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Säo Paulo med. j ; 139(3): 241-250, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252244


ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & control
Article in English | WPRIM | ID: wpr-921099


INTRODUCTION@#Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.@*METHODS@#Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.@*RESULTS@#There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (@*CONCLUSION@#The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.

Humans , Postoperative Complications/prevention & control , Preoperative Care , Preoperative Exercise , Prospective Studies , Retrospective Studies
ABCD arq. bras. cir. dig ; 34(3): e1598, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1355503


ABSTRACT Background: Gastro-omentopexy promotes the reconnection of the stomach to the gastroesplenic and gastrocolic ligaments and constitutes an alternative for the prevention of complications in laparoscopic vertical gastrectomy. Aim: To demonstrate the benefits of the gastro-omentopexy technique in patients undergoing sleeve gastrectomy, with possible reduction in postoperative complications. Methods: Prospective, non-randomized, case series type study, consisting of a clinical population of 179 patients who underwent the technique in 2018, with follow-up between 6-12 months in the postoperative period. Results: From the participants 71.5% were women, aged between 30-40 years (36.3%). As for the prevalence of complications in the postoperative period, the low prevalence was evident, with emphasis on readmission (1.1%); reoperation (1.1%); wound infection (1.1%); bleeding hemorrhage (0.5%); and stricture (1.1%). However, temporary symptoms were present such as nausea/vomiting, food intolerance, epigastric pain and feeling of fullness, right after surgery. Conclusion: The technique promoted a significant improvement in quality of life and control of comorbidities. In addition, it was associated with a low prevalence of stenosis, and with no fistula, making the method safer.

RESUMO Racional: A gastro-omentopexia promove a reconexão do estômago aos ligamentos gastroesplênico e gastrocólico e pode constituir alternativa para prevenção de complicações na gastrectomia vertical laparoscópica. Objetivo: Demonstrar os benefícios da gastro-omentopexia em pacientes submetidos à gastrectomia vertical laparoscópica com redução de complicações. Métodos: Estudo prospectivo, não randomizado, do tipo série de casos, constituído por população de 179 pacientes que realizaram a técnica, com acompanhamento entre 6-12 meses no pós-operatório. Resultados: Dos participantes 71,5% eram mulheres, com faixa etária entre 30-40 anos (36,3%). Quanto às complicações no pós-operatório evidenciou-se baixa prevalência delas com destaque para reinternação (1,1%); reoperação (1,1%); infecção de ferida (1,1%); sangramento/hemorragia (0,5%); e estenose gástrica (1,1%). Entretanto, surgiram sintomas temporários como náusea/vômito, intolerância alimentar, dor epigástrica e sensação de plenitude, logo após a operação. Houve melhora nas variáveis de qualidade de vida analisadas. Conclusão: A técnica promoveu melhora na qualidade de vida e no controle das comorbidades. Além disso, esteve associada à baixa prevalência de estenose, e sem ocorrência de fístula, tornando o método mais seguro.

Humans , Female , Adult , Obesity, Morbid/surgery , Laparoscopy , Postoperative Complications/surgery , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Quality of Life , Stomach , Prospective Studies , Retrospective Studies , Treatment Outcome , Gastrectomy
Rev. cuba. enferm ; 36(4): e3262, tab
Article in Spanish | LILACS, BDENF, CUMED | ID: biblio-1280289


Introducción: Durante las cirugías ocurren complicaciones y muertes, las que pueden ser prevenibles. Esta circunstancia hizo que la Organización Mundial de la Salud estableciera una lista de verificación de cirugía segura, que debe aplicarse para aminorar posibles riesgos y favorecer la seguridad del paciente durante la cirugía. Objetivo: Identificar la relación entre la aplicación de la lista de verificación de cirugía segura y utilidad según la opinión de las enfermeras. Métodos: Estudio cuantitativo, diseño correlacional y trasversal, realizado en sala de operaciones del Instituto Nacional de Enfermedades Neoplásicas, Lima - Perú, desde setiembre hasta octubre de 2018. La población de estudio quedó conformada por 46 enfermeras, las técnicas utilizadas fueron la encuesta y la observación. Los instrumentos fueron el cuestionario y la lista de observación, el cuestionario fue validado por 8 expertos y prueba piloto, tuvo un alfa de Crombach de 0,731. La lista de observación fue elaborada por la Organización Mundial de la Salud. Los datos fueron procesados a través del programa Excel, a fin de realizar el análisis de frecuencias y porcentajes, se aplicó la prueba chi cuadrado para identificar la relación entre las variables de estudio. Resultados: Al aplicar la prueba estadística Chi cuadrado se evidenció que no existe relación entre ambas variables (p > 0,06); el 66 por ciento de los profesionales de enfermería consideraron que es útil y el 56,5 por ciento aplican la lista de verificación de cirugía segura. Conclusiones: No se encontró relación entre la aplicación de la lista de verificación de cirugía segura y la utilidad según la opinión de las enfermeras(AU)

ABSTRACT Introduction: During surgeries complications and deaths occur, which can be preventable, this circumstance led the World Health Organization to establish a safe surgery checklist, which must be applied to reduce possible risks and promote patient safety during surgery. Objective: To identify the relationship between the application of the safe surgery checklist and its usefulness according to the opinion of the nurses. Methods: Quantitative study, correlational and cross-sectional design, carried out in the operating room of the National Institute of Neoplastic Diseases, Lima - Peru, from September to October 2018, the study population made up of 46 nurses, the techniques used were observation and poll; the instruments the questionnaire and observation list, the questionnaire was validated by 8 experts and a pilot test, had a Crombach alpha of 0.731. The watchlist was developed by the World Health Organization. The data were processed through the Excel program, in order to carry out the analysis of frequencies and percentages, the chi square test was applied to identify the relationship between the study variables. Results: When applying the Chi square statistical test, it was evident that there is no relationship between both variables (p > 0.06); 66.00 percent of nursing professionals consider it to be useful and 56.50 percent apply the safe surgery checklist. Conclusions: No relationship was found between the application of the safe surgery checklist and its usefulness according to the nurses' opinion(AU)

Humans , Operating Rooms , Postoperative Complications/prevention & control , World Health Organization , Checklist/methods , Patient Safety , Cross-Sectional Studies
Prensa méd. argent ; 106(10): 611-617, 20200000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1362689


Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.

Humans , Appendicitis/complications , Postoperative Care , Postoperative Complications/prevention & control , General Surgery , Wound Infection/prevention & control , Prospective Studies , Demographic Data , Abdominal Abscess/prevention & control , Delayed Diagnosis , Length of Stay
Rev. cuba. anestesiol. reanim ; 19(3): e631, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1138884


Introducción: El aumento de la expectativa de vida determina un incremento en la incidencia de enfermedades con indicación quirúrgica. El avance en las técnicas quirúrgicas, los cuidados intensivos y el conocimiento más profundo del proceso de envejecimiento tiende a favorecer la disminución de la morbimortalidad perioperatoria del paciente geriátrico. Objetivo: Determinar la incidencia de complicaciones intra y posoperatorias en pacientes geriátricos durante la cirugía abdominal mayor electiva. Métodos: Se realizó un estudio observacional descriptivo, de corte transversal a 373 pacientes geriátricos programados para intervención quirúrgica abdominal mayor desde enero de 2017 hasta diciembre de 2019 en el Hospital Clínico Quirúrgico Dr. Miguel Enríquez. Se registró la incidencia de complicaciones perioperatorias relacionándolas con las variables de estudio. Resultados: Las complicaciones más frecuentes fueron las cardiovasculares. La mortalidad fue escasa. Conclusiones: Las complicaciones perioperatorias detectadas en los pacientes geriátricos estudiados, se relacionan con las enfermedades previas, el tipo y la envergadura de la cirugía y con el tiempo quirúrgico(AU)

Introduction: The increase in life expectancy determines an increase in the incidence of diseases with surgical indication. Advances in surgical techniques, intensive care and deeper understanding of the aging process tend to favor the reduction of perioperative morbidity and mortality among geriatric patients. Objective: To determine the incidence of intraoperative and postoperative complications among geriatric patients during elective major abdominal surgery. Methods: A descriptive, cross-sectional and observational study was carried out with 373 geriatric patients scheduled for major abdominal surgery from January 2017 to December 2019 at Dr. Miguel Enríquez Clinical-Surgical Hospital. The incidence of perioperative complications was recorded, relating them to the study variables. Results: The most frequent complications were the cardiovascular ones. Mortality was low. Conclusions: The perioperative complications identified among the geriatric patients studied are related with previous diseases, with the type and extent of surgery, and with the surgical time(AU)

Humans , Aged , Aged, 80 and over , Postoperative Complications/prevention & control , Indicators of Morbidity and Mortality , Perioperative Care/methods , Abdomen/surgery , Intraoperative Care/methods , Postoperative Complications/epidemiology , Aging , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study
Rev. bras. anestesiol ; 70(4): 364-387, July-Aug. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137197


Abstract The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative review, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.

Resumo Os padrões evolutivos para a prevenção do tromboembolismo venoso perioperatório e a introdução de medicações antitrombóticas cada vez mais potentes resultaram em preocupações com o aumento do risco de sangramento neuroaxial. Após o consenso da Sociedade Brasileira de Anestesiologia em 2014, novos medicamentos anticoagulantes orais foram aprovados pelas instituições reguladoras internacionais, assim como pela ANVISA. As sociedades que buscam abordar o manejo perioperatório desses fármacos apresentam recomendações conflitantes. Em resposta a essas questões e à necessidade de uma abordagem mais racional, as condutas foram atualizadas nesta revisão narrativa e feitas declarações de consenso. Elas foram projetadas para encorajar a assistência ao paciente de forma segura e de qualidade, mas não podem garantir um resultado específico. Tal como acontece com qualquer recomendação de orientação clínica, estas estão sujeitas a revisão com o conhecimento de avanços específicos de complicações. O objetivo foi avaliar aspectos da segurança em anestesia e analgesia regional em pacientes em uso de medicações antitrombóticas, tais como: possíveis complicações decorrentes da técnica; fatores de risco associados ao hematoma espinhal, estratégias de prevenção, diagnóstico e tratamento; intervalo seguro para suspensão e reinício da medicação após o bloqueio regional.

Humans , Practice Guidelines as Topic , Anesthesia, Conduction/methods , Anticoagulants/administration & dosage , Postoperative Complications/prevention & control , Brazil , Risk Factors , Perioperative Care/methods , Venous Thromboembolism/prevention & control , Hemorrhage/chemically induced , Anticoagulants/adverse effects
Rev. bras. cir. cardiovasc ; 35(3): 368-374, May-June 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137261


Abstract Objective: The current review evaluates recent literature on the different aspects of prophylaxis in postoperative pulmonary and venous thromboembolism and their main risk factors. Methods: The literature survey was carried out based on the PubMed data using the keywords "coronary artery bypass graft" and "venous thromboembolism" as components of the search field title. Results: Studies reported several risk factors for postoperative thromboembolism including advanced age, postoperative immobilization, type of thromboprophylaxis, obesity, and location of the surgery. Conclusion: According to the studies, tailored prophylaxis could be easily adapted to decrease the intensity and duration of postoperative thromboembolism in a patient with several disorders and comorbidities, especially in cardiovascular disease.

Humans , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Postoperative Complications/prevention & control , Coronary Artery Bypass/adverse effects , Risk Factors , Anticoagulants/therapeutic use
Int. j. morphol ; 38(3): 552-557, June 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098286


La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.

Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.

Humans , Female , Adult , Middle Aged , Aged , Young Adult , Cholelithiasis/surgery , Celiac Artery/diagnostic imaging , Computed Tomography Angiography/methods , Postoperative Complications/prevention & control , Preoperative Care , Cholelithiasis/diagnostic imaging , Comorbidity , Celiac Artery/anatomy & histology , Cholecystectomy, Laparoscopic
Rev. cuba. cir ; 59(2): e957, abr.-jun. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1126419


RESUMEN La pandemia actual COVID-19 ha afectado la población mundial con cifras alarmantes de contaminados y fallecidos, con un agotamiento de los recursos logísticos de los sistemas de salud. No serán pocos los pacientes sospechosos o confirmados de esta enfermedad que necesitarán tratamiento quirúrgico impostergable. El objetivo del estudio es exponer un conjunto de medidas para garantizar la mejor atención de estos pacientes, reducir la posibilidad de contagio entre pacientes, del personal sanitario y el desarrollo de complicaciones postoperatorias. Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. La reorganización de los servicios quirúrgicos es necesaria para garantizar la mejor atención a los pacientes, salvaguardar al personal sanitario y utilizar adecuadamente los recursos del sistema de salud(AU)

ABSTRACT The current COVID-19 pandemic has affected the world population with alarming numbers of contaminated and fatalities, with a depletion of the logistical resources of health systems. There will be few suspected or confirmed patients of this disease who will need urgent surgical treatment. The objective of the study is to present a set of measures to guarantee the best care of these patients, reduce the possibility of contagion between patients, health personnel and the development of postoperative complications. A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. The reorganization of surgical services is necessary to guarantee the best care for patients, safeguard health personnel, and use the resources of the health system properly(AU)

Humans , Health Personnel/standards , Coronavirus Infections/diagnosis , Abdomen, Acute/surgery , Postoperative Complications/prevention & control , Review Literature as Topic , Databases, Bibliographic
Rev. bras. anestesiol ; 70(3): 215-219, May-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137185


Abstract Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

Resumo Introdução: Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão-ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática. Objetivo: Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares. Método: Foram incluídas no estudo 40 pacientes do sexo feminino ASA I-II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24ª hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS - do inglês Numeric Rating Scale). Resultados: A quantidade média de seroma na 24ª hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24ª hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001). Conclusões: O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.

Postoperative Complications/prevention & control , Breast Neoplasms/surgery , Seroma/prevention & control , Mastectomy , Nerve Block/methods , Spinal Nerves , Double-Blind Method , Prospective Studies , Lymph Node Excision , Middle Aged
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 4-10, mar. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1100756


Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)

A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Laryngeal Neoplasms/surgery , Neoplasm Recurrence, Local/prevention & control , Postoperative Complications/prevention & control , Surgical Procedures, Operative/methods , Vocal Cords/pathology , Voice Quality , Tracheostomy/statistics & numerical data , Laryngeal Neoplasms/classification , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/physiopathology , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/radiotherapy , Prospective Studies , Epiglottis/pathology , Duration of Therapy , Intubation, Gastrointestinal/statistics & numerical data
Rev. cir. (Impr.) ; 72(1): 30-35, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092887


Resumen Introducción Los Programas de Recuperación Mejorada (PRM) en cirugía colorrectal disminuyen las complicaciones y acortan la estadía hospitalaria. La implementación de un PRM representa un desafío en nuestro sistema de salud público, dado la alta demanda y recursos limitados. Objetivo Evaluar el efecto en la estadía hospitalaria (EH) posterior a la implementación de un PRM en cirugía colorrectal electiva en un hospital público. Materiales y Método Estudio retrospectivo, que incluyó pacientes entre 15 y 85 años operados electivamente de resecciones colorrectales en un hospital público entre 1 de enero de 2015 y 31 de diciembre de 2016. Se compararon dos grupos: 1) total de pacientes operados electivamente 1 año posterior a la implementación del PRM (post-PRM) y 2) total de pacientes operados electivamente un año previo a la implementación de PRM (pre-PRM), en términos de EH, reingresos, complicaciones y mortalidad a 30 días. Se realizó análisis de tiempo a evento para comparar la EH entre ambos grupos. Resultados Un total de 144 pacientes fueron incluidos: 92 en el grupo post-PRM y 52 en el grupo pre-PRM. No hubo diferencias clínicas entre ambos grupos. La mediana de EH en el grupo post-PRM fue 2 días menor que en el grupo control (5 vs 7 días, test de log-rank, p = 0,03). No hubo diferencia en complicaciones, reingresos ni mortalidad. Conclusión La implementación de un PRM en cirugía colorrectal electiva en un hospital público se asocia a una disminución de la EH sin aumento de morbimortalidad.

Background Enhanced Recovery Programs (ERP) in colorectal surgery has proved to decrease complications and shorten hospital stay. The implementation of an ERP could be a difficult task in a high-demanding public health system with limited resources. Aim Evaluate the effect on length of stay (LOS) after the implantation of an ERP for colorectal surgery in a resource-limited public hospital. Materials and Method This retrospective study included patients aged 15-85 years who underwent elective colorectal surgery at a resource-limited public hospital in Chile between January 1, 2015 and December 31, 2016. We compared two groups: (1) total number of patients operated electively after 1-year of ERP implementation (post-ERP group) and (2) total number of patients electively operated 1-year previous ERP (pre-ERP group) in terms of LOS, readmissions, complications, and 30-day mortality. A time to event analysis was performed to evaluate differences in LOS. Results A total of 144 patients were included in this study: 92 in the post-ERP group and 52 in the pre-ERP group. There were no clinical differences between groups. The median LOS in the post-ERP group was 2 days lower than that in the control group (5 vs 7 days, log-rank test p = 0.03). There were no differences in complications, readmissions, and 30-day mortality. Conclusions The implementation of an ERP for colorectal surgery in a resource-limited hospital was associated with decreased LOS without increasing morbidity.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Program Evaluation , Colonoscopy/rehabilitation , Length of Stay , Postoperative Complications/prevention & control , Colorectal Neoplasms/surgery , Colonoscopy/methods , Perioperative Care/methods , Recovery of Function
ABCD arq. bras. cir. dig ; 33(3): e1544, 2020. tab
Article in English | LILACS | ID: biblio-1152624


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.

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
Article in Chinese | WPRIM | ID: wpr-879922


OBJECTIVE@#To summarize the experience of perioperative prevention during double-lung transplantation for elderly patients with coronavirus disease 2019 (COVID-19).@*METHODS@#Clinical data of 2 elderly patients with COVID-19 who underwent double-lung transplantation in the First Affiliated Hospital of Zhejiang University School of Medicine in March 2020 were retrospectively reviewed. Perioperative protective measures were introduced in terms of medical staffing, respiratory tract, pressure injuries, air in operating room, instruments and equipment, pathological specimens, and information management.@*RESULTS@#Two cases of double-lung transplantation were successfully completed, and the patients had no operation-related complications. Extracorporeal membrane oxygenator was successfully removed 2 to 4 days after surgery and the patients recovered well. There was no infection among medical staff.@*CONCLUSIONS@#Adequate preoperative preparation, complete patient transfer procedures, proper placement of instruments and equipment, strengthening of intraoperative care management, and attention to prevention of pressure injury complications can maximize the safety of COVID-19 patients and medical staff.

Aged , Betacoronavirus , COVID-19 , Coronavirus Infections , Humans , Lung Transplantation/standards , Pandemics , Perioperative Care/standards , Pneumonia, Viral , Postoperative Complications/prevention & control , Retrospective Studies , SARS-CoV-2 , Transplant Recipients
Cuenca; s.n; Universidad de Cuenca; 2020. 41 p. ilus; tab. CD-ROM.
Thesis in Spanish | LILACS | ID: biblio-1102646


Abstract: Background: hernia is one of the most frequent pathologies in General Surgery, a common reason for surgical consultation, the resolution of this pathology currently has extensive debates about the surgical approach related to open or laparoscopic hernioplasty, with advantages and disadvantages exposed to each. Objective: to determine the prevalence and factors associated with complications of inguinal posthernioplasty at the Vicente Corral Moscoso and José Carrasco Arteaga Hospitals, 2018-2019.Material and methods: It's analytical, cross-sectional study. 240 clinical records that met the inclusion criteria were reviewed. Data were collected using a form and were tabulated in the SPSS version 15 program. The qualitative variables were analyzed with frequency and percentage and the quantitative variables with arithmetic mean and standard deviation, the associated factors were analyzed with Odds Ratio, 95% CI, Chi square and binary logistic regression (p <0.05).Results: 240 patients who had the inclusion criteria were analyzed, the majority were men (81.7%), the mean age was 53.4 years SD ± 16.57. The prevalence of postoperative complications was 27.5%, with those occurring within the first 24 hours being more frequent with 15.8%. Among the factors associated with statistical significance were: male sex (OR 4.6; 95% CI 1.5-13.5; p <0.00) and surgical technique (OR 3.4; 95% CI 1.2-9; p <0.01).Conclusions: prevalence of postoperative complications was similar to the literature consulted and was associated with factors such as: male sex and surgical technique.

Humans , Female , Middle Aged , Herniorrhaphy/instrumentation , Hernia, Inguinal/diagnosis , Postoperative Complications/prevention & control , Contraindications, Procedure
Rev Rene (Online) ; 21: 43167, 2020. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1087328


Objetivo: identificar a realização de atividades congruentes com os padrões de qualidade dos cuidados de enfermagem por enfermeiros especialistas em enfermagem médico-cirúrgica, no contexto hospitalar. Métodos: estudo descritivo, concretizado em 36 hospitais, no qual participaram 259 enfermeiros especialistas em enfermagem médico-cirúrgica. Para coleta de dados, usou-se de questionário, posteriormente analisado por meio de estatística descritiva. Resultados: os enfermeiros participantes avaliaram com melhores escores as atividades relativas às dimensões responsabilidade e rigor, satisfação do cliente e prevenção de complicações; e com menores escores, as atividades integradas nas dimensões promoção da saúde, readaptação funcional e bem-estar e autocuidado. Conclusão: embora os achados evidenciem atuação dos enfermeiros especialistas na área de enfermagem médico-cirúrgica que tende a ser coerente com os padrões de qualidade, sinalizaram-se lacunas no exercício profissional e potencialidades que podem subsidiar o processo de qualificação desses profissionais, alertar os gestores e qualificar a assistência de enfermagem. (

Objective: to identify the performance of activities con-gruent with the quality standards of nursing care by expert nurses in medical-surgical nursing, in the hospital context. Methods: a descriptive study, carried out in 36 hospitals, in which 259 nurses specialized in medical-surgical nursing participated. For data collection, a questionnaire was used, later analyzed using descriptive statistics. Results: the par-ticipating nurses evaluated activities related to the dimen-sions of responsibility and rigor, customer satisfaction and prevention of complications with better scores; and with lo-wer scores, activities integrated in the dimensions of health promotion, functional readaptation and well-being and self--care. Conclusion: although the findings show the perfor-mance of expert nurses in the medical-surgical nursing area that tends to be consistent with quality standards, gaps in professional practice and potentialities that can support the qualification process of these professionals were signaled, alert managers and qualify nursing care

Humans , Male , Female , Adult , Middle Aged , Quality Assurance, Health Care , Medical-Surgical Nursing , Hospitals , Nursing Care , Portugal , Postoperative Complications/prevention & control , Self Care , Patient Satisfaction , Health Promotion , Intraoperative Complications/prevention & control
Rev. méd. Minas Gerais ; 30: e-3012, 2020.
Article in Portuguese | LILACS | ID: biblio-1118030


Introdução: A prática do jejum pré-operatório se consolidou no século XX e prosseguiu praticamente inalterada até os anos 80, onde passou a ser reestruturada. Diante disso, o presente artigo tem o intuito de realizar uma revisão sobre o jejum pré operatório orientado na literatura comparando-o com o que é encontrado dentro da realidade brasileira. Metodologia: Trata-se de um estudo de revisão da literatura, de natureza exploratória, realizada por meio de pesquisa de artigos científicos, dissertações e teses disponíveis nas bases de dados online. Resultados: a American Society of Anesthesiologists desenvolveu a Task "Force on Preoperative Fasting" que estabelece para líquidos claros um jejum mínimo de 2 horas e para dieta leve de 6 horas. No Brasil, um estudo com 3.175 pacientes revelou que 46% deles jejuaram por um período superior a 12 horas. Discussão: Além de não aumentar a possibilidade de danos, observa-se que a redução do tempo de jejum pré-operatório está associada a benefícios no processo de recuperação do paciente. Dentre as causas para o jejum prolongado nas instituições de saúde do Brasil estão o atraso nas operações, a transferência de horário e de período ou o seu adiamento para o próximo dia. Conclusão: o aprimoramento do jejum pré-operatório é necessário, tendo como estratégia a melhor comunicação entre equipes médicas e de enfermagem e o paciente atendido nas instituições hospitalares. (AU)

Background: The practice of preoperative fasting was consolidated in the twentieth century and remained unchanged until the 1980s, when it was questioned. Therefore, the present article aims to review the preoperative fasting oriented in the literature comparing it with what is found in Brazilian reality. Methods: This is an exploratory literature review study, conducted through research of scientific articles, dissertations and theses available in online databases. Results: The American Society of Anesthesiologists has developed the Task Force on Preoperative Fasting, which establishes for clear liquids a minimum fasting of 2 hours and 6 hours for a light diet. In Brazil, a study with 3,175 patients revealed that 46% of them fasted for more than 12 hours. Discussion: In addition to not increasing the possibility of damage, it is observed that the reduction of preoperative fasting time is associated with benefits in patient's recovery process. Causes of prolonged fasting in Brazilian health institutions include delayed operations, changes on time and period, or postponement to the next day. Conclusions: the improvement of preoperative fasting is necessary, having as strategy a better communication between medical and nursing teams and the patients treated at hospitals. (AU)

Humans , Fasting , Preoperative Period , Physician-Patient Relations , Postoperative Complications/prevention & control , Time Factors , Intraoperative Complications/prevention & control , Nurse-Patient Relations