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2.
Rev. bras. ginecol. obstet ; 42(7): 415-419, July 2020. tab
Article in English | LILACS | ID: biblio-1137852

ABSTRACT

Abstract It is estimated that around 28 million surgeries will be postponed or canceled worldwide as a result of this pandemic, causing a delay in the diagnosis and treatment of more than 2 million cancer cases. In Brazil, both the National Health Agency (ANS) and National Health Surveillance Agency (ANVISA) advised the postponement of elective and non-essential surgeries, causing a considerable impact on the number of surgical procedures that decreased by 33.4% in this period. However, some women need treatment for various gynecological diseases that cannot be postponed. The purpose of this article is to present recommendations on surgical treatment during the COVID-19 pandemic.


Resumo Estima-se que cerca de 28 milhões de cirurgias sejam postergadas ou canceladas nomundo em decorrência desta pandemia, causando atraso no diagnóstico e tratamento de mais de 2 milhões de casos oncológicos. No Brasil, tanto a ANS (Agencia Nacional de Saúde) comoa ANVISA (Agencia Nacional de Vigilância Sanitária) orientaram o adiamento das cirurgias eletivas e não essenciais, tendo um impacto considerável no número de procedimentos cirúrgicos comdiminuição de 33,4% neste período no Brasil.No entanto, algumasmulheres necessitam de tratamento para várias doenças ginecológicas, algumas das quais não podem ser adiadas. O objetivo deste artigo é apresentar recomendações sobre o tratamento cirúrgico durante a pandemia de COVID-19.


Subject(s)
Humans , Female , Patient Care Planning , Pneumonia, Viral/epidemiology , Gynecologic Surgical Procedures/statistics & numerical data , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Brazil/epidemiology , Cross Infection/prevention & control , Risk Factors , Elective Surgical Procedures/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Betacoronavirus , SARS-CoV-2 , COVID-19
3.
ABCD arq. bras. cir. dig ; 33(3): e1544, 2020. tab
Article in English | LILACS | ID: biblio-1152624

ABSTRACT

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.


RESUMO Racional: No Brasil, a abordagem baseada em metas foi nomeada de Projeto ACERTO e tem obtido bons resultados quando aplicada em operações eletivas com diminuição do tempo de internação, retorno mais precoce as atividades sem incremento de morbimortalidade. Objetivo: Analisar o impacto do ACERTO na assistência prestada em operações de emergência. Métodos: Foi realizado um estudo de intervenção em hospital de trauma. Foram comparados 452 pacientes submetidos à operações de emergência e acompanhados pelo serviço de cirurgia geral no período de outubro a dezembro de 2018 (fase pré-ACERTO, n=243) e no período de março a junho de 2019 (fase pós-ACERTO, n=209). Foram avaliados: reintrodução da dieta, volume de hidratação venosa pós-operatória infundido, tempo de uso de catéteres, sondas e drenos, analgesia pós-operatória, prevenção de vômitos pós-operatórios, mobilização precoce e fisioterapia. Resultados: Após a implantação do ACERTO houve reintrodução mais precoce da dieta, foi atingido o aporte calórico ideal mais precocemente, retirada mais precoce da hidratação venosa, maior prescrição de analgesia pós-operatória, de profilaxia de vômitos pós-operatórios e maior prescrição de fisioterapia e mobilização precoce em todos (p<0,01); na análise multivariada não houve alteração nas taxas de complicações observadas pré e pós-ACERTO (10,7% vs. 7,7% (p=0,268) e houve diminuição do tempo de internação pós-ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusão: A implantação do projeto ACERTO diminuiu o tempo de internação hospitalar, melhorou a assistência médica prestada sem incremento das taxas de complicações avaliadas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Patient Discharge/statistics & numerical data , Postoperative Complications/prevention & control , Surgical Procedures, Operative/standards , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Length of Stay/statistics & numerical data , Postoperative Complications/epidemiology , Time Factors , Brazil , Clinical Protocols , Treatment Outcome , Recovery of Function , Hospitals, Public
4.
Cad. Saúde Pública (Online) ; 36(1): e00218218, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1055613

ABSTRACT

Resumo: Este artigo tem como objetivo avaliar a influência das características hospitalares sobre a chance de realização de cesariana eletiva na Região Sudeste do Brasil. Foram utilizados dados da pesquisa Nascer no Brasil, realizada entre fevereiro de 2011 e outubro de 2012. A presente análise inclui a amostra da Região Sudeste, compreendendo 10.155 mulheres. O grupo de mulheres submetidas à cesariana eletiva foi comparado ao de mulheres que entraram em trabalho de parto ou foram submetidas à indução do parto, independentemente se fizeram cesariana intraparto ou parto vaginal. Com exceção da idade gestacional, todas as características obstétricas analisadas mostraram-se associadas à cesariana eletiva. Nesse grupo, 60,5% não possuíam cesariana prévia à gestação atual e 64,7% eram de baixo risco. Dentre os partos com financiamento público, observou-se maior chance de cesárea eletiva nas mulheres que foram atendidas nos hospitais com < 1.500 (OR = 2,11; IC95%: 1,37-3,26) e entre 1.500-2.999 partos/ano (OR = 1,45; IC95%: 1,04-2,02) e nos hospitais mistos (OR = 1,81; IC95%: 1,37-2,39). Nos hospitais mistos, a magnitude da associação é maior quando localizados em não capitais com volume > 3.000 partos/ano (OR = 3,45; IC95%: 1,68-7,08) e atinge seu maior valor nos hospitais localizados em não capitais com volume < 3.000 partos/ano (OR = 4,08; IC95%: 2,61-6,37). Em contrapartida, não observou-se associação entre cesariana eletiva e os hospitais públicos localizados em não capitais do Sudeste. As prevalências de cesariana eletiva nos hospitais públicos da Região Sudeste são altas quando comparadas a outros países, e sofrem importante influência das características hospitalares.


Resumen: El objetivo de este artículo es evaluar la influencia de las características hospitalarias sobre la oportunidad de realización de cesáreas electivas en la región sudeste de Brasil. Se utilizan datos de la investigación Nacer en Brasil, realizada entre febrero de 2011 y octubre de 2012. El presente análisis incluye la muestra de la región sudeste, comprendiendo a 10.155 mujeres. El grupo de mujeres sometidas a una cesárea electiva se comparó con el de mujeres que entraron en trabajo de parto o fueron sometidas a la inducción del parto, independientemente si tuvieron cesárea intraparto o parto vaginal. Con excepción de la edad gestacional, todas las características obstétricas analizadas se mostraron asociadas con la cesárea electiva. En ese grupo un 60,5% no tuvieron una cesárea previa y un 64,7% tenían gestaciones de riesgo bajo. Entre los partos con financiación pública se observó una mayor oportunidad de cesárea electiva en las mujeres que fueron atendidas en los hospitales con < 1.500 (OR = 2,11; IC95%: 1,37-3,26) y entre 1.500-2.999 partos/año (OR = 1,45; IC95%: 1,04-2,02) y en los hospitales mixtos (OR = 1,81; IC95%: 1,37-2,39). En los hospitales mixtos, la magnitud de la asociación es mayor cuando están localizados fuera de la capital (OR = 3,45; IC95%: 1,68-7,08), en los con volumen > 3.000 partos/año, y alcanza su mayor valor en los hospitales fuera de las capitales con volumen < 3.000 partos/año (OR = 4,08; IC95%: 2,61-6,37). Como contrapartida, no se observó asociación entre cesárea electiva y los hospitales públicos localizados fuera de las capitales del sudeste. Las prevalencias de cesárea electiva en los hospitales públicos de la región sudeste son altas, cuando se comparan con las de otros países, y sufren una importante influencia de las características hospitalarias.


Abstract: This article aims to assess the influence of hospital characteristics on the odds of performing an elective cesarean in the Southeast region of Brazil. Data were obtained from the Birth in Brazil study, conducted from February 2011 to October 2012. The current analysis includes the sample from Southeast Brazil, with 10,155 women. The group of women that underwent elective cesareans was compared to the women who went into labor or underwent labor induction, regardless they had intrapartum cesarean or vaginal delivery. Except for gestational age, all the obstetric characteristics analyzed were associated with elective cesarean. In this group, 60.5% had no prior cesarean and 64.7% had low-risk gestations. Among the births with public financing, there were higher odds of elective cesareans in women treated at hospitals with < 1,500 births/year (OR = 2.11; 95%CI: 1.37-3.26) and 1,500-2,999 births/year (OR = 1.45; 95%CI: 1.04-2.02) and in mixed hospitals (OR = 1.81; 95%CI: 1.37-2.39). In the mixed hospitals, the association was stronger when located in non-capital cities with > 3,000 births/year (OR = 3.45; 95%CI: 1.68-7.08), reaching the highest level in hospitals in non-capital cities with < 3,000 births/year (OR = 4.08; 95%CI: 2.61-6.37). Meanwhile, no association was seen between elective cesarean and public hospitals located in non-capital cities of the Southeast region. Prevalence rates of elective cesareans in public hospitals in Southeast Brazil are high when compared to other countries, and they are heavily influenced by hospital characteristics.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Cesarean Section/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Socioeconomic Factors , Brazil , Hospitals, Private , Hospitals, Public
5.
Ciênc. Saúde Colet ; 24(12): 4541-4554, dez. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1055751

ABSTRACT

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.


Subject(s)
Humans , Adult , Aged , State Health Plans , Economic Recession , Health Services Accessibility , Inpatients , National Health Programs/economics , Quality of Health Care , Surgical Procedures, Operative/mortality , Surgical Procedures, Operative/trends , Brazil/epidemiology , Health Care Rationing , Hospital Information Systems , Hospital Mortality/trends , Angioplasty/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Arthroplasty, Replacement, Hip/statistics & numerical data , Resource Allocation , Healthcare Disparities , Middle Aged
6.
Geriatr., Gerontol. Aging (Impr.) ; 13(1): 24-27, jan-mar.2019. tab
Article in Portuguese | LILACS | ID: biblio-1005551

ABSTRACT

INTRODUÇÃO: Delirium é uma mudança aguda na cognição e atenção, comum no período pós-operatório em pessoas idosas, associada ao aumento de custos e à permanência hospitalar. OBJETIVO: Avaliar frequência, fatores de risco e influência no período de permanência hospitalar de delirium pós-operatório em pacientes idosos submetidos a cirurgias não cardíacas eletivas. MÉTODO: Estudo do tipo transversal, observacional, de pessoas idosas (65 anos de idade ou mais), internadas para realização de cirurgia eletiva não cardíaca. Durante o período pré-operatório imediato (24 horas) foram avaliados os fatores de risco: idade, gênero, cognição (MiniCog), funcionalidade (Katz e time up and go), fármacos e aspectos clínicos. O delirium, no pós-operatório imediato (até 72 horas), foi avaliado através do Confusion Assesment Method (CAM). RESULTADOS: Oitenta e três pacientes foram incluídos na pesquisa, sendo 44,6% (n = 37) de cirurgia ortopédica, 42,16% (n = 35) de cirurgia geral e 13,3% (n = 11) de cirurgia urológica. Predominou o sexo masculino (53%), com idade média de 73 anos (65 a 94) anos. Na amostra de pacientes, 9,6% (n = 8) apresentaram delirium pós-operatório: 6% do tipo hiperativo (n = 5), 2,4% do tipo hipoativo (n = 2) e 1,2% do tipo misto (n = 1). Eram mais idosos (p = 0,02), com maior declínio cognitivo (p = 0,01), anemia (p = 0,04) e prolongamento na permanência hospitalar (p = 0,001). CONCLUSÃO: O delirium pós-operatório foi observado com maior frequência nos pacientes mais idosos, portadores de declínio cognitivo e anemia, com influência no período de hospitalização, demonstrando a importância de uma avaliação preventiva mais abrangente no período pré-operatório.


INTRODUCTION: Delirium is an acute change in cognition and attention, common in the postoperative period in older patients, associated with increased costs and longer hospital stay. OBJECTIVE: To evaluate the frequency, risk factors, and influence of postoperative delirium in older patients submitted to elective noncardiac surgery. METHOD: This was a cross-sectional, observational study of older adults (65 years or older) hospitalized for elective noncardiac surgery. During the immediate preoperative period (24 hours), risk factors such as age, sex, cognition (MiniCog), functional status (Katz and Timed Up and Go), medications, and clinical aspects were evaluated. Delirium, in the immediate postoperative period (up to 72 hours), was evaluated using the Confusion Assessment Method (CAM). RESULTS: A total of 83 patients were included in the study. Of these, 44.6% (n = 37) had undergone orthopedic surgery, 42.16% (n = 35), general surgery, and 13.3% (n = 11), urological surgery. Most participants were men (53%), with a mean age of 73 (65­94) years. Overall, 9.6% (n = 8) had postoperative delirium: 6% of the hyperactive subtype (n = 5), 2.4% of the hypoactive subtype (n = 2), and 1.2% of the mixed subtype (n = 1). These patients were older (p = 0.02), had greater cognitive decline (p = 0.01), anemia (p = 0.04), and prolonged hospital stay (p = 0.001). CONCLUSION: Postoperative delirium was more commonly observed in the older old with cognitive decline and anemia, with an impact on hospital length of stay, highlighting the importance of a more comprehensive preventive evaluation in the preoperative period.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Elective Surgical Procedures/statistics & numerical data , Delirium/diagnosis , Delirium/epidemiology , Postoperative Cognitive Complications/diagnosis , Postoperative Period , Health of the Elderly , Cross-Sectional Studies , Risk Factors , Cognitive Reserve/physiology , Hospitalization , Anemia/surgery
7.
Palmas; Secretaria de Estado da Saúde; 2019. 363 p.
Non-conventional in Portuguese | LILACS, ColecionaSUS, CONASS, SES-TO | ID: biblio-1140585

ABSTRACT

Apresenta o resumo das ações desenvolvidas em 2019 no âmbito da Saúde no Estado do Tocantins.


It presents the summary of the actions developed in 2019 in the scope of Health in the State of Tocantins.


Presenta el resumen de las acciones desarrolladas en 2019 en el ámbito de la Salud en el Estado de Tocantins.


Il présente la synthèse des actions développées en 2019 dans le cadre de la Santé dans l'Etat de Tocantins.


Subject(s)
Humans , Health Services Administration , Annual Report , Public Health Surveillance , Personnel Management/statistics & numerical data , Pharmaceutical Services/statistics & numerical data , Health Education/statistics & numerical data , Women's Health/statistics & numerical data , Corneal Transplantation/statistics & numerical data , Renal Dialysis/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Patient Safety/statistics & numerical data , Mental Health Services/statistics & numerical data
8.
Rev. chil. cir ; 70(4): 322-328, ago. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959390

ABSTRACT

Resumen Introducción: Las suspensiones quirúrgicas constituyen una problemática compleja en el ámbito de la administración de pabellones, que afecta tanto a pacientes como al personal de pabellón, y que compromete la eficiencia financiera de las instituciones de salud. Existe escasa información acerca de la incidencia y características de las suspensiones quirúrgicas en nuestro país. Objetivo: Caracterizar las suspensiones quirúrgicas en un centro académico chileno, describiendo su incidencia global y por especialidad. Materiales y Métodos: Se incluyó información recopilada de manera prospectiva acerca de la programación y actividad de pabellón, y de una cohorte de pacientes suspendidos de cirugía entre el 1 de enero de 2016 y el 20 de mayo de 2017. Para calcular el porcentaje de suspensiones se utilizaron 3 grupos en base a 6 períodos de 4 semanas. Se aplicó la transformación de doble arcoseno de Freeman-Turkey y el test-t de Student. Resultados: Durante el período del estudio se programaron 11.398 cirugías, de ellas 492 fueron suspendidas. La incidencia de suspensiones de los 3 períodos fue de 4,38% (IC 95% de 3,78% a 5,01%), 4,15% (IC 95% de 3,51% a 4,85%) y 4,10% (IC 95% de 3,50% a 4,74%) respectivamente. Al menos en un 57% de los casos la principal causa de suspensión se identificó como un cambio en la condición médica del paciente. Discusión y Conclusiones: Nuestros resultados muestran, de manera consistente, que las suspensiones se encuentran entre un 3% y un 5%, lo que está dentro de los estándares internacionales, y pueden ser utilizados como un "benchmarking" para comparaciones a nivel nacional.


Introduction: Surgical cancellations are a complex problem in the field of Operating Room Management, affecting patients, staff, including surgeons and anesthetists, and compromising the finances of health institutions. The available information about the incidence and characteristics of surgical cancellations in our country are scarce. Objective: The aim of this article is to characterize the surgical cancellations in a Chilean academic center, describing its global incidence and by specialty. Materials and Methods: Prospective information on surgical schedule and Operating Room activity was included in this cohort study of surgical case cancellations occurring from January 1, 2016 through May 20, 2017. To calculate the percentage of cancellations, 3 groups were used based on 6 periods of 4 weeks. The Freeman-Turkey double-arcsine transformation and Student's t-test were applied. Results: During the study period, 11,398 surgeries were programmed, of which 492 were cancelled. The incidence of cancellations for the 3 periods was 4.38% (95% CI 3.78% to 5.01%), 4.15% (95% CI 3.51% to 4.85%) and 4.10% (95% CI of 3.50% to 4.74%) respectively. In at least 57% of cases the main identifiable cause of cancellation was a change in the patient's medical condition. Discussion and Conclusions: Our results consistently show that the cancellation rates range between 3% and 5%, which is within international standards, and can be used as benchmarking for comparisons at a national level.


Subject(s)
Humans , Operating Rooms/organization & administration , Elective Surgical Procedures/statistics & numerical data , Hospitals, University/statistics & numerical data , Appointments and Schedules , Confidence Intervals , Chile , Epidemiology, Descriptive , Incidence , Cohort Studies
9.
Rev. chil. obstet. ginecol. (En línea) ; 83(4): 415-425, 2018. tab
Article in Spanish | LILACS | ID: biblio-978114

ABSTRACT

RESUMEN Introducción y objetivos: La ejecución de cesáreas para la interrupción del embarazo y su tasa óptima de utilización ha sido un tema controversial desde sus inicios. En esta línea Robsons y Cols proponen una clasificación para evaluar y comparar de manera eficaz las prácticas realizadas en las distintas instituciones de salud. El objetivo de este trabajo fue comparar la tasa de cesáreas realizadas durante el año 2017 tanto en el Hospital Clínico Universidad de Chile (HCUCH) como en el Hospital base San José de Osorno (HBSJO), y de esta forma, describir sus diferencias estadísticas. Métodos: Los resultados se obtuvieron mediante la recopilación de datos del libro de pabellones disponible en ambos departamentos. Resultados: Se observó una diferencia significativa en la interrupción del embarazo vía alta, la que alcanzó un 55,7% en el HCUCH, en contraste con un 35,7% en el HBSJO. En el HCUCH, el 87,8% de la totalidad de los partos correspondieron a mujeres con embarazos de bajo riesgo, realizándose cesárea en el 52,9% de ellas. En el HBSJO en cambio, las cifras fueron de un 74,6% y 32,2% respectivamente. En las únicas categorías en las cuales no existió una diferencia estadísticamente significativa en cuanto a la tasa de cesáreas realizadas fueron las distocias de presentación y los embarazos gemelares, alcanzando un a tasa de 100% en embarazos gemelares en el HBSJO. Las hipótesis que explican estas diferencias radican principalmente en la organización administrativa y a la población atendida en cada hospital. Conclusiones: Los distintos centros asistenciales de nuestro país se rigen por distintas formas de funcionamiento. Esto explica entre otras cosas, la diferencia estadísticamente significativa que se produce al comparar la tasa de cesárea del HCUCH con el HBSJO. Hacemos un llamado en este trabajo a utilizar el método de clasificación de Robson para facilitar la supervisión y la comparación crítica de estos índices en los hospitales.


ABSTRACT Introduction and objectives: The caesarean section execution for the interruption of pregnancy and its optimal rate of use, has been a controversial issue since its inception. In this line Robsons and Cols propose a classification to standardize and effectively compare the practices carried out in the different health institutions. The aim of this study was to compare the rate of cesareans performed during 2017 both at the "University Clinical Hospital of Chile" (HCUCH) and at the "San José de Osorno Hospital" (HBSJO), and in this way, describe their statistical differences. Methods: The results were obtained by collecting data from the pavilion book available in both departments. Results: There was a significant difference in the cesarean rate between both hospitals. This difference reached 55.7% in the HCUCH, in contrast to 35.7% in the HBSJO. In the HCUCH, 87.8% of all the deliveries corresponded to women with low risk pregnancies, with cesarean sections performed in 52.9% of them. On the other hand, in the HBSJO the values were 74.6% and 32.2% respectively. The only categories in which there was no statistically significant difference in the rate of cesarean sections performed, were pregnancies with dystocia presentation and twin pregnancies, reaching a 100% of surgical intervention in this last group. The hypotheses that explain these differences lie mainly in the administrative organization and the population served in each hospital. Conclusions: The different healthcare centers in our country are governed by different ways of functioning. This explains, among other things, the statistically significant difference that occurs when comparing the cesarean rate of the HCUCH and the HBSJO. We encourage in this study to use Robson's classification method to facilitate the supervision and critical comparison of these indices in hospitals.


Subject(s)
Cesarean Section/statistics & numerical data , Hospitals, Maternity/statistics & numerical data , Hospitals, University , Pregnancy Complications/epidemiology , Prenatal Care , Labor Onset , Comparative Study , Elective Surgical Procedures/statistics & numerical data
10.
Rev. bras. enferm ; 70(3): 535-542, May-June 2017. tab, graf
Article in English | LILACS, BDENF | ID: biblio-843676

ABSTRACT

ABSTRACT Objective: To characterize cancellations of elective surgeries according to clinical and non-clinical reasons, as well as to verify seasonal influence and determine the estimated reduction of the index. Method: Quantitative, descriptive and retrospective study with secondary data extracted from the Public Hospital of the State of São Paulo database. Results: Out of the 8,443 (100%) elective surgeries scheduled, 7,870 (93.21%) were performed and 573 (6.79%) were canceled. Out of these 573 (100%) people, 48.33% were canceled for clinical reasons and 46.40% were for non-clinical reasons. Among the non-clinical reasons for surgery cancellations, those related to medical reasons stood out: at the request of the surgeon/change of approach (17.93%), followed by non-hospitalized patient (8.96%). There was no indication of seasonality regarding the reasons for cancellation in the assessed period. Conclusion: Although the rate of elective surgeries cancellations is lower than that of other hospitals with similar characteristics, it is still possible to reduce it from 6.79% to 1.36%, considering that 80% of the reasons for cancellation are avoidable.


RESUMEN Objetivo: Caracterizar las cancelaciones quirúrgicas electivas según motivos clínicos y no clínicos y verificar la influencia estacional y la estimativa de reducción del índice. Método: Estudio cuantitativo, descriptivo y retrospectivo con datos secundarios, extraídos del banco de datos de un Hospital Público del Estado de São Paulo. Resultados: Del 100% (8.443) de las cirugías electivas marcadas, se realizaron 7.870 (93,21%) y se suspendieron 573 (6,79%). Del 100% (573), 48,33% se cancelaron por razones clínicas y el 46,40%, por razones no clínicas. Entre los motivos no clínicos, preponderaron los relacionados a razones médicas, categorizados como: pedido del cirujano/cambio de conducta (17,93%), seguida de no internación del paciente (8,96%). No hubo indicación de influencia estacional para la cancelación durante el período analizado. Conclusión: A pesar de que el porcentaje de cancelación quirúrgica electiva fue menor que la de otros hospitales de características similares, todavía es posible reducirla del 6,79% al 1,36%, considerando que el 80% de los motivos de la cancelación pueden ser prevenidos.


RESUMO Objetivo: Caracterizar cancelamentos cirúrgicos eletivos segundo motivos clínicos e não clínicos, assim como verificar a influência sazonal e a estimativa de redução do índice. Método: Estudo quantitativo, descritivo e retrospectivo com dados secundários, extraídos de banco de dados de Hospital Público do Estado de São Paulo. Resultados: Das 8.443 (100%) cirurgias eletivas agendadas, realizaram-se 7.870 (93,21%) e suspenderam-se 573 (6,79%). Destas 573 (100%), 48,33% foram por razões clínicas e 46,40% não clínicas. Dentre os motivos não clínicos de cancelamento cirúrgico, preponderaram os relacionados às razões médicas, categorizadas como: a pedido do cirurgião/mudança de conduta (17,93%), seguida por paciente não internou (8,96%). Não houve indicação de sazonalidade quanto à ocorrência de motivos de cancelamento no período analisado. Conclusão: Apesar de a taxa de cancelamento cirúrgico eletivo apresentar-se menor que de outros hospitais de características semelhantes, ainda é possível reduzi-la de 6,79% para 1,36%, considerando que 80% das razões de cancelamento são preveníveis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Choice Behavior , Elective Surgical Procedures/statistics & numerical data , Brazil , Retrospective Studies , Hospitals, Public/organization & administration , Hospitals, Public/statistics & numerical data , Middle Aged
11.
Rev. méd. Chile ; 144(3): 317-324, mar. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-784900

ABSTRACT

Background: Cholelithiasis (CL) represents a major health burden in Chile, with rates of cholecystectomy (CCT) of ~40.000 per year. The explicit health care guaranties (GES) program includes prioritized CCT for CL carriers between 35 and 49 years of age. Aim: To assess the access and opportunity of CCT in a screening program of CL in Family Medicine Centers, according to the age of the patients. Material and Methods: A systematic ultrasound screening program of CL was developed in Family Medicine Centers ANCORA-UC between March 2009 and March 2013 during which 1.450 individuals were assessed, (80% women) and 281 were identified as having CL (19.4%). After a minimum follow up interval of six months, patients with CL were contacted and surveyed by phone. They were categorized as being beneficiaries of the GES program (those aged between 35 to 49 years) or not (those aged < 35 o > 49 years). Results: Two hundred thirteen patients were contacted (76%), 81 beneficiaries of the program and 132 non-beneficiaries. The attending physician indicated CCT to 191 patients (89.6%). During a mean follow-up time of 641 days/person, 100 patients had CCT, 11% of which were emergency interventions due to complications. A greater proportion of program beneficiaries than non-beneficiaries had an elective CCT (74 and 21% respectively). The waiting interval for elective CCT was longer in non-beneficiaries compared with beneficiaries (340 ± 247 and 229 ± 201 days respectively). Only 46% of the elective CCT in GES patients were done within deadlines determined by the program (≤ 150 days). Conclusions: The age of patients at the moment of CL diagnosis conditions the access and opportunity to CCT. Beneficiaries of the explicit health care guaranties program have higher rates of cholecystectomy with less waiting time.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Primary Health Care/statistics & numerical data , Cholecystectomy/statistics & numerical data , Cholelithiasis/surgery , Health Services Accessibility/statistics & numerical data , Time Factors , Cholelithiasis/diagnostic imaging , Chile , Sex Factors , Follow-Up Studies , Waiting Lists , Age Factors , Elective Surgical Procedures/statistics & numerical data , Statistics, Nonparametric
12.
Rev. bras. cir. cardiovasc ; 30(6): 605-609, Nov.-Dec. 2015. tab
Article in English | LILACS | ID: lil-774542

ABSTRACT

ABSTRACT OBJECTIVE: To test several weaning predictors as determinants of successful extubation after elective cardiac surgery. METHODS: The study was conducted at a tertiary hospital with 100 adult patients undergoing elective cardiac surgery from September to December 2014. We recorded demographic, clinical and surgical data, plus the following predictive indexes: static compliance (Cstat), tidal volume (Vt), respiratory rate (f), f/ Vt ratio, arterial partial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2), and the integrative weaning index (IWI). Extubation was considered successful when there was no need for reintubation within 48 hours. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were used to evaluate each index. RESULTS: The majority of the patients were male (60%), with mean age of 55.4±14.9 years and low risk of death (62%), according to InsCor. All of the patients were successfully extubated. Tobin Index presented the highest SE (0.99) and LR+ (0.99), followed by IWI (SE=0.98; LR+ =0.98). Other scores, such as SP, NPV and LR-were nullified due to lack of extubation failure. CONCLUSION: All of the weaning predictors tested in this sample of patients submitted to elective cardiac surgery showed high sensitivity, highlighting f/Vt and IWI.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Heart Valves/surgery , Respiration, Artificial/methods , Ventilator Weaning/statistics & numerical data , Airway Extubation , Elective Surgical Procedures/statistics & numerical data , Likelihood Functions , Postoperative Period , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Tidal Volume/physiology , Ventilator Weaning/methods
13.
Article in English | IMSEAR | ID: sea-157493

ABSTRACT

Caesarian section (C/S) is a very common obstetric procedure. It had many advantages and disadvantages. In this age of consumer awareness, patient has to give an informed consent before the procedure – means merits and demerits of the procedure shall be known to the patient. She also has the right to choose between different procedures, type of incision and anesthesia, where possible. We have studied that status amongst 100 such patients, only 7% of them being illiterate, who had undergone elective C/S in SNP Hospital, a two tier hospital of Kolkata. The result was shocking. 65% of the mothers did not have any idea regarding the procedure they are undergoing. 1/3rd of the patients even did not know why they are having C/S. None of them was given any choice regarding anesthesia and only 9% regarding incision. A detail of the study is presented.


Subject(s)
Adult , Awareness , Cesarean Section/education , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Elective Surgical Procedures/education , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Female , Humans , India , Informed Consent , Pregnancy , Surveys and Questionnaires
14.
Arq. bras. oftalmol ; 75(5): 333-336, set.-out. 2012. tab
Article in Portuguese | LILACS | ID: lil-667577

ABSTRACT

OBJETIVO: Analisar a incidência e causas de cancelamento de cirurgias de catarata em um hospital público de referência. MÉTODOS: Trata-se de um estudo retrospectivo em que foram analisados o número de cancelamentos de facectomias durante o ano de 2009. Foram analisados sexo, idade, tipo de procedimento suspenso (facoemulsificação ou extração extracapsular do cristalino), tipo de anestesia, convênio (Sistema Único de Saúde ou convênio/particular) e motivo de suspensão da cirurgia (causas clínicas, institucionais ou pessoais). RESULTADOS: Foram agendadas no período 2.965 cirurgias de catarata, havendo 650 cancelamentos (21,92%). Dentre as principais razões para a suspensão do procedimento destacaram-se as causas clínicas (86,90%). Os meses de inverno apresentaram os maiores índices de suspensão de cirurgias de catarata. CONCLUSÃO: A taxa de cancelamento de cirurgia de catarata em serviços públicos parece ser a mesma que há 10 anos. A principal causa de suspensão deve-se por condições clínicas (hipertensão, diabetes, falta de exames, etc.).


PURPOSE: To report the incidence and causes of cataract surgery cancellations in a public hospital. METHODS: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). RESULTS: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. CONCLUSION: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).


Subject(s)
Aged , Humans , Middle Aged , Cataract Extraction/statistics & numerical data , Efficiency, Organizational , Refusal to Treat/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Brazil , Hospitals, Public/statistics & numerical data , Retrospective Studies
15.
Rev. Assoc. Med. Bras. (1992) ; 57(3): 323-327, May-June 2011. tab
Article in Portuguese | LILACS | ID: lil-591361

ABSTRACT

OBJETIVO: Identificar a prevalência de estenose carotídea (EC) e os possíveis preditores de mortalidade em indivíduos submetidos à cirurgia de revascularização miocárdica (CRM) eletiva. MÉTODOS: Estudo de coorte que incluiu 393 candidatos à CRM. Todos os pacientes realizaram ultrassonografia com Doppler em cores de artérias carótidas antes da CRM e foram seguidos durante a internação quanto à morbidade e mortalidade. A EC foi considerada clinicamente relevante quando > 50 por cento. Um p < 0,05 foi considerado significativo. Regressão logística foi realizada para definir preditores independentes de mortalidade. RESULTADOS: A prevalência de EC foi de 17,4 por cento. Após regressão logística, EC > 50 por cento (p = 0,001) e insuficiência renal crônica (IRC) (p = 0,03) foram preditores, independentes de mortalidade. CONCLUSÃO: EC mostrou ter uma prevalência elevada na amostra estudada e, conjuntamente com a IRC, foi preditor, independente de mortalidade.


OBJECTIVE: To identify carotid stenosis (CS) prevalence and potential mortality predictors in individuals undergoing elective coronary artery bypass grafting (CABG). METHODS: Cohort study including 393 scheduled for CABG. All patients underwent a color Doppler ultrasound study of the carotid arteries prior to CABG and were assessed for morbidity and mortality over the hospitalization. CS was considered clinically relevant when if > 50 percent. Significance was set at p < 0.05. Logistic regression was used to define mortality independent predictors. RESULTS: CS prevalence was 17.4 percent. Following logistic regression analysis, CS > 50 percent (p = 0.001) and chronic renal failure (CRF) (p = 0.03) remained as mortality independent predictors. CONCLUSION: CS showed a high prevalence in the study sample and together with CRF was a mortality independent factor.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carotid Stenosis/epidemiology , Coronary Artery Bypass/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Cohort Studies , Carotid Stenosis/mortality , Carotid Stenosis , Kidney Failure, Chronic/mortality , Prevalence , Postoperative Complications/mortality , Regression Analysis , Ultrasonography, Doppler, Color
16.
Rev. latinoam. enferm ; 16(5): 838-843, Sept.-Oct. 2008. tab
Article in English, Spanish, Portuguese | LILACS, BDENF | ID: lil-498508

ABSTRACT

The aim of this descriptive study was to compare preoperative and post-operative sleep/wake cycle (SWC) patterns of 22 women undergoing elective surgery, with up to one day of hospitalization. The study was approved by the local Review Board. Voluntary women (average age 39 ± 9) filled out a Sleep Journal for 23 consecutive days, before and after the surgery (46 days total). Data were analyzed with Wilcoxon's matched-pairs test. The findings showed slight and transitory SWC changes (increased latency, reduced efficiency and later wake-up time) after the surgery. Nevertheless, sleep quality was improved and there was a fast return to the SWC patterns observed before the intervention, perhaps due to the early exposition to daily routine, e.g. the environmental clues that are important to rhythmic synchronization.


Este estudio tuvo como objetivo comparar las características del ciclo vigilia/sueño (CVS) de 22 mujeres sometidas a cirugía ginecológica electiva con hasta un día de hospitalización, entre las etapas pre y post operatoria. El estudio fue aprobado por el Comité de Ética de la institución. Las voluntarias (39 ± 9 años) llenaron un Diario del Sueño durante 23 días consecutivos, antes y después de la cirugía (46 días en total). Los datos fueron comparados por medio de la prueba de Wilcoxon para muestras pareadas. Lo encontrado reveló alteraciones discretas y transitorias del CVS (aumento de la latencia, reducción de la eficiencia y despertar más tardío) después de la cirugía, sin embargo con mejoría de la calidad del sueño y rápido retorno a las características anteriores a la intervención, talvez por la exposición precoz a la rutina del día a día, o sea, a las señales ambientales relevantes para la sincronización del ritmo.


Este estudo teve como objetivo comparar as características do ciclo vigília/sono (CVS) de 22 mulheres submetidas a cirurgia ginecológica eletiva com até um dia de hospitalização, entre as etapas pré e pós-operatória. O estudo foi aprovado pelo Comitê de Ética da instituição. As voluntárias (39±9 anos) preencheram um diário de sono durante 23 dias consecutivos, antes e após a cirurgia (46 dias no total). Os dados foram comparados por meio do teste de Wilcoxon para amostras pareadas. Os achados revelaram alterações discretas e transitórias do CVS (aumento da latência, redução da eficiência e despertar mais tardio) após a cirurgia, porém, com melhora da qualidade do sono e rápido retorno às características anteriores à intervenção, talvez pela exposição precoce à rotina do dia-a-dia, ou seja, às pistas ambientais relevantes para a sincronização do ritmo.


Subject(s)
Adult , Female , Humans , Middle Aged , Gynecologic Surgical Procedures/statistics & numerical data , Hospitalization/statistics & numerical data , Length of Stay/statistics & numerical data , Outpatient Clinics, Hospital/statistics & numerical data , Sleep , Elective Surgical Procedures/statistics & numerical data , Wakefulness , Cross-Sectional Studies
17.
Rev. chil. cir ; 59(5): 326-329, oct. 2007. graf
Article in Spanish | LILACS | ID: lil-477321

ABSTRACT

El trauma en Chile es la primera causa de muerte en pacientes menores de 45 años, siendo el trauma penetrante torácico especialmente importante debido a su alta frecuencia en nuestro medio. Este es un estudio observacional censal descriptivo, en el cual se revisaron los libros de protocolo operatorio del Hospital Carlos Van Burén de Valparaíso, desde Diciembre de 1997 hasta enero del 2006, obteniendo el total de pacientes ingresados por trauma penetrante torácico a los que se les realizó pleurotomía mínima, siendo estos 203 pacientes. Se revisaron las fichas con el objetivo de determinar cuántos pacientes respondieron adecuadamente sólo con pleurotomía mínima y cuántos requirieron toracotomia de urgencia o electiva. Los resultados se describen en porcentajes obteniendo que del total de pacientes 92,6 por ciento corresponden a hombres y 7,39 por ciento corresponden a mujeres. De los 203 pacientes estudiados 10,8 por ciento requirieron toracotomia y 89,2 por ciento evolucionaron favorablemente sólo con pleurotomía mínima. La causa más frecuente de toracotomia fue el hemotórax masivo (50 por ciento), el cual fue manejado satisfactoriamente, siendo diagnosticado y tratado precozmente. El trauma penetrante torácico es más frecuente en el sexo masculino, sobre todo jóvenes, siendo la mayoría resueltos exitosamente con la pleurotomía mínima en la Unidad de Emergencias.


Background: Trauma is the first cause of death among subjects of less than 45 years of age in Chile. Penetrating chest trauma is common. Aim: To assess the need for thoracotomy among patients with penetrating chest trauma. Material and methods: Retrospective review of operative protocols of all tube thoracostomies performed in a General Hospital from 1997 to 2006. Results: In the study period, 275 protocols of tube thoracostomy were found and 72 had to be discarded. Therefore, 203 patients, aged 15 to 80 years (188 males), were included in the study. Eleven percent of patients required a surgical thoracotomy and the rest only required the tube thoracostomy. The most common reason to perform a thoracotomy was massive hemothorax in 50 percent of cases. Conclusions: Most cases of penetrating chest trauma occur in men and can be successfully treated with a tube thoracostomy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Chest Tubes , Wounds, Penetrating/surgery , Thoracostomy/statistics & numerical data , Thoracotomy/statistics & numerical data , Thoracic Injuries/surgery , Emergencies , Epidemiology, Descriptive , Hemothorax/surgery , Pneumothorax/surgery , Elective Surgical Procedures/statistics & numerical data , Sex Distribution
18.
Clinics ; 62(4): 427-432, 2007. tab
Article in English | LILACS, SES-SP | ID: lil-460025

ABSTRACT

BACKGROUND: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. OBJECTIVE: To determine the safety of open bedside tracheostomy (OBT) as a routine intensive care units (ICU) procedure without any selection criteria, considering its peri and postoperative complications. METHOD: Retrospective medical chart review of all patients that underwent elective tracheostomy between April 1999 and December 2005 at ICU of three private hospitals. RESULTS: The study group comprised 552 patients with a mean age of 69.6 ± 15.8 years. The incidence of significant complications (until 30 days after the procedure) was 4.34 percent (24 cases): 9 minor bleeding, 9 major bleeding, 2 subcutaneous emphysema, 4 stomal infections. Late complications were: laryngotracheal stenosis in 2 and tracheoinomminate fistula in 1 patient. CONCLUSIONS: OBT seems to be a safe and simple procedure, when performed by a team of experienced physicians under controlled circumstances, and should be considered as an option for ICU patients.


INTRODUÇÃO: A traqueostomia é um procedimento eletivo realizado em pacientes de unidades de terapia intensiva sob ventilação mecânica prolongada. O risco associado ao transporte, custos e dificuldades de agendamento cirúrgico são alguns obstáculos para uma maior aceitação da traqueostomia. O uso de rígidos critérios de seleção para a realização deste procedimento a beira do leito exclui muitos pacientes que se beneficiariam deste método. OBJETIVO: Determinar à segurança da traqueostomia convencional a beira do leito como procedimento de rotina (sem a utilização dos critérios de seleção) em unidades de terapia intensiva, considerando as complicações intra e pós-operatórias. MÉTODO: Revisão retrospectiva de prontuários de pacientes submetidos à traqueostomia eletiva nas unidades de terapia intensiva de três hospitais privados no período de abril de 1999 a dezembro de 2005. RESULTADOS: Foram incluídos 552 pacientes com idade media de 69.6 ± 15.8 anos. A incidência de complicações pós-operatórias (até o 30° pós-operatório) foi 4.34 por cento (24 casos): 9 sangramentos leves, 9 sangramentos importantes, 2 enfisemas subcutâneos, 4 infecções do estoma. As complicações tardias observadas foram: estenose laringotraqueal em 2 pacientes e fistula traqueo-inominada em 1 paciente. CONCLUSÃO: A traqueostomia convencional a beira do leito parece ser um procedimento simples e seguro quando realizado por equipe experiente em condições controladas, deve, portanto ser considerada como uma opção para pacientes em terapia intensiva sob ventilação prolongada.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Intensive Care Units , Elective Surgical Procedures , Tracheostomy , Retrospective Studies , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Tracheostomy/adverse effects , Tracheostomy/methods , Tracheostomy/statistics & numerical data
19.
Säo Paulo med. j ; 124(6): 313-315, Nov. 7, 2006. tab
Article in English | LILACS | ID: lil-441168

ABSTRACT

CONTEXT AND OBJECTIVE: There are no studies on birth weights among full-term infants born by means of elective cesarean section. We aimed to study this in private and public hospitals. DESIGN AND SETTING: Retrospective study at Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. METHODS: Data were collected from the municipal medical birth register of Uberaba from January to December 2000. The data obtained (maternal age, type of delivery, number of prenatal care visits and birth weight, from full-term pregnancy) from the university hospital (UH), which is a tertiary hospital that only attends patients within the National Health System (SUS), were compared with data from four private hospitals (PHs) that attend health insurance plans and private patients. Student's t test, chi2 test and multiple logistic regression were used for statistical analysis, with the significance level set at p < 0.05. RESULTS: In the PHs, 1,100 out of 1,354 births (81.2 percent) were by cesarean section and in the UH, 373 out of 1,332 (28 percent). Birth weight increased significantly in association with increasing numbers of prenatal care visits, except for cesarean section cases in PHs. Birth weights among vaginal delivery cases in PHs were greater than in the UH (p < 0.05), but this was not observed among cesarean section cases. Multiple logistic regression showed that there was greater risk of low birth weight in PHs (odds ratio: 2.33; 95 percent confidence interval: 1.19 to 4.55). CONCLUSION: Elective cesarean section performed in PHs may be associated with low birth weight among full-term infants.


CONTEXTO E OBJETIVO: Uma das principais causas do aumento das taxas de cesariana no Brasil é o predominante caráter eletivo das indicações, principalmente em hospitais privados. O risco de desconforto respiratório neonatal pode ser uma complicação da cesariana eletiva, mas pelos nossos conhecimentos, não há estudo sobre peso ao nascimento de fetos a termo. Portanto, o objetivo deste trabalho é estudar o peso de fetos a termo nascidos em hospitais privados e públicos. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado de Janeiro a Dezembro de 2000 na Universidade Federal do Triângulo Mineiro, em que os dados foram coletados do registro médico de nascimento de Uberaba (Brasil). MÉTODOS: Nós comparamos os dados obtidos (idade materna, tipo de parto, número de consultas pré-natais e o peso ao nascer de fetos a termo) no Hospital Universitário (HU), hospital terciário que atendo pelo Sistema Unico de Saúde (SUS) com quatro hospitais da rede privada (HPs - Hospitais Particulares) que atendem planos de saúde e privados. Os testes de "T de Student's", "chi2" e regressão logística múltipla foram usados para análise estatística com nível de significância estabelecido em p < 0,05. RESULTADOS: 1.100 em 1.354 (81,2 por cento) e 373 em 1.332 (28 por cento) cesarianas ocorreram, respectivamente, no HPs e HU. Nós observamos que o peso ao nascimento aumenta significantemente em associação com o número de consulta pré-natais, com exceção das cesarianas no HPs. Além disso, o peso ao nascimento nos partos vaginais no HPs é maior que no HU (p < 0,05) mas isto não é observado nas cesarianas. A análise de regressão múltipla demonstrou que o risco de baixo peso ao nascer no HPs é 2,33 (1,19 to 4,55). CONCLUSÃO: As cesarianas eletivas realizadas nos hospitais privados podem estar associadas a um menor peso ao nascimento de fetos a termo.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Birth Weight , Cesarean Section/statistics & numerical data , Delivery, Obstetric/statistics & numerical data , Infant, Low Birth Weight , Elective Surgical Procedures/statistics & numerical data , Brazil/epidemiology , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Logistic Models , Maternal Age , Prenatal Care/statistics & numerical data , Retrospective Studies
20.
Article in English | IMSEAR | ID: sea-46132

ABSTRACT

BACKGROUND: Abdominal surgeries are the commonest major operations that are performed in the department of surgery. AIM: To find out the different causes of emergency and elective abdominal surgeries at Nepalgunj Medical College Teaching Hospital (NGMCTH) Nepalgunj, Nepal. MATERIAL AND METHOD: This is a retrospective study conducted in the department of surgery at NGMCTH Nepalgunj, Nepal, over a period of 2 years (2001 to 2003). The patients included in this study were drawn from Banke, Bardiya, Kailali, Kanchanpur, Surkhet, Dang, Dailake, and Tikapur. They belong to both sexes and different age groups. All the records of these patients under went laparotomy for elective as well as emergency conditions were included in this study. The data were analyzed; tabulated and following results were obtained. RESULTS: The commonest cause of emergency laparotomies were peritonitis (peptic ulcer, enteric and appendicular perforations) whereas, the commonest cause of elective laparotomies were chronic cholecystitis with cholelithiasis followed by chronic appendicitis and pyloric obstruction. CONCLUSION: Over all, cholecystectomy for cholecystitis with cholelithiasis was the commonest operation, which was done in last two years. This disease may be because of excessive use of saturated animal fat and vegetable oil. Peritonitis was the 2nd commonest cause of abdominal surgery. Among the causes of peritonitis, peptic ulcer perforations were the frequent followed by enteric and appendicular perforations. Appendicitis was the 3rd commonest cause of abdominal surgery. Nepal, being a Hindu country, people consume excessive amount of meat, and possibly due to this, the disease of the appendix was very high as compared to other Asian countries where people live on bulk cellulose diet.


Subject(s)
Abdomen/surgery , Adolescent , Adult , Child , Child, Preschool , Emergencies , Female , Humans , Laparotomy/statistics & numerical data , Male , Nepal , Elective Surgical Procedures/statistics & numerical data
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