Factores asociados a mortalidad postoperatoria del adulto mayor sometido a cirugía abdominal en el Centro Médico Naval durante el periodo 2009-2011 / Factors associated with post-operative mortality in the elderly patients undergoing abdominal surgery at the Medical Center Naval from January 2009 to December 2011

RESUMEN

Objetivo: Determinar cuáles son los factores asociados a la mortalidad postoperatoria en los pacientes adultos mayores sometidos a cirugía abdominal en el Centro Médico Naval durante el periodo de Enero del 2009 a Diciembre 2011. Material y métodos: Es un estudio observacional, analítico, retrospectivo de casos controles, se incluyo a todos los pacientes mayores de 65 años operados durante el periodo 2009-2011 y cuyas historias clínicas estén completas, de las cuales se obtendrán las variables en estudio, a través de una ficha de recolección de datos. Se analizarán variables preoperatorias, intraoperatorias y postoperatorias. Se analizarán los factores de riesgo de morbimortalidad en los pacientes intervenidos de emergencia y en los intervenidos electivamente. Se realizará un análisis multivariable correlacionando las diferentes variables mediante la prueba de la X2 Pearson con un intervalo de confianza del 95 por ciento. Resultados: Durante el periodo que abarca el estudio fueron intervenidos 385 pacientes ancianos con ingreso hospitalario 122 de emergencia y 263 de forma electiva. Durante el ingreso hospitalario murió un total de 28 pacientes; 1 intraoperatoriamente y 27 tras la intervención quirúrgica. Variables preoperatorias Existe asociación entre el número de patologías y la reducción de la sobrevida (p<0.0001); la edad mayor a 75 años demostró tener una mayor mortalidad estadísticamente significativa (p=0.004 y Ji2=8.145); Se encontró que existe asociación entre un mayor grado de ASA y una menor sobrevida, la cual fue estadísticamente significativa (p<0.0001 y Ji2=60.717); la mayor mortalidad se encontró en pacientes con patología de intestino Delgado y colon, con sobrevidas menores al 77.1 por ciento, esto fue estadísticamente significativo. (p<0.0001 y Ji2=23.212). Variables intraoperatorias La cirugía de emergencia es un factor de riesgo independiente de mortalidad (22.13 por ciento de mortalidad en relación con el...

ABSTRACT

Objective: To determine the factors associated with post-operative mortality in the elderly patients undergoing abdominal surgery in the Medical Center Naval from January 2009 to December 2011. Materials and methods: it was an observational, analytical, retrospective case-control study encompassing all patients over 65 years who underwent surgeries during the 2009-2011 periods, whose medical records were complete and from which the variables under study were obtained through data-collecting cards. Pre-operative, operative and post-operative variables were analyzed. There was an assessment of the risk factors for mortality and morbidity in the patients undergoing emergency surgery and those operated electively. A multi-variable analysis correlating the different variables using the X2 Pearson test with a confidence interval of 95 per cent was also carried out. During the period of the study, 385 patients with hospital admission were operated 122 for emergency and 263 for elective surgery. During the admission to hospital, 28 patients died; one during surgery, and the other 27 after surgery. Pre-operative Variables There is association between the number of pathologies and the decrease in survival (p<0.0001); an age greater than 75 years demonstrated a statistically significant higher mortality (p=0.004 and Ji2=8.145); an association was found to be between a higher grade of ASA and a lower survival, which was statistically significant (p<0.0001 and Ji2=60.717); the highest mortality was found in patients with esophagus, stomach, small intestine and colon pathologies, with survival rates lower than 77.1 per cent, being this statistically significant (p<0.0001 and Ji2=23.212). Operative Variables Emergency surgery is an independent risk factor for mortality (22.13 per cent of mortality compared to the 0, 38 per cent for elective surgery). The type of injury showed to be associated with a lower survival rate, which was statistically significant...