Comparison of blood glucose level in diabetics undergoing orthopedic surgeries with general or spinal anesthesia

Background: Diabetes increases the risk of peri-operative morbidity and mortality and research to decrease intraoperative blood glucose variations has been continued without any results. The objective of this study was to evaluate the blood glucose level in diabetics undergoing orthopedic surgeries with general or spinal anesthesia

Methods: In this prospective cross-sectional descriptive analytic study the blood glucose levels were evaluated in 80 diabetic patients undergoing orthopedic surgeries during general and spinal anesthesia before surgery, after incision, after one hour and in recovery

Results: 25 patients were male and 55 were female. The age of patients in spinal group was 64.90+/- 10.73 and in general group 60.78+/-10.86 years old. Body Mass Index in spinal group was 27.85+/-3.69 and in general group 29.43+/-3.57. Blood glucose levels were not significantly different between two groups. The blood glucose levels were significant in samples taken between incision and recovery period in both groups

Conclusions: The blood glucose level during surgery and anesthesia has been increased continuously and this increase in general group had a steeper slope but it was acceptable

Institutional impact of EVAR's incorporation in the treatment of abdominal aortic aneurysm: a 12 years' experience analysis

Abstract Introduction: Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective: To analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods: A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results: The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions: Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.

Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery

PURPOSE: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. RESULTS: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (chi2=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (chi2=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. CONCLUSION: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.

Fatores de risco para mortalidade de pacientes submetidos à revascularização miocárdica / Risk factors for mortality of patients undergoing coronary artery bypass graft surgery

Introdução: Cirurgia de revascularização do miocárdio é um procedimento seguro realizado em todo o mundo com taxas baixas de mortalidade e morbidade na população geral. Objetivo: Estudar fatores de risco para mortalidade de pacientes submetidos à revascularização miocárdica com circulação extracorpórea. Métodos: Foram estudados retrospectivamente e de forma consecutiva 1.628 pacientes submetidos à revascularização com circulação extracorpórea no período de dezembro de 1999 a fevereiro de 2012. A análise de dados foi efetuada por meio dos testes t de Student não pareado, Mann-Whitney e exato de Fisher para dados categóricos. Regressão logística, Odds Ratio e IC95% foram utilizados para definição de fatores de risco para mortalidade. Resultados: Do total de 1.628 pacientes submetidos à cirurgia de revascularização do miocárdio com circulação extracorpórea, 141 (8,7%) foram a óbito. Após regressão logística, foram identificados como fatores de risco para mortalidade as variáveis diálise (OR=7,61; IC 95% 3,58-16,20), lesão neurológica tipo I (OR = 4,42; IC 95% 2,48-7,81), uso de BIA (OR=3,38; IC 95% 1,98-5,79), tempo de CEC (OR = 3,09; IC 95% 2,04-4,68), creatinina pico - admissão > 0,4 mg/dL (OR=2,67; IC 95% 1,79-4,00), idade > 65 anos (OR=2,31; IC 95% 1,55-3,44) e tempo entre admissão hospitalar e procedimento cirúrgico (OR = 1,53; IC 95% 1,03-2,27). Conclusão: Diálise, lesão neurológica tipo I, uso de balão intra- aórtico, tempo de circulação extracorpórea (> 115 minutos), creatinina pico-admissão > 0,4 mg/dL, idade > 65 anos e tempo entre admissão hospitalar e procedimento cirúrgico foram considerados como fatores de risco para mortalidade em pacientes submetidos à cirurgia de revascularização do miocárdio com circulação extracorpórea. .

Introduction: Coronary artery bypass grafting is a safe procedure performed worldwide with low rates of mortality and morbidity in general population. Objective: To investigate risk factors for mortality of patients undergoing coronary artery bypass grafting coronary artery bypass grafting surgery. Methods: A total of 1,628 consecutive patients undergoing on-pump coronary artery bypass grafting were retrospectively studied from December 1999 to February 2012. Data analysis involved paired Student t test, Mann-Whitney test and Fisher’s exact test for the categorical data. Logistic regression, Odds Ratio and 95%CI were used for definition of risk factors for mortality. Results: Of a total of 1,628 patients undergoing on-pump coronary artery bypass grafting, 141 (8.7%) died. The following risk factors for mortality were identified after logistic regression: dialysis (OR=7.61; 95%CI 3.58-16.20), neurologic dysfunction type I (OR=4.42; 95%CI 2.48-7.81), use of IABP (OR=3.38; 95%CI 1.98-5.79), cardiopulmonary bypass time (OR=3.09; 95%CI 2.04-4.68), serum creatinine on admission and peak values > 0.4mg/dL (OR=2.67; 95%CI 1.79-4.00), age > 65 years (OR=2.31; 95%CI 1.55-3.44), and time between hospital admission and and surgical procedure (OR=1.53; 95%CI 1.03-2.27). Conclusion: Dialysis, type I neurologic dysfunction, use of IABP, cardiopulmonary bypass time (> 115 minutes), serum creatinine on admission and peak values>0.4mg/dL, age > 65 years and time between hospital admission and surgical procedure were considered as risk factors for mortality in patients undergoing on-pump coronary artery bypass grafting surgery. .

Resultados del tratamiento de 215 tumores pancreáticos y periampulares en el Hospital Hermanos Ameijeiras / Results of the treatment for 215 pancreatic and periampular tumors at Hermanos Ameijeiras hospital

Introducción. el cáncer pancreático es una de las neoplasias más letales, ocupa el quinto lugar en frecuencia en occidente y tiene una supervivencia asociada inferior al 20 por ciento al año y al 3 por ciento a los 5 años. La única posibilidad de curación la brindan intervenciones quirúrgicas de gran envergadura que conllevan una alta tasa de morbilidad y mortalidad. Objetivo: caracterizar a los pacientes según variables demográficas, enfermedades asociadas y manifestaciones clínicas, e identificar estudios de mayor valor para el diagnóstico y la relación entre las variables perioperatorias y la aparición de complicaciones, mortalidad hospitalaria y evolucion posoperatoria. Métodos. se realizó un estudio observacional, longitudinal y prospectivo con pacientes con tumores pancreáticos y periampulares que fueron tratados en el Servicio de Cirugía General del Hospital Clínico Quirúrgico Hermanos Ameijeiras entre enero de 2006 y diciembre de 2011. Resultados. hubo un total de 215 pacientes con tumores de páncreas: 178 lesiones periampulares y 37 lesiones del cuerpo y la cola de páncreas. Se resecaron 24 lesiones pancreáticas distales y fueron intervenidos quirúrgicamente 153 pacientes con lesiones periampulares, de las cuales se resecaron 83. Se realizaron 78 pancreatoduodenectomías cefálicas y la localización más frecuente fue la ampolla de Vater (36 pacientes, 50,7 por ciento), seguida de la cabeza del páncreas (26 pacientes, 36,6 por ciento). Hubo complicaciones en el 66,2 por ciento de los pacientes. La mortalidad perioperatoria fue del 4,2 por ciento y la hospitalaria del 23,9 por ciento. Conclusiones. los tumores periampulares fueron más frecuentes entre los 50 y 69 años. La enfermedad asociada más frecuente fue la hipertensión arterial, y la ictericia, el síntoma fundamental. La colangiopancreatografía retrógrada endoscópica fue el examen de mayor sensibilidad. La mortalidad hospitalaria estuvo relacionada con las enfermedades asociadas, el tiempo quirúrgico, la transfusión sanguínea operatoria y las complicaciones(AU)

Introduction: pancreatic cancer is one of the most deadly cancers; it ranks the 5th place in frequency in the Western countries and its associated survival is under 20 percent annually and lower than 3 percent at 5 years. The only chance for healing is surgery, usually complex interventions with high morbidity and mortality rates. Objetive: to characterize patients by demographic features, associated diseases, and clinical manifestations, and to identify more valuable studies for diagnosis and related peroperative variables associated with complications, mortality and evolution. Methods: prospective, longitudinal and observational study was conducted on patients diagnosed with pancreatic and periampular tumors, who were treated at the general surgery service of Hermanos Ameijeiras clinical and surgical hospital from January 2006 through December 2011. Results: a total of 215 patients with pancreatic tumors, 178 periampular lesions and 37 injures in the body and the pancreas head. Twenty four distal pancreatic lesions were resected whereas 153 periampular locations, 83 of them were ablated. There were 78 cephalic pancreatoduodenectomies and most frequent localization was Vater ampoule in 36 patients (50.7 percent), followed by the head of the pancreas in 26 patients (36.6 percent). Complications were found on 66.2 percent of cases. Perioperative mortality rate was 4.2 percent whereas hospital mortality amounted to 23.9 percent. Conclusions: periampular tumors were more common in patients aged 50 to 69 years; the most related disease was high blood pressure and the fundamental symptom was jaundice. Endoscopic retrograde cholangiopancreatography was the most sensible paraclinical test. In-hospital mortality was associated to related diseases, surgical time, blood transfusions and complications(AU)

Robot-assisted vs. Laparoscopic Partial Nephrectomy: utilization rates and perioperative outcomes

Objectives To examine the effect of surgical approach on perioperative morbidity and mortality after partial nephrectomy. Materials and Methods Within the Nationwide Inpatient Sample, patients who underwent RAPN or LPN between October 2008 and December 2009 were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality, stratified according to RAPN vs. LPN, were compared. Results Overall, 851 (72.5%) patients underwent RAPN and 323 (27.5%) underwent LPN. For RAPN and LPN respectively, the following rates were recorded in the propensity-score matched cohort: blood transfusions, 4.5 vs. 6.8% (p = 0.223); intraoperative complications, 5.2 vs. 2.6% (p = 0.096); postoperative complications, 10.6 vs. 13.5% (p = 0.268); prolonged length of stay, 6.8 vs. 9.4% (p = 0.238); in-hospital mortality, 0.0 vs. 0.0%. Conclusions RAPN has supplanted LPN as the predominant minimally invasive surgical approach for renal masses. Perioperative outcomes after RAPN and LPN are comparable. Interpretation of these findings needs to take into account the lack of adjustment for case complexity and surgical expertise. .

Fatores de risco pré, intra e pós-operatórios para mortalidade hospitalar em pacientes submetidos à cirurgia de aorta / Risk factors for pre, intra, and postoperative hospital mortality in patients undergoing aortic surgery

OBJETIVOS: O objetivo primário deste estudo é identificar preditores de óbito hospitalar em pacientes submetidos à cirurgia de aorta. O objetivo secundário é identificar fatores associados ao desfecho clínico composto hospitalar (óbito, sangramento, disfunção ventricular ou complicações neurológicas). MÉTODOS: Delineamento transversal com componente longitudinal; por meio de revisão de prontuários, foram incluídos 257 pacientes. Os critérios de inclusão foram: dissecção crônica de aorta tipo A de Stanford e aneurisma de aorta ascendente. Foram excluídos casos de dissecção aguda de aorta, qualquer tipo, e aneurisma de aorta não envolvendo segmento ascendente. As variáveis avaliadas foram demografia, fatores pré, intra e pós-operatórios. RESULTADOS: Variáveis com risco aumentado de óbito hospitalar (RC; IC95%; P valor): etnia negra (6,8; 1,54 30,2; 0,04), doença cerebrovascular (10,5; 1,12-98,7; 0,04), hemopericárdio (35,1; 3,73-330,2; 0,002), operação de Cabrol (9,9; 1,47-66,36; 0,019), cirurgia de revascularização miocárdica simultânea (4,4; 1,31-15,06; 0,017), revisão de hemostasia (5,72; 1,29-25,29; 0,021) e circulação extracorpórea (CEC) [min] (1,016; 1,007-1,026; 0,001). Dor torácica associou-se com risco reduzido de óbito hospitalar (0,27; 0,08-0,94; 0,04). Variáveis com risco aumentado do desfecho clínico composto hospitalar foram: uso de antifibrinolítico (3,2; 1,65-6,27; 0,0006), complicação renal (7,4; 1,52-36,0; 0,013), complicação pulmonar (3,7; 1,5-8,8; 0,004), EuroScore (1,23; 1,08-1,41; 0,003) e tempo de CEC [min] (1,01; 1,00-1,02; 0,027). CONCLUSÃO: Etnia negra, doença cerebrovascular, hemopericárcio, operação de Cabrol, revascularização miocárdica simultânea, revisão de hemostasia e tempo de CEC associaram-se com risco aumentado de óbito hospitalar. Dor torácica associou-se com risco reduzido de óbito hospitalar. Uso de antifibrinolítico, complicação renal, complicação pulmonar, EuroScore e tempo de CEC associaram-se ao desfecho clínico composto hospitalar.

OBJECTIVES: The primary objective was to identify predictors of hospital mortality in patients undergoing aortic surgery. The secondary objective was to identify factors associated with clinical outcome composed hospital (death, bleeding, neurologic complications or ventricular dysfunction). METHODS: A cross-sectional design with longitudinal component. Through chart review, 257 patients were included. Inclusion criteria were: aortic dissection Stanford type A and ascending aortic aneurysm. Exclusion criteria were acute aortic dissection, of any kind, and no aortic aneurysm involving the ascending segment. Variables assessed: demographics, preoperative factors, intraoperative and postoperative. RESULTS: Variables with increased risk of hospital mortality (OR, 95% CI, P value): black ethnicity (6.8, 1.54-30.2; 0.04), cerebrovascular disease (10.5, 1.12-98.7; 0.04), hemopericardium (35.1, 3.73-330.2; 0.002), Cabrol operation (9.9, 1.47-66.36; 0.019), CABG simultaneous (4.4; 1.31 to 15.06; 0.017), bleeding (5.72, 1.29-25.29; 0.021) and cardiopulmonary bypass (CPB) time [min] (1.016; 1.0071.026; 0.001). Thoracic pain was associated with reduced risk of hospital death (0.27, 0.08-0.94, 0.04). Variables with increased risk of hospital clinical outcome compound were: use of antifibrinolytic (3.2, 1.65-6.27; 0.0006), renal complications (7.4, 1.52-36.0; 0.013), pulmonary complications (3.7, 1.58.8, 0.004), EuroScore (1.23; 1.08-1.41; 0.003) and CPB time [min] (1.01; 1.00 to 1.02; 0.027). CONCLUSION: Ethnicity black, cerebrovascular disease, hemopericardium, Cabrol operation, CABG simultaneous, hemostasis review and CPB time was associated with increased risk of hospital death. Chest pain was associated with reduced risk of hospital death. Use of antifibrinolytic, renal complications, pulmonary complications, EuroScore and CPB time were associated with clinical outcome hospital compound.

Medical negligence in surgery: 112 cases retrospective analysis / 法医学杂志

OBJECTIVE@#To explore the general characteristics of medical negligence in surgery in order to provide the reference for forensic practices.@*METHODS@#One hundred and twelve cases of medical negligence in surgical department were retrospectively analyzed in Fada Institute of Forensic Medicine and Science from 2008 to 2010.@*RESULTS@#The common types of medical negligence cases in the surgery were improper operation procedure (28.57%), failure of consent (26.79%), and inadequate monitoring (22.32%). The results of complications included disability or functional impairment (61.61%), death (31.25%) and transient impairment with no obvious adverse reactions (7.14%). The most common roles played by the medical negligence cases were minor role (26.79%), equal role (19.64%), and slight role (14.29%).@*CONCLUSION@#Significant attention should be paid to the operation procedure, consent, and monitoring. It should be cautious to not make assessment on involvement degree of medical negligence.

Frequency of intraoperative cardiac arrest and medium-term survival / Frequencia de parada cardiaca intraoperatoria e sobrevida no medio prazo

CONTEXT AND OBJECTIVE: Although advances in surgical and anesthetic techniques have reduced perioperative morbidity-mortality, the survival rate following cardiac arrest remains low. The aim of this study was to evaluate, over the course of one year, the prevalence of intraoperative cardiac arrest and the 30-day survival rate after this event in a tertiary teaching hospital. DESIGN AND SETTING: Prospective cohort study in a tertiary teaching hospital. METHODS: Following approval by the institutional ethics committee, anesthetic procedures and cases of intraoperative cardiac arrest between January and December 2007 were evaluated. Patients undergoing cardiac surgery were excluded. The data were gathered prospectively using the modified Utstein model, with evaluation of demographic data, pre-arrest conditions, intraoperative care, care during arrest and postoperative outcome up to the 30th day. The data were recorded by the attending anesthesiologist. RESULTS: During the study period, 40,379 anesthetic procedures were performed, and 52 cases of intraoperative cardiac arrest occurred (frequency of 13:10,000). Among these, 69% presented spontaneous return of circulation after the initial arrest, and only 25% survived for 30 days after the event. The following factors were associated with shorter survival: American Society of Anesthesiologists physical status IV and V, emergency surgery, hemorrhagic events, hypovolemia as the cause of arrest and use of atropine during resuscitation. CONCLUSIONS: Although the frequency of cardiac arrest in the surgical environment has declined and resources to attend to this exist, the survival rate is low. Factors associated with worst prognosis are more frequent in critical patients. .

CONTEXTO E OBJETIVO: Apesar de avanços nas técnicas cirúrgicas e anestésicas terem reduzido a morbimortalidade perioperatória, a taxa de sobrevivência após parada cardíaca (PC) permanece baixa. O objetivo deste estudo foi avaliar, ao longo de um ano, a incidência de PC intraoperatória e de sobrevida por 30 dias após esse evento em um hospital terciário de ensino. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectivo em hospital terci ário de ensino. MÉTODOS: Após aprovação pela Comissão de Ética institucional, os procedimentos anestésicos e os casos de PC intraoperatórios foram avaliados no período de janeiro a dezembro de 2007, excluindo-se pacientes submetidos a cirurgia cardíaca. Os dados foram coletados prospectivamente utilizando o modelo Utstein modificado, com avaliação dos dados demográficos, das condições pré-PC, dos cuidados intraoperatórios e durante a PC e do desfecho pós-operatório até o trigésimo dia. Os dados foram registrados pelo anestesiologista assistente. RESULTADOS: Durante o per íodo de estudo, 40.379 procedimentos anestésicos foram realizados, com ocorrência de 52 casos de PC intraoperatória (frequência de 13:10000). Entre estes, 69% apresentaram retorno da circulação espontânea após a primeira parada e apenas 25% sobreviveram 30 dias após o evento. Os seguintes fatores foram associados com menor sobrevida: estado físico IV e V (Sociedade Americana de Anestesiologia), cirurgias de emergência, eventos hemorrágicos, hipovolemia como causa da parada e uso de atropina durante a reanimação. CONCLUSÕES: Embora a frequência de PC no ambiente cirúrgico tenha caído e existam recursos para seu atendimento, a taxa de sobrevivência é baixa. ...

Resultados da cirurgia por estenose aórtica em pacientes acima de 75 anos, em 4,5 anos de seguimento / Results of aortic valve surgery in patients over 75 years old, at 4.5 years of follow-up

INTRODUÇÃO: O aumento da expectativa de vida da população tem levado à maior necessidade de intervenções cirúrgicas sobre a valva aórtica. OBJETIVOS: Avaliar a mortalidade precoce e a médio prazo, a necessidade de reoperação para troca valvar e complicações valvares [tromboembolismo sistêmico (TES) e endocardite infecciosa em prótese (EI)] em pacientes acima de 75 anos submetidos a cirurgia de estenose aórtica. MÉTODOS: Estudo retrospectivo de 230 casos, operados no período de 2002 a 2007. A idade média foi de 83,4 anos, sendo 53% do sexo masculino, 73,2% hipertensos, 17,9% portadores de fibrilação atrial e 14,4% com cirurgia cardíaca prévia. Outro procedimento cardíaco esteve associado em 39,1% dos casos. RESULTADOS: Em 4,51 anos de seguimento médio, a sobrevida geral foi de 57,4%. Ocorreram 13,9% óbitos intra-hospitalares (9,4% no grupo cirurgia de estenose aórtica isolada vs. 20,9% quando outro procedimento cirúrgico foi associado) e 28,7% óbitos após a alta hospitalar (25,0% vs. 34,4%), com 34 destes por causas cardiovasculares. Ocorreram seis casos de EI, oito casos de TES e seis reoperações para troca valvar. Os preditores de mortalidade geral foram: tempo de isquemia >90 min (RC 1,99 IC 95% 1,06-3,74), fração de ejeção <60% (RC 1,76 IC 95% 1,10-2,81) e acidente vascular encefálico prévio (RC 2,43 IC 95% 1,18-5,30). CONCLUSÃO: Ainda que o risco cirúrgico imediato de idosos seja elevado, as taxas de sobrevida referentes ao tratamento cirúrgico em pacientes acima de 75 anos são aceitáveis e permitem essa intervenção. O prognóstico é agravado, sobretudo, pela associação com doença arterial coronariana.

BACKGROUND: The increased longevity elevated the frequency of elderly requiring surgery, among them the correction of aortic stenosis. OBJECTIVES: To evaluate medium-term mortality, need for reoperation for valve replacement and valve complications [systemic thromboembolism (STE) and prosthetic endocarditis (PE)] in patients over 75 years old who had undergone surgery for aortic stenosis. METHODS: Retrospective study of 230 patients from 2002 to 2007. Mean age was 83.4 years and 53% were male. The prevalence of hypertension was 73.2%, atrial fibrillation 17.9% and previous cardiac surgery 14.4%. Another cardiac procedure was associated in 39.1%. RESULTS: In a mean follow-up of 4.51 years the overall survival of the population studied was 57.4%. Death in the immediate postoperative period occurred in 13.9% (9.4% in the isolated aortic stenosis surgery group vs. 20.9% when another procedure was associated). Deaths in the medium term occurred in 28.7% of the patients (25.0% vs. 34.4%), with 34 of these because of cardiovascular causes. There were 6 cases of PE, 8 cases of STE and 6 reoperations. The predictors of mortality were ischemia time >90 min (OR 1.99 95% CI 1.06-3.74), ejection fraction <60% (OR 1.76 95% CI 1.10-2.81) and prior stroke (OR 2.43 95% CI 1.18-5.30). CONCLUSION: Although the immediate surgical risk of the elderly is high, survival rates for surgical treatment of patients over 75 years old are acceptable and allow this intervention. The prognosis is worse especially because of the association with coronary artery disease.

Morbimortalidad precoz y alejada del reemplazo valvular aórtico con prótesis mecánica y biológica durante la última década: El estándar de oro / Early and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade: The gold standard

Background: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AYR as a valid comparative standard. Aim: To evaluate both perioperative and ¡ate morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses. Patients and methods: Retrospective review of medical records and operative protocols of patients undergoing AVR between January 1995 and December 2005. Patients with previous cardiac surgery, aortic balloonplasty or simultaneous cardiovascular procedures were excluded. Results: During the study period, 788 patients underwent AVR and 317 met the inclusion criteria. Of the latter, 175patients aged 13 to 83years (63 percent males) were subjected to AVRm and 142patients aged 49 to 87 years (64 percent males), were subjected to AVRb. Five (1.6 percent) patients died during the perioperative period (one AVRm and four AVRb). All were older than 65years. Perioperative complications were recorded in 29 and 25 percent of patients in AVRm and AVRb groups, respectively (NS). During a median follow-up of six years, complications were recorded in 12 and 4 percent of patients in AVRm and AVRb groups, respectively (p <0.05). The actuarial survival for AVRm group at 1, 5 and 10years, was 96, 92 and 87 percent, respectively. The figures for AVRb group were 95, 86 and 83 percent, respectively (NS). The 10 year reintervention free survival was 97 percent for the AVRm group and 84 percent for the AVRb (p <0.05). Conclusions: Perioperative mortality and rates of complications of AVR in this series of patients are low, which compares favorably with other series (Rev Méd Chile 2009; 137:1153-62).

Short- and Long-Term Results of Triple Valve Surgery: A Single Center Experience

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.

The Thai Anesthesia Incidents (THAI Study) of anesthetic risk factors related to perioperative death and perioperative cardiovascular complications in intracranial surgery.

OBJECTIVE: To evaluate the correlations between anesthetic risk factors and perioperative cardiovascular complications as well as perioperative death within 72 hours. MATERIAL AND METHOD: This case controlled took the data from the Thai Anesthesia Incidents Study (THAI Study), a prospective multi-centered registry of anesthesia in Thailand. The authors included all the patients who received intracranial surgery from 20 hospitals throughout Thailand. The present study was divided into two groups and focused on anesthetic factors that possibly related to perioperative cardiovascular complications or perioperative death. The statistical analysis were Chi Square test and logistic regression model with the statistical significance if p-value < 0.05 demonstrated in Odds ratio (OR) and 95% confidence interval. RESULTS: From the 7,430 patients, there were 63 patients (0.85%) with perioperative cardiovascular complication. The American Society of Anesthesiologists (ASA) physical status 3-5 (OR 5.77, 95% CI 2.33-14.27) and the absence of anesthesiologists (OR 2.19, 95% CI 1.06-4.54) had statistical correlation with the cardiovascular complication. Eighty-four patients (1.13%) who died within 72 hours post operatively were found. The ASA physical status 3-5 (OR 10.14, 95% CI 3.42-30.02), the emergency circumstance (OR 3.55, 95% CI 1.31-9.60), and the absence of endtidal carbondioxide monitor (OR 2.27, 95% CI 1.26-4.09) had statistical correlation with the perioperative death. CONCLUSION: Predictors of perioperative cardiovascular complications in intracranial surgical patients were ASA physical status 3-5 and absence of certified board anesthesiologists. Risk factors of perioperative death were ASA physical status 3-5, emergency condition, and absence or no monitoring of capnometer.

The Thai anesthesia incidents study (THAI Study) of perioperative death in geriatric patients.

BACKGROUND: The study was part of the Thai Anesthesia Incidents Study (THAI Study), a multi-centered study conducted by the Royal College of Anesthesiologists of Thailand, aiming to survey anesthetic related complications in Thailand. OBJECTIVE: Identify the incidence and factors related to perioperative death in geriatric patients. Material and Method: During a 12 months period (March 1, 2003 - February 28, 2004), a prospective multicenter descriptive study conducted in 20 hospitals comprising of seven university, five tertiary, four general and four district hospitals across Thailand. Anesthesia personnel filled up patient-related data, surgical-related, and anesthesia related variables and adverse outcomes of geriatric patients (age > or =65 yr) on a structured data entry form. The data were collected during pre-anesthetic, intra-operative, and 24 hr post operative periods. RESULTS: The overall mortality was 39.3 per 10,000 anesthetics from the registry of 23,899 geriatric patients receiving anesthesia. Multiple regression analysis showed that higher American Society of Anesthesiologists (ASA) physical status grading (p < 0.001), emergency operation (p = 0.031) and current medications (p = 0.043) were factors related to 24 hr perioperative death in geriatric patients. Patient's underlying diseases and duration of operations were not significantly related to death. CONCLUSION: The present study showed an incidence of 24-hr perioperative death of 1:254 in geriatric patients receiving anesthesia, which is comparable to other countries. Mortality in elderly patients operated under anesthesia can be predicted by ASA physical status, current medications, and emergency condition.

Reseccionea hepáticas en el servicio de cirugía general del Hospital Privado: 13 años de experiencia resecciones hepátidas / Liver resection in hospital privado's general surgery department: 13- year experience liver resections

Las resecciones hepáticas constituyen el tratamiento de elección en las neoplasias hepáticas primárias y en algunos casos de tumores metastáticos, pero conllevan tasas significativas de morbilidad y mortalidad. Objetivo: Presentar nuestra experiencia en cirurgías hepáticas. Material y método: Se incluyeron 40 paciente sometidos a hepatectomías en nuestra Institución desde diciembre de 1991 a diciembre de 2004. Los datos fueron recolectados en forma retrospectiva y analizados mediante método estadístico descriptivo. Resultados: Los diagnósticos incluyeron enfermedades hepáticas primarias benignas (n=9, 22.5%) y malígnas (n=7, 17.5%) y enfermedades hepáticas metastásicas (n=24, 60%). Dentro de las metástasis, la más frecuente fue el adenocarcinoma de colon (n=7, 17.42%). El índice de complicaciones quirúrgicas inmediatas fue del 55% (n=22). Hubo 4 muertees peri-operatorias (10%) y la tasa promedio de estadía hospitalaria fue de 10,8 días. Conclusiones: Nuestros hallazgos demostraron que la indicación más frecuentes de resección hepática en nuestra experiencia es las metástasis de adenocarcinoma de colon y que los resultados observado en nuestra serie son comparables a los obtenidos por otras Instituciones a nivel mundial con similar flujo de pacientes.

Liver resection constitutes the treatment of choice in the liver primary neoplasms and some cases of metastatic tumors, but entail significant morbidity and mortality rates. OBJECTIVE: To present our experience in hepatic surgery. MATERIAL AND METHODS: We included 40 patients who underwent hepatectomies in our Institution from December 1991 through December 2004. The information was collected retrospectively and was analized descriptive and statistically. RESULTS: 40 patients underwent 40 hepatectomies. The diagnosis included primary benign hepatic disease (n= 9, 22.5%), primary hepatic malignancy (n= 7, 17.5%) and metastatic hepatic disease (n= 24, 60%). In the metastatic group, the most frecuent pathology was colonic adenocarcinoma (n= 17, 42%). There were 4 perioperatory deaths (10%) and the average hospitaly stay was 10.8 days. CONCLUSIONS: our data shows that the most frequent indication of hepatic resection in our experience was metastatic colonic adenocarcinoma as compared to the other Institutions with similar experience.

Factores asociados a mortalidad en cirugía mayor: análisis retrospectivo en un centro de referencia / Mortality associated factor in major surgery: retrospective analysis in a referral center

Background. There are very few studies that analyze surgical morbidity and mortality in the general population and the factors associated with those events. Objective. To determine factors associated to mortality in surgical procedures performed in a tertiary referral center in Mexico City. Methods. We retrospectively analyze surgical mortality in 4,157 consecutive surgical procedures performed in a one-year period from 1/1/2000 through 12/31/2000. Categorical variables were analyzed with the chi-square test and continuous variables with the t-Student test. Significance was defined as p < O.OB. Results. During the study period there were 76 postoperative deaths, representing a mortality rate of 1.82%. Mean patient's age in the entire cohort was 48.7 ± 17.6 years and for the patients who died in the postoperative period 57.8 ± 17.8 years (p < 0.05). Sixty-six percent of deaths were attributed to the primary or surgical disease. In 33.8% of postoperative deaths an adverse event was identified as responsible for the outcome. In 23% of cases there was a potentially preventable event, representing 0.3% of surgical procedures. Most patients (96.9%) had at least one co-morbid condition and 61.5% had two or more. Almost 80% of surgical deaths occurred in patients with ASA score III of TV and albumin levels below 3.5 g/dL. Most common cause of death was sepsis, reported in 35% of patients who died in the postoperative period. Conclusion. Surgical mortality in our series is low. In 0.3% of procedures it was detected a potentially preventable event. Postoperative deaths occurred in older patients with low albumin levels.

Introducción. Existen pocos estudios que analicen la mortalidad quirúrgica general y los factores asociados a la misma. Objetivo. Estudiar las causas y factores asociados a mortalidad quirúrgica en las intervenciones quirúrgicas realizadas en el INCMNSZ. Métodos. Se analizó en forma retrospectiva la mortalidad quirúrgica asociada a 4,157 procedimientos consecutivos realizados del 1/1/2000 al 31/12/2000. Los factores asociados a mortalidad fueron analizados mediante la prueba de chi-cuadrada para variables categóricas y t de Student para variables continuas. Se estableció como significativa a p < 0.05. Resultados. Durante ese periodo ocurrieron 76 muertes postoperatorias, lo que representa una mortalidad global de 1.82% para todos los procedimientos. El promedio de edad para los 4,157 procedimientos fue de 48.7 ± 17.6 años y para las muertes postoperatorias fue de 57.8 ± 17.8 años (p < 0.05). El 66.2% de las muertes se atribuyeron a la enfermedad de base o a la patología que motivó la cirugía. En 33.8% de las muertes se identificó algún evento diferente a la enfermedad primaria como responsable de la muerte. En 23% se identificó algún evento potencialmente prevenible, lo que representa 0.3% del total de eventos quirúrgicos. El 96.9% de los pacientes tenía al menos una comorbilidad y 61.5% cursaba con dos o más. El 78.5% de las muertes sucedió en pacientes ASA III-IV. El 80% de las muertes se asoció a niveles preoperatorios de albúmina por debajo de 3.5 g/dL. La causa de muerte más frecuentemente reportada fue sepsis en 35% de los eventos. Conclusión. La mortalidad postoperatoria en nuestra serie es baja. En 0.3% de los pacientes sometidos a cirugía se detectó algún evento potencialmente prevenible. Las muertes postoperatorias ocurrieron en pacientes más viejos y con niveles bajos de albúmina.