Appendectomy: prognostic factors in the brazilian unified health system

SUMMARY INTRODUCTION: Acute appendicitis (AA) is the most common cause of surgical acute abdomen. Postoperative complications in emergency care are reflections of the surgical procedure and pre- and postoperative factors. OBJECTIVE: Define prognostic factors for patients who underwent appendectomy, comparing them with the literature. METHODS: Descriptive observational study with a cross-sectional design based on data from the emergency/urgency appendectomy records between September 2018 and April 2019. Variables of interest were considered based on intrinsic patient data, clinical status, and perioperative management factors. Primary outcomes considered: postoperative complications from hospital admission discharge and prolonged hospital stay for > 2 days. Secondary outcome: death. The results were evaluated by Fisher's exact test (p <0.05). RESULTS: We identified 48 patients undergoing an appendectomy. Young adults accounted for 68.7%. From the total, 58.3% were males, 6 (12.5%) had hospitalization> 2 days, 4 (8.3%) had complications and no deaths. Among the variables, the stage of AA, the time of complaint up until seeking care, and advanced age were correlated with worse prognosis during hospitalization (p <0.05). The emergence of immediate postoperative complications was correlated with longer hospital stay (p <0.05). DISCUSSION: The descriptive data of the sample converge with the epidemiological profile of patients with AA in the literature, corroborating the applicability of conventional guidelines. The results strengthen the hypothesis that the patient's flow with abdominal manifestations is complicated from the first contact with SUS to the resolution of the condition. CONCLUSION: Knowledge of the epidemiological profile and perioperative predictors that are most related to complications favor the appropriate management of patients.

RESUMO INTRODUÇÃO: Apendicite aguda (AA) é causa mais comum de abdome agudo cirúrgico. Complicações pós-operatórias na emergência são reflexos do ato cirúrgico e fatores pré e pós-operatórios. OBJETIVO: Definir fatores prognósticos para paciente pós apendicectomia, comparando com a literatura. MÉTODOS: Estudo observacional descritivo e analítico com formação de base transversal de dados dos prontuários de apendicectomias de emergência/urgência entre setembro de 2018 e abril de 2019. Variáveis de interesse foram consideradas a partir dos dados intrínsecos ao paciente, quadro clínico e manejo perioperatório. Desfechos primários combinados considerados foram complicações pós-operatórias da internação até alta hospitalar e prolongamento da internação > dois dias. Desfecho secundário foi óbito. Resultados avaliados pelo teste exato de Fisher (p<0,05). RESULTADOS: Identificaram-se 48 pacientes submetidos à apendicectomia. Adultos jovens corresponderam a 68,7%. Do total, sexo masculino (58,3%), seis (12,5%) tiveram internação > dois dias, quatro (8,3%) cursaram com complicação e nenhum óbito. Dentre as variáveis consideradas, fase de apresentação da AA tempo de queixa até procura do atendimento e idade avançada correlacionaram com pior prognóstico durante internação (p<0,05). Surgimento de complicações pós-operatórias imediatas correlacionou-se com maior tempo de internação (p<0,05). DISCUSSÃO: Dados descritivos da amostra convergem com perfil epidemiológico de pacientes com AA na literatura, corroborando aplicabilidade das diretrizes convencionais. Resultados fortalecem a hipótese de que o fluxo do paciente com manifestações abdominais é complicado desde o primo-contato com o SUS até a resolução do quadro. CONCLUSÃO: Conhecimento do perfil epidemiológico e dos preditores perioperatórios que mais se relacionam com complicações favorecem manejo adequado dos pacientes.

Perineal Rectosigmoidectomy Associated with Low Colorectal Anastomosis for Complete Rectal Prolapse Correction – Altemeier’s Procedure

Introduction: Rectal prolapse constitutes in rectal protrusion through anal orifice. It’s more frequent in elderly women and the correction is exclusively surgical and fundamental, given the condition’s social relevance. We intend to describe a perineal rectosigmoidectomy (Altemeier) for correction of prolapse in multi-morbidity elder patient. Case Report: Female patient, 78 years old, evaluated by proctology ward of CHSBC. She Came in with complaint of anal region bulge for past 2 years. Proctological examination showed 15 cm rectal procidentia Rectal prolapse’s diagnosis came from colonoscopy. A perineal rectosigmoidectomy associated with colorectal anastomosis was done (Altemeier’s Procedure). There was appropriate postoperative evolution, discharge with good wound healing and ambulatorial follow up with good general healing.Discussion: Rectal prolapse is a result of anatomical alterations due to factors such as age and multiparity. Clinical presentation: abdominal discomfort, constipation, feces and gases release. Itleads to life quality loss, thus surgical interventions become essential. Corrective surgeries seek to give back fecal continence. Currently, procedures branch out into abdominal and perineal. Altemeier consists in complete rectal removal via perineum. It’s appropriate for high surgical risk elders, since it has the lowest complications rate

Perception of risk factors for cancer in the ABC population

SUMMARY OBJECTIVE To evaluate the knowledge about risk factors for cancer in patients treated at the ABC Medical School (FMABC). METHODS Cross-sectional observational study conducted in 2019. The American Cancer Institute's Cancer Risk Awareness Survey questionnaire was used with 29 cancer risk factors, 14 of which were proven to cause cancer and 15 without consensus or scientific evidence of causality with cancer but that are often reminded by most of the population. Qualitative variables were described by frequency and percentage, and quantitative variables by mean and standard deviation or median and range depending on normality, assessed by the Shapiro-Wilk test. The study was conducted in accordance with the Helsinki Declaration for Research and approved by the Research Ethics Committee. RESULTS 191 patients were included. Median age 54 (20 to 90), 64% female. 35.6% reported current or previous smoking. 3.1% consumed alcohol more than 5 drinks/week. 56% reported sedentary lifestyle. 44% had at least 1 case of cancer in relatives up to 2nd degree. The average of correct answers in the analyzed population was 12.83 ± 3.06. A weak positive correlation was observed between income and number of cases (rho = 0.177, p = 0.02). No relationship was observed between the number of correct answers and level of education, age, sex, marital status, race or patients with a positive family history for cancer. CONCLUSION The knowledge about risk factors for cancer in the ABC population is low, which may contribute to the adoption of risk behaviors for the disease.

RESUMO OBJETIVO Avaliar o conhecimento sobre fatores de risco para câncer em pacientes atendidos nos ambulatórios da Faculdade de Medicina do ABC (FMABC). MÉTODOS Estudo transversal e observacional conduzido em 2019. Foi utilizado o questionário Cancer Risk Awarness Survey do American Institute for Cancer Research com 29 fatores de risco para câncer, sendo 14 fatores comprovadamente causadores de câncer e 15 sem consenso ou evidência científica de causalidade com o câncer, mas que são frequentemente citados pela população. Variáveis qualitativas foram descritas por frequência e porcentagem, e variáveis quantitativas por média e desvio padrão ou mediana e intervalo a depender da normalidade, avaliada pelo teste de Shapiro-Wilk. Estudo realizado de acordo com a Declaração de Helsinque para pesquisa e aprovado pelo Comitê de Ética em Pesquisa. RESULTADOS Foram incluídos 191 pacientes. Mediana de idade 54 (20 a 90), 64% do sexo feminino; 35,6% reportaram tabagismo atual ou anterior; 3,1% consumiam mais que cinco doses de álcool por semana; 56% reportaram sedentarismo; 44% tinham pelo menos um caso de câncer em parentes de até segundo grau. A média de acertos na população analisada foi 12,83 ± 3,06. Foi observada correlação positiva fraca entre renda e número de acertos (rho=0,177, p=0,02). Não foram observadas relações entre o número de acertos e nível de escolaridade, idade, sexo, estado civil, cor ou pacientes com história familiar positiva para câncer. CONCLUSÃO O conhecimento sobre fatores de risco para câncer na população do ABC é baixo, o que pode contribuir para a adoção de comportamentos de risco para a doença.