ABSTRACT
BACKGROUND: New therapies have revolutionized the treatment of Crohn's disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6-6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0-1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2-1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
Subject(s)
Crohn Disease , Humans , Crohn Disease/surgery , Crohn Disease/diagnosis , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Retrospective Studies , Risk Factors , HospitalsABSTRACT
ABSTRACT BACKGROUND New therapies have revolutionized the treatment of Crohn's disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6-6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0-1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2-1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
RESUMO RACIONAL Novas terapias revolucionaram o tratamento da Doença de Crohn, mas em alguns países a taxa de cirurgias não se modificou, a frequência de cirurgias de emergência é subestimada e o risco cirúrgico é pouco estudado. OBJETIVOS Analisar fatores de risco e as indicações para cirurgia primária em pacientes com doença de Crohn, em Hospital terciário. MÉTODOS: Análise de banco de dados coletado prospectivamente, de 107 pacientes com doença de Crohn de 2015 a 2021. Os principais desfechos foram a incidência de tratamento cirúrgico, tipos de procedimentos realizados, recidiva cirúrgica, tempo livre de cirurgia e fatores de risco. RESULTADOS: A intervenção cirúrgica foi realizada em 54.2% dos pacientes, sendo a maioria dos procedimentos cirúrgicos de urgência (68.9%). Os procedimentos eletivos (31.1%) foram realizados mais de 11 anos após o diagnóstico. As principais indicações cirúrgicas foram estenose ileal (34,5%) e fístula anorretal (20,7%), sendo o procedimento mais frequente a enterectomia (24,1%). As cirurgias para recidiva foram mais comuns em procedimentos de urgência (OR 2,1; IC95% 1,6-6,6). O fenótipo de comportamento estenosante Montreal L1 (RR = 1,3; IC 95%: 1,0-1,8, p=0,04) e a doença perianal (RR 1,43; IC95% 1,2-1,7) aumentaram o risco de cirurgias de emergência. A regressão linear múltipla mostrou a idade ao diagnóstico como fator de risco para cirurgia (p=0,004). O estudo do tempo livre de cirurgia não mostrou diferença na curva de Kaplan Meier para a classificação Montreal (p=0,73). CONCLUSÕES: Os principais fatores de risco para intervenções cirúrgicas foram estenoses em doenças ileais e jejunais, idade ao diagnóstico, doença perianal e indicações de urgência.
ABSTRACT
Úlcera do pé diabético é uma das complicações de diabetes mellitus que ocorre por causas multifatoriais. A abordagem multidisciplinar e multiprofissional do paciente com pé diabético é recomendada, uma vez que a afecção possui alta prevalência e que as ações de prevenção e controle das lesões são potencialmente eficazes. Há um crescente interesse da comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser amplo. Desse modo, o objetivo da presente pesquisa foi avaliar a influência da ozonioterapia em pacientes com feridas do pé diabético. Metodologia: Tratou-se de revisão narrativa de literatura acerca da terapia com ozônio para tratamento de ferida do pé diabético. Foram utilizados os termos "ozônio", "ozônioterapia", "ozonização", "pé diabético", úlcera do pé diabético", bem como suas traduções para o inglês "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer". Foram consultadas as bases acadêmicas PubMed, Scielo, Lilacs e EBSCOhost. Resultados/Discussão: Muitas vezes o tratamento convencional para feridas é ineficiente devido à multiplicação de bactérias resistentes. Para feridas infectadas, primeiramente pode-se empregar o ozônio como desinfetante, pois o gás é tanto bactericida como fungicida, e para se obter uma ferida livre de patógenos; posteriormente, pode-se aplicar doses baixas da mistura gasosa oxigênio-ozônio para acelerar a cicatrização da lesão. Dentre as formas de tratamento com ozônio estão a utilização de óleo ozonizado sobre a ferida e a aplicação local de uma mistura de gases ozônio e oxigênio diretamente sobre a úlcera. Além disso, o ozônio funciona bem quando insuflado em microambiente controlado (saco plástico). a ozonização, quando comparada ao uso de antibióticos convencionais, pode reduzir o tamanho das lesões e abreviar o tempo de internação dos pacientes a curto prazo, mas aparentemente não promove a cura total da úlcera nem reduz o número de complicações. Conclusão: Há um crescente interesse pela comunidade científica e boa aceitação do tratamento com ozônio pelas revistas acadêmicas, apesar de o número de pesquisas acerca do assunto não ser grande. Diversos trabalhos demonstraram resultados positivos da utilização de ozônio como adjuvante da terapia convencional para úlceras do pé diabético, e concluíram que a ozonioterapia é uma ferramenta terapêutica complementar ao tratamento convencional. Apesar disso, ainda há muito a aprofundar acerca do tema e mais pesquisas devem ser conduzidas para validar a ozonioterapia na prática clínica.
Diabetic foot ulcer is one of the complications of diabetes mellitus that occurs due to multifactorial causes. The multidisciplinary and multidisciplinary approach of patients with diabetic feet is recommended, since the condition has a high prevalence and the actions for the prevention and control of injuries are potentially effective. There is growing interest from the scientific community and Good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Thus, the objective of the present research was to evaluate the influence of ozone therapy in patients with diabetic foot wounds. Methodology: It was a narrative literature review about ozone therapy for the treatment of diabetic foot wounds. The terms "ozone", "ozone therapy", "ozonization", "diabetic foot", diabetic foot ulcer were used, as well as their English translations "ozone", "ozonetherapy", "diabetic foot", "diabetic foot ulcer ". The academic bases PubMed, Scielo, Lilacs and EBSCOhost were consulted. Results / Discussion: The conventional treatment for wounds is often inefficient due to the multiplication of resistant bacteria. For infected wounds, ozone can first be used as a disinfectant, as the gas is both bactericidal and fungicidal, and to obtain a pathogen-free wound; subsequently, low doses of the oxygen-ozone gas mixture can be applied to accelerate the healing of the lesion. Among the forms of treatment with ozone are the use of ozonized oil on the wound and the local application of a mixture of ozone and oxygen gases directly on the ulcer. In addition, ozone works well when inflated in a controlled microenvironment (plastic bag). ozonation, when compared to the use of conventional antibiotics, can reduce the size of the lesions and shorten the patients' hospitalization time in the short term, but apparently does not promote a complete healing of the ulcer or reduce the number of complications. Conclusion: There is a growing interest in the scientific community and good acceptance of ozone treatment by academic journals, although the number of studies on the subject is not large. Several studies have shown positive results from the use of ozone as an adjunct to conventional therapy for diabetic foot ulcers, and concluded that ozone therapy is a therapeutic tool complementary to conventional treatment. Despite this, there is still much to be done about the topic and more research must be conducted to validate ozone therapy in clinical practice.
