Clinical and surgical dilemmas in octogenarian patients with small bowel obstruction / Dilemas clínicos e cirúrgicos em pacientes octogenários com obstrução do intestino delgado

ABSTRACT BACKGROUND: Small bowel obstruction (SBO) is a major problem in emergencies. Comorbidities increase morbimortality, which is reflected in higher costs. There is a lack of Latin American evidence comparing the differences in postoperative results and costs associated with SBO management. AIMS: To compare the risk of surgical morbimortality and costs of SBO surgery treatment in patients older and younger than 80 years. METHODS: Retrospective analysis of patients diagnosed with SBO at the University of Chile Clinic Hospital from January 2014 to December 2017. Patients with any medical treatment were excluded. Parametric statistics were used (a 5% error was considered statistically significant, with a 95% confidence interval). RESULTS: A total of 218 patients were included, of which 18.8% aged 80 years and older. There were no differences in comorbidities between octogenarians and non-octogenarians. The most frequent etiologies were adhesions, hernias, and tumors. In octogenarian patients, there were significantly more complications (46.3 vs. 24.3%, p=0.007, p<0.050). There were no statistically significant differences in terms of surgical complications: 9.6% in <80 years and 14.6% in octogenarians (p=0.390, p>0.050). In medical complications, a statistically significant difference was evidenced with 22.5% in <80 years vs 39.0% in octogenarians (p=0.040, p<0.050). There were 20 reoperated patients: 30% octogenarians and 70% non-octogenarians without statistically significant differences (p=0.220, p>0.050). Regarding hospital stay, the average was significantly higher in octogenarians (17.4 vs. 11.0 days; p=0.005, p<0.050), and so were the costs, being USD 9,555 vs. USD 4,214 (p=0.013, p<0.050). CONCLUSIONS: Patients aged 80 years and older with surgical SBO treatment have a higher risk of medical complications, length of hospital stay, and associated costs compared to those younger.

RESUMO RACIONAL: A obstrução do intestino delgado (OID) é um grande problema em emergências. As comorbidades aumentam a morbimortalidade, o que se reflete no aumento dos custos. Há uma falta de evidência latino-americana comparando as diferenças nos resultados pós-operatórios e custos associados ao manejo da OID. OBJETIVOS: Comparar o risco de morbimortalidade cirúrgica e os custos de tratamento cirúrgico da OID em pacientes com idade inferior e superior a 80 anos. MÉTODOS: Análise retrospectiva de pacientes diagnosticados com OID no Hospital Clínico da Universidade do Chile entre janeiro de 2014 e dezembro de 2017. Pacientes com qualquer tratamento médico foram excluídos. Estatísticas paramétricas foram usadas: erro de 5% foi considerado estatisticamente significante, com intervalo de confiança de 95%. RESULTADOS: Um total de 218 pacientes foram incluídos, dos quais 18,8% tinham 80 anos ou mais. Não houve diferenças nas comorbidades entre octogenários e não octogenários. As etiologias mais frequentes foram aderências, hérnias e tumores. Nos pacientes octogenários houve significativamente mais complicações (46,3 vs. 24,3%, p=0,007, p<0,050). Não houve diferenças estatisticamente significativas quanto às complicações cirúrgicas: 9,6% em <80 anos e 14,6% em octogenários (p=0,390, p>0,050). Nas complicações médicas foi evidenciada diferença estatisticamente significativa com 22,5% em <80 anos vs. 39.0% em octogenários (p=0,040, p<0,050). Foram reoperados 20 pacientes: 30% octogenários e 70% não octogenários, sem diferenças estatisticamente significativas (p=0,220, p>0,050). Em relação ao tempo de internação, a média foi significativamente maior nos octogenários (17,4 v/s 11,0 dias; p=0,005, p<0,050). Da mesma forma, também foram os custos com 9.555 USD vs. 4.214 USD (p=0,013, p<0,050). CONCLUSÕES: Pacientes com 80 anos ou mais com tratamento cirúrgico de OID têm maior risco de complicações médicas, tempo de internação e custos associados em comparação aos mais jovens.

Manejo exitoso de síndrome de vejiga hiperactiva refractaria con toxina botulínica A / Successful management of refractory overactive bladder syndrome with botulinum toxin A

Introducción: El síndrome de vejiga hiperactiva (VHA) afecta hasta al 43% de las mujeres. La terapia escalonada incluye cambios de hábitos, fármacos y neuromodulación. Hasta el 40% de las pacientes llegan a requerir terapia avanzada alternativa, como toxina botulínica (TB). Objetivo: Reportar los resultados del tratamiento con toxina botulínica en mujeres con VHA refractaria a tratamiento de primera y segunda línea, en un hospital público en Chile. Método: Estudio de cohorte retrospectivo desde una base de datos recolectada prospectivamente del Hospital Sótero del Río entre 2018 y 2022. Se incluyeron 33 pacientes con tratamiento farmacológico y neuromodulación previa, con una edad promedio de 57 años, sometidas a inyección cistoscópica de TB a detrusor, analizando datos demográficos, antecedentes y complicaciones. Se realizó seguimiento con frecuencia miccional, paños/día, escala de gravedad de Sandvik (ISI) y encuesta Patient Global Impression Improvement (PGI-I). Resultados: Los datos comparativos pre/post TB, respectivamente, fueron: frecuencia miccional diurna 11/6 y nocturna 5/1; paños/día 5/3; ISI 8/3. Veinte de 33 mujeres refirieron estar excelente o mucho mejor (PGI-I). Conclusiones: Es posible realizar manejo con TB en mujeres con VHA refractaria a primera y segunda línea, con buenos resultados e impacto significativo en la calidad de vida.

Introduction: Overactive bladder syndrome (OABS) affects up to 43% of women. Staggered therapy includes habit changes, drugs, and peripheral neuromodulation. Up to 40% of patients may require advanced alternative therapy such as botulinum toxin A (BT). Objective: To report the results of treatment with TB in women with OABS refractory to first- and second-line treatment in a public hospital in Chile. Method: Retrospective cohort study from prospectively collected database from Hospital Sótero del Río between 2018 and 2022. Thirty-three patients with previous pharmacological treatment and neuromodulation were included, with an average age of 57 years, undergoing cystoscopic injection of TB to detrusor. Demographic data, history, and complications were analyzed. Follow-up was performed with voiding frequency, cloths/day, Sandvik Severity Scale (ISI) and Patient Global Impression Improvement (PGI-I) survey. Results: Comparative data pre/post TB, respectively showed: daytime voiding frequency 11/6 and nighttime 5/1; cloths/day 5/3; ISI 8/3. 20 of 33 women reported being excellent or much better (PGI-I). Conclusions: TB management in women with OABS refractory to first- and second-line treatment has good results and significant impact on quality of life.