results: All groups demonstrated superior bone repair when compared to the Clot Group 30 days in the two analyzed parameters. The RTR® Group, in 30 and 90 days, presented repair of the cortical bone and bone tissue formations in the central region of the defect greater than in the 90-day Clot Group, which presented partial repair of the cortical bone and few bone tissue formations in the region of the defect (p <0.05). Conclusions: The RTR® favored the bone neoformation in the adopted experimental model and can be indicated in cases of bone of critical size(AU)