RESUMO
Resumen Antecedentes: Existe consenso en que la cesárea ha sido fundamental en la disminución de la morbimortalidad materno-infantil, sin embargo, desde 1985 expertos consultados por la Organización Mundial de la Salud (OMS), concluyeron que la tasa ideal de cesáreas debe oscilar entre el 10 y el 15%. La proporción real actual supera ampliamente lo recomendado. El último informe de la Organización para la Cooperación y el Desarrollo Económicos (OCDE), publicado en enero de 2019, señala a Chile en el tercer lugar con mayor porcentaje de cesáreas. Este dato es preocupante, ya que el exceso de intervenciones quirúrgicas vs. parto normal se asocia a un aumento de la morbimortalidad materna y a un mayor riesgo para el recién nacido. Objetivo: Revisar los porcentajes de cesáreas en las muertes maternas, tanto en establecimientos públicos como privados de la región de Los Lagos, Chile, y detectar si existe una asociación entre cesáreas y mortalidad materna. Resultados: Se puede apreciar una relación entre las cesáreas y las muertes maternas.
Abstract Background: There is consensus that cesarean section has been essential in reducing maternal and child morbidity and mortality, however, since 1985 experts consulted by the World Health Organization (WHO), concluded that the ideal rate of cesarean sections should range between 10 and 15%. The current and real proportion exceeds what is recommended. The latest report from the Organization for Economic Cooperation and Development (OECD), published in January 2019, places Chile in third place with the highest percentage of cesarean sections. This data is worrying since the excess of surgical interventions vs. normal delivery is associated with increased maternal morbidity and mortality and increased risk to the newborn. Objective: To review the percentages of cesarean sections in maternal deaths, both in public and private establishments in the Los Lagos region, Chile, and to detect if there is an association between cesarean sections and maternal mortality. Results: A relationship between cesarean sections and maternal deaths, can be seen.
RESUMO
Objective:To investigate the effects on perceived quality of a management assessment system for orthopedic surgery in elderly patients.Methods:Based on the concept of lean management and process nodes in systems, an information management system was established to evaluate the perceived quality of surgical service for elderly orthopedic patients.Four hundred and two elderly orthopedic patients receiving orthopedic surgery after the implementation of the management system were included in the observation group, while 402 elderly patients undergoing orthopedic surgery before the implementation of management system formed the control group.Results:The incidence of hypothermia in patients admitted to the resuscitation room after surgery was lower in the observation group than in the control group(1.7% vs.4.5%, χ2=5.136、 P=0.023). The incidence of shivering during resuscitation was lower and the satisfaction rate of surgical services was higher in the observation group than in the control group(0.7% vs.3.2%) χ2=5.279、 P=0.022, 96.55(95.58, 97.28)分, vs.87.9(83.2, 89.95)分, Z=-4.16, P=0.00). Conclusions:A perceived quality assessment system composed of lean management and information technology for surgical services can reduce complications and improve satisfaction for patients receiving surgery.
RESUMO
El incremento de la cesárea, que constituye la operación obstétrica más comúnmente efectuada, ha sido motivo de preocupación en los últimos años. En esta revisión se ha perseguido identificar básicamente los problemas que genera este aumento, a fin de que pueda servir no solo como estrategia para el análisis y control de la ejecución de ese proceso en los servicios de obstetricia, sino como herramienta de trabajo para los gerentes de salud; pero en el artículo se ha tratado también lo concerniente al impacto de este tipo de cirugía en la morbilidad y mortalidad maternas, por lo cual se concluye que este es un proceder quirúrgico que debe reservarse para cuando exista una fundamentación científica confirmada para su realización, con vistas a garantizar el resultado exitoso en el binomio madre-hijo.
The increase of cesarean section, that constitutes the most commonly obstetric operation carried out, has been reason of concern in the last years. The aim in this review has been to identify basically the problems generated by this increase, so that it can serve not only as strategy for the analysis and control of that process in the surgical services, but also as work tool for the health managers; the work has also dealt with impact of this surgery type in the maternal morbidity and mortality, reason why it is concluded that this is a surgical procedure that should be reserved in case of a confirmed scientific reason for its realization, for guaranteeing the successful result in the binomial mother-son.