RESUMO
INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5 percent. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45 percent. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, ...
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Circulação Extracorpórea/efeitos adversos , Mortalidade Hospitalar , Revascularização Miocárdica/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/efeitos adversos , Terapia Combinada , Complicações do Diabetes , Métodos Epidemiológicos , Endocardite/complicações , Revascularização Miocárdica/mortalidade , Cuidados Pós-Operatórios/classificação , Cuidados Pré-Operatórios/classificação , Choque Cardiogênico/complicaçõesRESUMO
Se abordan tópicos sobre las Infecciones postoperatorias, y su clasificación. Teniendo en cuenta su localización; Infección del Sitio Operatorio; el agente patógeno. Se analizan los factores que intervienen en la génesis de una infección; diagnóstico; profilaxis y tratamiento...(AU)
Topics are approached on the postoperative Infections, and their classification. Keeping in mind their localization; Infection of the Operative Place; the agent patógeno. The factors are analyzed that intervene in the genesis of an infection; diagnosis; prevention and treatment...(AU)
Assuntos
Humanos , Cuidados Pós-Operatórios/classificação , Infecção da Ferida Cirúrgica/diagnóstico , Controle de Infecções/métodos , Infecção da Ferida Cirúrgica/terapiaRESUMO
La corrección quirúrgica de la escoliosis idiopática es tema de controversia, en cuanto a su efectividad en el plano transverso. La deformidad no ocurre por rotación sino por desplazamiento ventrolateral de la columna. Pensamos que con un nuevo instrumento, siguiendo la técnica de Cotrel-Dubousset y con la experiencia del Dr. Luque, en México, se logrará la corrección en todos los planos. Los pacientes tratados tenían una escoliosis idiopática operaron 8, aquí mostramos la evaluación postoperatoria de 2, siete meses después de la cirugía, donde se logró la disminución de la escoliosis costal y la medialización de las vértebras en los planos sagital, coronal y transverso, se espera que la modificación será mayor además de la ausencia de complicaciones postquirúrgicas