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.

Mortalidad operatoria en cirugía mayor. Análisis retrospectivo en un Servicio de Cirugía / Operative mortality in major surgery. Retrospective analysis in a Surgery Service

RESUMEN Introducción: la propia asistencia médica provoca, en determinadas situaciones, problemas de salud que pueden llegar a ser importantes para el enfermo. El análisis de la mortalidad es uno de los parámetros utilizados para investigar la seguridad en la realización de procederes de cirugía mayor. Objetivo: determinar los factores asociados a la mortalidad operatoria en cirugías mayores. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo, de los pacientes que fallecieron tras la realización de una cirugía mayor, en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, en el período comprendido de enero de 2011 a diciembre de 2019. Resultados: la tercera edad aportó 77,3 % de los fallecidos. La hipertensión arterial, diabetes mellitus y cardiopatía isquémica fueron las principales comorbilidades. El abdomen agudo fue el diagnóstico operatorio más frecuente con 98 (58,3 %). Las complicaciones aportaron el 11,9 % de los fallecidos; los eventos adversos, 29,7 %, y por el curso natural de la enfermedad, murió un 58,3 %. El síndrome de disfunción múltiple de órganos y el shock séptico resultaron las principales causas de muerte (62 %). Conclusiones: la mortalidad operatoria estuvo asociada a factores de riesgo como edad avanzada, enfermedades crónicas y cirugía de urgencia. Los eventos adversos elevan la incidencia de mortalidad en cirugía mayor. Las infecciones son la principal causa de mortalidad operatoria (AU).

ABSTRACT Introduction: medical care itself causes, in certain situations, health problems that could be very important for the patient. The mortality analysis is one of the parameters used to study safety performing procedures of major surgery. Objective: to determine the factors associated to operatory mortality in major surgeries. Materials and methods: a retrospective, descriptive and observational study was carried out of the patients who passed away after undergoing a major surgery in the Military Hospital Dr. Mario Munoz Monroy in the period between January 2011 and December 2019. Results: 77.3 % of the deceased were elder people. The main co-morbidities were arterial hypertension, diabetes mellitus and ischemic heart disease. The most frequent surgery diagnosis was acute abdomen with 98 patients (58.3 %). Complications yielded 11.9 % of the deceases, adverse events 29.7 % and 58.3 % died due to the natural course of the disease. The organs multiple dysfunction syndrome and septic shock were the main causes of dead (62 %). Conclusions: operatory mortality was associated to risk factors like advanced age, chronic diseases and emergency surgery. The adverse events increase mortality incidence in major surgery. Infections are the main causes of operatory mortality (AU).

Mortalidad posoperatoria después de un año del evento quirúrgico en una cohorte de pacientes adultos mayores / One-year postoperative mortality in a cohort of older patients

AIM: To determine one-year postoperative mortality in patients older than 65 years at the Hospital Clínico de la Universidad de Chile. MATERIAL AND METHODS: After approval by the ethics committee, a random sample of 235 patients was obtained from 2,832 patients ≥ 65 years who underwent surgery that required general or regional anesthesia. This sample size was calculated to detect a mortality incidence of 10% ± 5%, with a power of 80%, an  error of 0.05, and a loss of 10%. We recorded the demographic variables together with the Charlson Comorbidity Index (CCI) score from the electronic medical records. While the date of mortality was obtained from the Civil Registry. RESULTS: We studied 233 patients with an age of 73.1 ± 6.3 years, 52.4% were women, and a mean CCI score of 4 (2-11) points. In total 65.7% underwent general anesthesia, 34.3% underwent regional anesthesia, and 24% underwent major surgery. Mortality at 30 days was 1.3% and at one year it was 6%. The patients who died were older and had a higher CCI, especially due to a higher incidence of dementia and solid tumors with metastases. CONCLUSIONS: In our study, postoperative mortality at one year was lower than those reported in older adult patients, and deceased patients were older with more comorbidities, especially with solid tumors with metastases and dementia.

OBJETIVO: Determinar la mortalidad al primer año postoperatorio de pacientes mayores de 65 años en el Hospital Clínico de la Universidad de Chile.MATERIALES Y MÉTODOS: Tras la aprobación del comité de ética, se obtuvo una muestra aleatoria de 235 pacientes de un total de 2.832 pacientes ≥ 65 años sometidos a una cirugía que requirió de anestesia general o regional. Este tamaño muestral fue calculado para detectar una incidencia de mortalidad de 10% ± 4%, con un poder de 80%, un error  de 0,05 y una pérdida de 10%. Se registraron los antecedentes demográficos, se calculó el puntaje de Charlson Comorbidity Index (CCI) y se consignó la mortalidad desde el Registro Civil. RESULTADOS: Se estudiaron 233 pacientes con una edad de 73,1 ± 6,3 años, un 52,4% fueron mujeres y una mediana del puntaje CCI de 4 (2-11) puntos. En total 65,7% fue intervenido bajo anestesia general y 34,3% bajo anestesia regional, y 24% fue sometido a una cirugía de alta complejidad. La mortalidad a los 30 días fue de 1,3% y al año fue de 6%. El grupo de pacientes fallecidos se caracterizó por ser más añoso y tener un CCI mayor, especialmente por una mayor incidencia de demencia y tumores con metástasis. CONCLUSIONES: En nuestro estudio se observó una mortalidad postoperatoria al año menor a lo reportado internacionalmente en pacientes adultos mayores. La mortalidad fue mayor en pacientes de mayor edad, con un mayor número de comorbilidades, con tumores sólidos con metástasis y demencia.

Mortalidad por peritonitis secundaria en una unidad de cuidados intensivos / Mortality from secondary peritonitis in an intensive care unit

RESUMEN Introducción: La peritonitis secundaria es el proceso inflamatorio en la cavidad peritoneal generado por perforación, inflamación o gangrena de una estructura intraabdominal o retroperitoneal Objetivo: determinar las características clínicas y epidemiológicas de los fallecidos por peritonitis secundaria en la unidad de cuidados intensivos del Hospital Provincial Docente Clínico Quirurgico Doctor León Cuervo Rubio desde enero del 2017 a diciembre del 2018. Métodos: se realizó una investigación observacional, descriptiva, transversal para determinar las características clínicas y epidemiológicas de los fallecidos por peritonitis secundaria en la unidad de cuidados intensivos del hospital provincial docente clínico quirúrgico Doctor León Cuervo Rubio desde enero del 2017 hasta diciembre del 2018, universo el total de pacientes quirúrgicos y la muestra los 34 fallecidos por peritonitis secundaria, la fuente utilizada las historias clínicas de cada paciente, los datos se agruparon según variables, las variables cualitativas, la distribución de frecuencias fue en absolutas(numero) y relativas (porcientos). Resultados: los fallecidos son del sexo femenino, de 60 a 79 años, con estadía de 16 a 23 dias, el germen aislado en los cultivos fue la Escherichia coli, el índice de Mannhein fue mayor de 29, la principal complicación quirúrgica el absceso residual y sistémica la respiratoria. Conclusiones: la mortalidad por peritonitis secundaria continúa siendo un problema de salud en las unidades de cuidados intensivos a pesar de contar con todos los medios para su tratamiento y el índice de Mannhein continúa siendo un buen predictor de mortalidad (AU).

SUMMARY Introduction: Secondary peritonitis is the inflammatory process in the peritoneal cavity generated by perforation, inflammation or gangrene of an intra-abdominal or retroperitoneal structure Objective: to determine the clinical and epidemiological characteristics of those killed by secondary peritonitis in the intensive care unit of the Doctor Leon Cuervo Rubio Surgical Clinical Teaching Provincial Hospital from January 2017 to December 2018. Methods: an observational, descriptive, cross-sectional investigation was carried out to determine the clinical and epidemiological characteristics of those killed by secondary peritonitis in the intensive care unit of the provincial surgical clinical teaching hospital Doctor León Cuervo Rubio from January 2017 to December 2018, universe the total of surgical patients and the sample of 34 deaths due to secondary peritonitis, the source used the medical records of each patient, the data were grouped according to variables, qualitative variables, frequency distribution was absolute (number) and relative (percent) ). Results: the deceased are of the female sex, from 60 to 79 years, with a stay of 16 to 23 days, the germ isolated in the cultures was Escherichia coli, the Mannhein index was greater than 29, the main surgical complication the residual abscess and systemic respiratory. Conclusions: Mortality from secondary peritonitis continues to be a health problem in intensive care units despite having all the means to treat it and the Mannhein index continues to be a good predictor of mortality (AU).

Indicadores hospitalares de acesso e efetividade e crise econômica: análise baseada nos dados do Sistema Único de Saúde, Brasil e estados da região Sudeste, 2009-2018 / Access and effectiveness inpatient care indicators and economic crisis: analysis based on the Brazilian Unified Health System data, Brazil and Southern Brazil states, 2009-2018

Resumo No contexto de crise e restrições de recursos é razoável supor o agravamento de fragilidades do Sistema Único de Saúde (SUS), como desigualdades regionais, subfinanciamento e problemas na qualidade do cuidado. Este estudo explorou a aplicação de indicadores de acesso e efetividade, facilmente compreensíveis e calculados, passíveis de refletir a crise na rede hospitalar. Cinco indicadores extraídos do Sistema de Informações Hospitalares, relativos ao Brasil e a estados da Região Sudeste, foram analisados no período de 2009-2018: internações resultantes em morte; internações cirúrgicas resultantes em morte; cirurgias eletivas no total das internações cirúrgicas; próteses de quadril na população de idosos; e angioplastias na população de 20 anos ou mais. Utilizaram-se gráficos de controle estatístico para a comparação dos indicadores entre estados, antes e a partir de 2014. No Brasil, as mortes hospitalares tiveram um leve crescimento enquanto que as mortes cirúrgicas uma queda; as cirurgias eletivas e próteses de quadril também diminuíram. No Sudeste, o Rio de Janeiro apresentou os piores resultados, em especial a queda de cirurgias eletivas. Os resultados ilustram o potencial dos indicadores para monitorar efeitos da crise sobre o cuidado hospitalar.

Abstract In the context of crisis and resource constraints, it is reasonable to assume the deteriorated weaknesses of the Unified Health System (SUS), such as regional inequalities, underfinancing, and care quality issues. This study explored the application of easily comprehensible and calculated access and effectiveness indicators that could reflect the hospital network crisis. Five indicators extracted from the Hospital Information System, related to Brazil and states of the Southeastern region, were analyzed in the 2009-2018 period: hospitalizations resulting in death; surgical hospitalizations resulting in death; elective surgeries in the total of surgical hospitalizations; hip prostheses in the senior population; and angioplasties in the population aged 20 years and over. Statistical control charts were used to compare indicators between states, before and from 2014. In Brazil, overall hospital deaths had a slight increase while surgical deaths declined; elective surgeries and hipprosthesis also decreased. In Southeastern Brazil, Rio de Janeiro was the worst performer, especially the decrease of the elective surgeries. The results illustrate the potential of indicators to monitor crisis effects on hospital care.

Particularities of upper lobe lung resection in case of tumors with bronchial and arterial plasty

In the case of lung cancer, surgery is the only method of therapy that gives the patient a chance to recover. However, even after radical surgery, up to 50 ­ 60 % of patients die in the subsequent five years from the disease progression. This study was aimed at identifying the technical particularities of surgery, depending on the side of the lung affected by a tumor and the possibility of applying the methods that improve the results of surgical therapy. The study was performed at the Thoracic Department of the Republican Clinical Oncology Dispensary in Ufa and the 1st Surgical Department of the Regional Oncology Center of the Regional Clinical Hospital in Khanty- Mansiysk. The study involved a total of 156 patients (including 148 male and eight female patients). The main result of the study has been the confirmation of the advantages of bronchoplastic surgery, which do not increase post-surgery mortality and improve the post-surgery period, and the relevant principles of preserving surgery.

Tendência de internações e mortalidade por causas cirúrgicas no Brasil, 2008 a 2016 / Trend of hospitalizations and mortality from surgical causes in Brazil, 2008 to 2016

RESUMO Objetivo: analisar a tendência de internações para realização de procedimentos cirúrgicos e de mortalidade cirúrgica no Brasil, no período de 2008 a 2016. Métodos: estudo ecológico, de séries temporais. Os dados sobre internações cirúrgicas e mortalidade entre 2008 e 2016 foram obtidos do Departamento de Informática do Sistema Único de Saúde. A análise de tendência foi realizada por meio de modelos de regressão polinomial. Resultados: foram realizados no período do estudo, 37.565.785 procedimentos cirúrgicos pelo Sistema Único de Saúde, uma média anual de 4.151.050 cirurgias. A média do coeficiente dos procedimentos cirúrgicos foi de 2,12 cirurgias por 100 habitantes/ano, com variação de 1,92 a 2,56 habitantes/ano entre as regiões do país. A taxa de mortalidade cirúrgica foi de 1,63%, com variação de 1,07% a 2,02% entre as regiões. Conclusão: constatou-se tendência significativa crescente dos procedimentos cirúrgicos realizados e de mortalidade cirúrgica; entretanto, o coeficiente de procedimentos cirúrgicos realizados é inferior ao preconizado pela meta internacional, com disparidades regionais no acesso aos cuidados cirúrgicos e na mortalidade, o que compromete a garantia da cobertura universal da saúde preconizada pelo Sistema Único de Saúde.

ABSTRACT Objective: to evaluate the trend of hospitalazions for surgical procedures and surgical mortality in Brazil, from 2008 to 2016. Methods: we conducted an ecological, time-series study. We obtained the data on surgical hospitalizations and mortality between 2008 and 2016 from the Department of Informatics of the Unified Health System (SUS). We performed the trend analysis using polynomial regression models. Results: in the period of the study, 37,565,785 surgical procedures were performed in the SUS, an average of 4,151,050 surgeries/year. The mean coefficient of the surgical procedures was 2.12 surgeries per 100 inhabitants/year, with a variation of 1.92 to 2.56 inhabitants/year among the country regions. The surgical mortality rate was 1.63%, ranging from 1.07% to 2.02% between the regions. Conclusion: there was a significant trend towards increasing number of surgical procedures carried out and of surgical mortality; however, the coefficient of surgical procedures is lower than recommended by international standards, with regional disparities in access to surgical care and mortality, which undermines the guarantee of universal health coverage expect from the Unified Health System.

Preoperative protocol and morbimortality in cervical surgery with anterior approach / Protocolo pré-operatório e morbimortalidade em cirurgia cervical com abordagem anterior / Protocolo preoperatorio y morbimortalidad en cirugía cervical con abordaje anterior

ABSTRACT Objective: To determine the correlation between morbidity/mortality and the pre-surgical protocol in patients undergoing anterior cervical surgical approach. Methods: Retrospective, cross-sectional and descriptive study, in which 114 patients who underwent anterior cervical surgical approach were reviewed, divided into two groups: "Group A" Conventional Presurgical Protocol (CPP) and "Group B" Extended Presurgical Protocol (EPP). Statistical analysis used the IBM SPSS Statistics Base v.24 software. Results: We evaluated 114 patients, 35 from "Group A", 79 from "Group B", 83 (72.8%) with cervical myelopathy, 30 (26.3%) with cervicobrachialgia. "Group A" had 10 cases of respiratory failure, with 5 secondary to bronchial secretion, 2 secondary to cervical hematoma. "Group B" had 12 cases of respiratory failure, 3 secondary to bronchial secretion and 1 secondary to cervical hematoma. Conclusions: The extended presurgical protocol can be the answer to reduce complications by improving selection parameters of the candidate patient for a surgical procedure of the cervical spine. Level of Evidence III; Case-control studyg.

RESUMO Objetivo: Determinar a correlação entre morbidade e mortalidade e o protocolo pré-cirúrgico, em pacientes submetidos à cirurgia de coluna cervical anterior. Método: Estudo retrospectivo, transversal e descritivo, em 114 pacientes com cirurgia cervical anterior, dois grupos foram montados: "Grupo A" pré-cirúrgico convencional (PPP) e "grupo B" protocolo pré-cirúrgico estendido (PPE), a análise v.24 SPSS Statistics Base. Resultados: 114 casos de pacientes, 35 "Grupo A", 79 "grupo B", 83 (72,8%) com a mielopatia cervical, 30 (26,3%) com cervicobraquialgia avaliada. No "Grupo A" forma relatados: 10 casos de insuficiência respiratória, 5 são secundárias a secreção brônquica, 2 são secundárias a hematoma cervical. No "Grupo B" foram relatados: 12 casos de aflição respiratória, 3 são secreção brônquica secundária e um secundário ao hematoma cervical. Conclusão: protocolo pré-cirúrgico estendido pode ser a resposta para reduzir as complicações, a partir do momento que se melhoram os parâmetros de seleção do paciente, que é candidato a um procedimento cirúrgico anterior da coluna cervical. Nível de evidência III, Estudo de caso controleg.

RESUMEN Objetivo: Determinar la correlación entre la morbimortalidad y el protocolo prequirúrgico en pacientes sometidos a cirugía de la columna cervical por vía anterior. Métodos: Estudio retrospectivo, transversal y descriptivo, en el cual se revisaron 114 pacientes con cirugía cervical anterior, divididos en dos grupos: "Grupo A", Protocolo Prequirúrgico Convencional (PPC) y "Grupo B" Protocolo Prequirúrgico Extendido (PPE). El análisis estadístico se hizo con el software IBM SPSS Statistics Base v.24. Resultados: Se evaluaron 114 casos de pacientes, 35 del "Grupo A", 79 del "Grupo B", 83 (72,8%) con mielopatía cervical, 30 (26,3%) con cervicobraquialgia. El "Grupo A" tuvo 10 casos de insuficiencia respiratoria, con 5 secundarios a secreción bronquial, 2 secundarios a hematoma cervical. El "Grupo B" tuvo 12 casos de insuficiencia respiratoria, 3 secundarios a secreción bronquial y 1 secundario a hematoma cervical. Conclusiones: El protocolo prequirúrgico extendido puede ser la respuesta para reducir las complicaciones mediante la mejoría de los parámetros de selección del paciente candidato a un procedimiento quirúrgico anterior de la columna cervical. Nivel de evidencia III; Estudio de caso controlg.

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.

Gerenciamento nutricional: relação de parâmetros nutricionais, tempo de internação e mortalidade em pacientes cirúrgicos / Nutritional management: nutritional parameters relationship, length of stay and mortality in surgical patients

Introdução: A avaliação do estado nutricional no período perioperatório é de fundamental importância na modulação da resposta orgânica ao trauma cirúrgico. Pacientes desnutridos possuem maior chance de apresentar complicações. Objetivo: Verificar a relação de parâmetros nutricionais com o tempo de internação e óbitos. Método: Estudo retrospectivo, transversal, com coleta de dados secundários, realizada por meio de ficha de triagem nutricional, NRS-2002, em hospital público de São Paulo, SP, entre abril e julho de 2012. Resultados: Foram avaliados 315 pacientes, a idade média encontrada foi de 64,06 anos, a média de internação foi de 10,97 dias, a maioria foi de idosos (66,35%) do gênero feminino. 6,3% dos pacientes foram a óbito. A maioria dos adultos apresentou excesso de peso. Havia 32,06% de pacientes idosos desnutridos. Os pacientes com neoplasias apresentaram média de índice de massa corporal (IMC) menor do que os sem neoplasias e maior tempo de internação. Idosos com neoplasias foram a óbito duas vezes mais do que os idosos sem a doença. A média da contagem total de linfócitos (CTL) dos pacientes (adultos e idosos) com neoplasias foi menor do que a dos adultos sem a doença. Os idosos que foram a óbito apresentaram IMC e CTL significativamente menor do que o grupo que não foi a óbito. Houve correlação negativa entre o IMC e o tempo de internação e entre a CTL e o tempo de internação de idosos. Conclusão: Existe correlação entre os parâmetros nutricionais IMC e CTL com o tempo de internação e óbitos de pacientes cirúrgicos adultos e idosos.(AU)

Introduction: The assessment of nutritional status in the perioperative period is of fundamental importance in the modulation of organic response to surgical trauma. Malnourished patients are more likely to have complications. Objective: To investigate the relationship of nutritional parameters with the length of hospitalization and deaths. Methods: A retrospective, cross-sectional study, with secondary data collection, carried out through nutritional screening record, NRS-2002. Study performed in a public hospital of São Paulo, SP, between April and July 2012. Results: A total of 315 patients, the mean age was 64.06 years, the average hospital stay was 10.97 days, most were elderly (66.35%) were female. 6.3% of patients died. Most adults showed overweight. 32.06% of elderly patients were undernourished. Patients with cancer had lower mean body mass index (BMI) than those without cancer and longer hospital stays. Seniors with cancer died two times more than older people without the disease. The mean total lymphocyte count (TLC) of patients (adults and elderly) with tumor was smaller than that of adults with the disease. The elderly who died showed BMI and TLC significantly lower than the group that was not death. There was a negative correlation between BMI and the length of stay and between the TLC and the hospitalization of the elderly. Conclusion: There is a correlation between nutritional parameters BMI and TLC with the length of hospitalization and deaths of adult and elderly surgical patients.(AU)

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.

Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática / Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the AmplatzerTM Duct Occluder in Children: A Systematic Review

Introdução: A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias. Métodos: Revisão sistemática em relação a desfechos clínicos e criação de modelo de decisão para avaliação da RCEI do Amplatzer® Duct Occluder (ADO) em comparação ao tratamento cirúrgico, para o fechamento da PCA. Os custos para ambos os métodos foram aqueles reembolsados pelo SUS em 2010, e o custo do conjunto (dispositivo + materiais de apoio) foi estimado em R$ 10.000,00. Foi considerado como limiar uma disposição para pagar equivalente a três vezes o Produto Interno Bruto brasileiro, resultando em R$ 57.000,00 por ano de vida salvo. Resultados: As duas técnicas foram seguras e eficazes, com menor morbidade e tempo de internação no fechamento percutâneo. A expectativa de vida ajustada foi similar nos dois grupos, sendo um pouco melhor para o ADO. O custo total foi calculado em R$ 8.507,00 para cirurgia e em R$ 11.000,00 para o ADO. A RCEI foi calculada em R$ 71.380,00 por ano de vida ganho. Uma análise de limiar demonstrou que a redução do valor do conjunto completo do ADO em R$ 492,65 traria a RCEI para o limiar aceitável para incorporação ao SUS nos dias de hoje. Conclusões: O tratamento percutâneo apresentou morbidade e tempo de internação menores, além de efetividade incremental semelhante àquela do tratamento cirúrgico. Com os...

Background: Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System (Sistema Único de Saúde - SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies. Methods: Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of AmplatzerTM Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved. Results: Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS. Conclusions: Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result...

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn / Mortalidade precoce apos cirurgia neonatal: analise de fatores de risco em um sistema otimizado de prestacao de cuidados de saude ao recem-nascido cirurgico

OBJECTIVE: Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center. METHODS: Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010) in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality. RESULTS: Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams), 28 (6.4%) patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA) score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132) and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266), compared to those who did not. CONCLUSION: The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population. .

Valor prognóstico do fragmento N-terminal do peptídeo natriurético tipo B em cirurgia não-cardíaca / Prognostic value of perioperative N-terminal pro-B-type natriuretic peptide in noncardiac surgery

FUNDAMENTO: Já foi demonstrado o uso do NT-proBNP pré-operatório para prever resultado cardíaco adverso, embora estudos recentes tenham sugerido que a determinação do NT-proBNP pós-operatório possa fornecer um valor adicional em pacientes submetidos à cirurgia não cardíaca. OBJETIVO: Avaliar o valor prognóstico perioperatório do NT-proBNP em pacientes de intermediário e alto risco cardiovascular submetidos à cirurgia não cardíaca. MÉTODOS: Este estudo incluiu prospectivamente 145 pacientes com idade > 45 anos, com pelo menos um fator de risco do Índice de Risco Cardíaco Revisado e submetidos à cirurgia de médio ou alto risco não-cardíaca. Os níveis de NTproBNP foram medidos no pré e pós-operatório. Preditores cardíacos de curto prazo foram avaliados por modelos de regressão logística. RESULTADOS: Durante uma mediana de acompanhamento de 29 dias, 17 pacientes (11,7%) apresentaram eventos cardíacos adversos importantes (MACE - 14 infartos do miocárdio não fatais, 2 paradas cardíacas não-fatais e 3 mortes cardíacas). Os níveis ótimos de limiar discriminatório para o NT-proBNP pré e pós-operatório foram 917 e 2962 pg/ mL, respectivamente. O NT-proBNP pré e pós-operatório (OR = 4,7, IC 95%: 1,62-13,73, p = 0,005 e OR 4,5, IC 95%: 1,53-13,16, p = 0,006) foram associados de forma significativa com MACE (eventos cardíacos adversos maiores). O NTproBNP pré-operatório foi significativa e independentemente associado com eventos cardíacos adversos em análise de regressão multivariada (OR ajustado 4,2, IC 95%: 1,38-12,62, p = 0,011). CONCLUSÃO: O NT-proBNP é um importante marcador de curto prazo de eventos cardiovasculares perioperatórios em pacientes de alto risco. Os níveis pós-operatórios foram menos informativos do que os níveis pré-operatórios. Uma única medição de NT-proBNP pré-operatório deve ser considerada na avaliação de risco pré-operatório.

BACKGROUND: Preoperative NT-proBNP has been shown to predict adverse cardiac outcomes, although recent studies suggested that postoperative NT-proBNP determination could provide additional information in patients submitted to noncardiac surgery. OBJECTIVE: To evaluate the prognostic value of perioperative NT-proBNP in intermediate and high risk cardiovascular patients undergoing noncardiac surgery. METHODS: This study prospectively enrolled 145 patients aged >45 years, with at least one Revised Cardiac Risk Index risk factor and submitted to intermediate or high risk noncardiac surgery. NT-proBNP levels were measured pre- and postoperatively. Short-term cardiac outcome predictors were evaluated by logistic regression models. RESULTS: During a median follow-up of 29 days, 17 patients (11.7%) experienced major adverse cardiac events (MACE- 14 nonfatal myocardial infarctions, 2 nonfatal cardiac arrests and 3 cardiac deaths). The optimum discriminatory threshold levels for pre- and postoperative NT-proBNP were 917 and 2962 pg/mL, respectively. Pre- and postoperative NT-proBNP (OR 4.7; 95% CI 1.62-13.73; p=0.005 and OR 4.5; 95% CI 1.53-13.16; p=0.006) were significantly associated with MACE. Preoperative NT-proBNP was significantly and independently associated with adverse cardiac events in multivariate regression analysis (adjusted OR 4.2; 95% CI 1.38-12.62; p=0.011). CONCLUSION: NT-proBNP is a powerful short-term marker of perioperative cardiovascular events in high risk patients. Postoperative levels were less informative than preoperative levels. A single preoperative NT-proBNP measurement should be considered in the preoperative risk assessment.

Preditores de mortalidade na cirurgia de revascularizção do miocárdio / Mortality predictors in coronary artery bypass grafting surgery

Fundamentos: A alta morbidade pós-operatória e os elevados índices de mortalidade dos pacientes submetidos à revascularização cirúrgica (RM) na fase aguda do infarto do miocárdio podem induzir o adiamento do procedimento. Objetivos: Identificar variáveis relacionadas à mortalidade, bem como os fatores de risco para o óbito de pacientes submetidos à cirurgia de revascularização do miocárdio. Métodos: A pesquisa foi realizada no período de setembro 2011 a maio 2012, no Hospital de Clínicas Gaspar Vianna, Belém, PA, Brasil. Foram utilizados prontuários de 240 pacientes, tendo sido aproveitados 223 (17 excluídos), referentes a pacientes internados no período de janeiro 2008 até dezembro 2011. Inicialmente foi calculada a frequência dos óbitos e, em seguida, a frequência das variáveis pré, intra e pós-operatórias e respectivos intervalos de confiança para caracterizar a população de estudo. Resultados: Dos 223 pacientes, 12 (5,4 %) foram a óbito. A variável no período pré-operatório mais significativa para o estudo foi a idade. No período intraoperatório, são os procedimentos cirúrgicos de urgência/emergência e, no pós-operatório, a transfusão sanguínea.Conclusão: No pós-operatório, as complicações cardiovasculares e as transfusões são fatores de risco, e a UTI se tornou um fator de proteção contra o óbito.

Background: High postoperative morbidity and mortality rates among patients undergoing coronary artery bypass surgery (CABG) during the acute phase of myocardial infarction may lead to the post ponement of these procedures.Objectives: To identify variables linked to o mortality and risk factors related to death among patients undergoing coronary artery bypass grafting surgery.Methods: The survey was conducted from September 2011 to May 2012 at the Hospital de Clinicas Gaspar Vianna in Belém, Pará State, Brazil, using the medical records of 240 patients (223 assessed and 17 excluded) admitted from January 2008 through December 2011. Initially, the death frequency was caculated, followed by the pre-, intra- and post-operative variable frequencies and their respective confidence intervals, in order to characterize the study population. Results: Among all 223 patients, 12 (5,4%) died, with age being the most significant varible in the pre-operative period. During the intra-operative stage, this was urgente or emergency surgical procedures, followed by post-operative blood transfusions. Conclusion: During the post-operative stage, cardiovascular complications and transfusions are risk factors, with the ICU constituting a protection fator against death.

Why the surgical patients are so critical in their intensive care unit arrival? / Porque os pacientes cirúrgicos chegam em estado tão crítico na unidade de terapia intensiva?

PURPOSE: To assess the ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) to stratify the severity of illness and the impact of delay transfer to an Intensive Care Unit (ICU) on the mortality of surgical critically ill patients. METHODS: Five hundred and twenty-nine patients (60.3% males and 39.7% females; mean age of 52.8 ± 18.5 years) admitted to the ICU were retrospectively studied. The patients were divided into survivors (n=365) and nonsurvivors (n=164). APACHE II and death risk were analysed by generation of receiver operating characteristic (ROC) curves. The interval time between referral and ICU arrival was also registered. The level of significance was 0.05. RESULTS: The mean APACHE II and death risk was 19.9 ± 9.6 and 37.7 ± 28.9%, respectively. The area under the ROC curve for APACHE II and death risk was 0.825 (CI = 0.765-0.875) and 0.803 (CI = 0.741-0.856). The overall mortality (31%) increased progressively with the delay time to ICU transfer, as also evidencied by the APACHE II score and death risk. CONCLUSION: This investigation shows that the longer patients wait for ICU transfer the higher is their criticallity upon ICU arrival, with an obvious negative impact on survival rates.

OBJETIVO: Investigar a habilidade do Acute Phisiologic and Chronic Health Evaluation II (APACHE II) na estratificação da gravidade e o impacto causado pelo tempo de transferência para a unidade de terapia intensiva (UTI) sobre a mortalidade de pacientes cirúrgicos em estado crítico. MÉTODOS: Foram estudados retrospectivamente 529 pacientes (60,3% homens e 39,7% mulheres, média de idade = 52,8 ± 18,5 anos) admitidos na UTI, divididos em sobreviventes (n=365) e não sobreviventes (n=164). O APACHE II e o risco de óbito (RO) foram analisados por curvas ROC (Receiver Operating Characteristics). O tempo decorrido entre a solicitação da vaga e a chegada do paciente na UTI foi verificado. Considerou-se um nível de significância de 0,05. RESULTADOS: O APACHE II e o risco de óbito foram de 19,9 ± 9,6 e 37,7 ± 28,9%, respectivamente. A área sob a curva ROC para o APACHE II foi de 0,825 (IC = 0,765-0,875) e para o RO de 0,803 (IC = 0,741-0,856). A mortalidade geral (31%) cresceu progressivamente com o tempo decorrido entre a solicitação da vaga e a chegada do paciente na UTI, também evidenciado pelo APACHE II e o risco de óbito. CONCLUSÃO: Esta investigação mostra que quanto maior é a demora na transferência do paciente para a UTI mais aumenta a gravidade dos pacientes, cujo impacto na sobrevida é negativo.

Anesthesia-related mortality in pediatric patients: a systematic review

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesiarelated mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

Factores asociados a mortalidad postoperatoria del adulto mayor sometido a cirugía abdominal en el Centro Médico Naval durante el periodo 2009-2011 / Factors associated with post-operative mortality in the elderly patients undergoing abdominal surgery at the Medical Center Naval from January 2009 to December 2011

Objetivo: Determinar cuáles son los factores asociados a la mortalidad postoperatoria en los pacientes adultos mayores sometidos a cirugía abdominal en el Centro Médico Naval durante el periodo de Enero del 2009 a Diciembre 2011. Material y métodos: Es un estudio observacional, analítico, retrospectivo de casos controles, se incluyo a todos los pacientes mayores de 65 años operados durante el periodo 2009-2011 y cuyas historias clínicas estén completas, de las cuales se obtendrán las variables en estudio, a través de una ficha de recolección de datos. Se analizarán variables preoperatorias, intraoperatorias y postoperatorias. Se analizarán los factores de riesgo de morbimortalidad en los pacientes intervenidos de emergencia y en los intervenidos electivamente. Se realizará un análisis multivariable correlacionando las diferentes variables mediante la prueba de la X2 Pearson con un intervalo de confianza del 95 por ciento. Resultados: Durante el periodo que abarca el estudio fueron intervenidos 385 pacientes ancianos con ingreso hospitalario: 122 de emergencia y 263 de forma electiva. Durante el ingreso hospitalario murió un total de 28 pacientes; 1 intraoperatoriamente y 27 tras la intervención quirúrgica. Variables preoperatorias: Existe asociación entre el número de patologías y la reducción de la sobrevida (p<0.0001); la edad mayor a 75 años demostró tener una mayor mortalidad estadísticamente significativa (p=0.004 y Ji2=8.145); Se encontró que existe asociación entre un mayor grado de ASA y una menor sobrevida, la cual fue estadísticamente significativa (p<0.0001 y Ji2=60.717); la mayor mortalidad se encontró en pacientes con patología de intestino Delgado y colon, con sobrevidas menores al 77.1 por ciento, esto fue estadísticamente significativo. (p<0.0001 y Ji2=23.212). Variables intraoperatorias: La cirugía de emergencia es un factor de riesgo independiente de mortalidad (22.13 por ciento de mortalidad en relación con el...

Objective: To determine the factors associated with post-operative mortality in the elderly patients undergoing abdominal surgery in the Medical Center Naval from January 2009 to December 2011. Materials and methods: it was an observational, analytical, retrospective case-control study encompassing all patients over 65 years who underwent surgeries during the 2009-2011 periods, whose medical records were complete and from which the variables under study were obtained through data-collecting cards. Pre-operative, operative and post-operative variables were analyzed. There was an assessment of the risk factors for mortality and morbidity in the patients undergoing emergency surgery and those operated electively. A multi-variable analysis correlating the different variables using the X2 Pearson test with a confidence interval of 95 per cent was also carried out. During the period of the study, 385 patients with hospital admission were operated: 122 for emergency and 263 for elective surgery. During the admission to hospital, 28 patients died; one during surgery, and the other 27 after surgery. Pre-operative Variables: There is association between the number of pathologies and the decrease in survival (p<0.0001); an age greater than 75 years demonstrated a statistically significant higher mortality (p=0.004 and Ji2=8.145); an association was found to be between a higher grade of ASA and a lower survival, which was statistically significant (p<0.0001 and Ji2=60.717); the highest mortality was found in patients with esophagus, stomach, small intestine and colon pathologies, with survival rates lower than 77.1 per cent, being this statistically significant (p<0.0001 and Ji2=23.212). Operative Variables: Emergency surgery is an independent risk factor for mortality (22.13 per cent of mortality compared to the 0, 38 per cent for elective surgery). The type of injury showed to be associated with a lower survival rate, which was statistically significant...

Factores de riesgo de presentar una complicación postoperatoria en pacientes operados de urgencia por patología herniaria / Risk factors for complications and mortality after emergency surgery for complicated hernias

Background: Thirteen percent of hernias require emergency surgery and of these, approximately 14 percent require an intestinal excision. Aim: To identify risk factors for postoperative complications after emergency surgical treatment of complicated hernias. Material and Methods: Using surgical room registries, all patients subjected to emergency surgery for complicated hernias between 2004 and 2008 were identified and their medical records were reviewed. Follow up was performed using data from hospital and outpatient medical records. Results: One hundred fifty two patients were identified but four were discarded due to lack of complete records. Therefore, 148 patients aged 24 to 95 years (104 females) were analyzed. Forty patients had postoperative complications (27 percent) and six died (4 percent). Obesity, hypertension, diabetes mellitus and an American Society of Anesthesiologists (ASA) classification, III or IV, were identified as risk factors for complications. Logistic regression only accepted hypertension as a risk factor with an odds ratio (OR) of 2.35 (95 percent confidence intervals (CI) 1.04-5.3). The predictors for mortality were obesity, hypertension, an ASA classification of III or IV and having a strangulated hernia. Logistic regression only accepted having a strangulated hernia as an independent risk factor with an OR of 16.4 (95 percent CI 1.6-167.7). Conclusions: Hypertension and having a strangulated hernia are risk factors for complications and mortality after emergency surgery for complicated hernias.

Introducción: Obteniendo los factores de riesgo de morbimortalidad postoperatoria, al tratar una hernia complicada de urgencia, podríamos definir mejor su tratamiento. Objetivo principal: Identificar los factores de riesgo de morbilidad postoperatoria en pacientes operados de urgencia por una hernia complicada en el Hospital Base de Osorno (HBO). Material y Método: Cohorte retrospectiva. Se incluyeron pacientes mayores de 14 años operados por patología hemiaria complicada en el servicio de urgencia del HBO entre los años 2004 y 2008. Se excluyeron aquellos que no contaron con datos en las variables de interés. Se realizó un análisis bivariado y una regresión logística. Medida de riesgo: odds ratio (OR). Intervalo de confianza 95 por ciento. Stata 10.0. Resultados: La cohorte incluyó 148 pacientes. Mediana de edad 66 años (24-95). La morbilidad y mortalidad postoperatoria fue un 27,02 por ciento (40 pacientes) y 4,05 por ciento (6 pacientes) respectivamente. Las variables obesidad, hipertensión arterial (HTA), diabetes mellitus (DM) y el tener un ASA III-IV resultaron ser significativas (p < 0,05) para morbilidad postoperatoria en el análisis bivariado. En la regresión logística, sólo el ser hipertenso resultó ser un factor de riesgo (OR: 2,35, IC 95 por ciento: 1,04-5,30). Los factores de riesgo para mortalidad que resultaron significativos en el análisis bivariado fueron ser obeso, hipertenso, presentar un ASA de III-IV y presentar hernia estrangulada (p < 0,05). En el análisis multivariado sólo el presentar una hernia estrangulada fue un factor de riesgo (OR: 16,4, IC 95 por ciento: 1,59-167,76). Conclusión: Ser hipertenso y la presencia de necrosis en el saco hemiario son factores de morbilidad y mortalidad postoperatoria respectivamente en el paciente que se opera por una hernia complicada de urgencia.