RESUMO
A pesar del desarrollo alcanzado en la era endoscópica, existen escépticos a la práctica de reintervenciones por cirugía de mínimo acceso (CMA). Con el objetivo de evaluar el resultado de la cirugía de mínimo acceso en las reintervenciones, se realizó un estudio comparativo, prospectivo, cuasi-experimental, en pacientes reintervenidos por cirugía convencional(N=64) y cirugía de mínimo acceso(N=32), atendidos en el Hospital Provincial Clínico Quirúrgico Docente Celia Sánchez Manduley de Manzanillo, Cuba entre el 2013 y 2017. El tiempo de evolución para ambas series fue similar, con un 60 por ciento de pacientes en los primeros tres días. El coleperitoneo (28,1 por ciento) y el hemotórax (28,1 por ciento) fueron las afecciones más representadas en los casos endoscópicos, realizándose aspiración y lavado. El 66,7 por ciento de los casos reintervenidos por CMA fueron tratados inicialmente por cirugía abierta, hubo una evolución favorable en el 94,4 por ciento. La media del tiempo quirúrgico fue inferior en la serie endoscópica (70,8 min), (Cirugía convencional 89,8 min), fueron convertidos 2 pacientes para un RR 3,54. La media aritmética de la estadía hospitalaria en la serie endoscópica fue 4,9 días, y 10,1 en la serie convencional. En la serie endoscópica se inició la alimentación de manera precoz (5,1 horas), y la reincorporación laboral se produjo a los 17,6 días. La cirugía de mínimo acceso permitió reintervenir con seguridad a pacientes de todas las edades, aplicando las mismas técnicas quirúrgicas, con un tiempo quirúrgico ligeramente inferior a la cirugía convencional, se redujeron los gastos hospitalarios por concepto de estadía y la incorporación precoz a las actividades sociales y productivas(AU)
Despite the development reached in the endoscopic era, there are skeptics to the practice of reoperations due to minimal access surgery (MAS). In order to evaluate the outcome of the minimally invasive surgery in the reinterventions, a comparative, prospective, quasi-experimental study was performed in patients reoperated by conventional surgery (N = 64) and minimal access surgery (N = 32), attended at the Provincial Teaching Surgical Clinical Hospital Celia Sánchez Manduley of Manzanillo, Cuba between 2013 and 2017. The evolution time for both series was similar, with 60 percent of patients in the first three days. The coleperitoneum (28.1 percent) and the hemothorax (28.1 percent) were the most represented conditions in the endoscopic cases, with aspiration and lavage being performed. 66.7 percent of the cases reoperated by MAS were initially treated by open surgery, a favorable evolution in 94.4 percent. The average surgical time was lower in the endoscopic series (70.8 min), (conventional surgery 89.8 min), 2 patients were converted to RR 3.54. The arithmetic mean of the hospital stay in the endoscopic series was 4.9 days, and 10.1 in the conventional series. In the endoscopic series, feeding was started early (5.1 hours), and labor reincorporation occurred at 17.6 days. The minimal access surgery allowed patients of all ages to safely undergo surgery, applying the same surgical techniques, with a surgical time slightly inferior to conventional surgery, hospital expenses were reduced due to the stay and early incorporation into social activities and productive(EU)
Assuntos
Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Laparoscopia/métodos , Estudos Prospectivos , Ensaios Clínicos Controlados não Aleatórios como AssuntoRESUMO
RESUMEN A pesar del desarrollo alcanzado en la era endoscópica, existen escépticos a la práctica de reintervenciones por cirugía de mínimo acceso (CMA). Con el objetivo de evaluar el resultado de la cirugía de mínimo acceso en las reintervenciones, se realizó un estudio comparativo, prospectivo, cuasi-experimental, en pacientes reintervenidos por cirugía convencional (N=64) y cirugía de mínimo acceso (N=32), atendidos en el Hospital Provincial Clínico Quirúrgico Docente "Celia Sánchez Manduley" de Manzanillo, Cuba entre el 2013 y 2017. El tiempo de evolución para ambas series fue similar, con un 60% de pacientes en los primeros tres días. El coleperitoneo (28,1%) y el hemotórax (28,1%) fueron las afecciones más representadas en los casos endoscópicos, realizándose aspiración y lavado. El 66,7% de los casos reintervenidos por CMA fueron tratados inicialmente por cirugía abierta, hubo una evolución favorable en el 94,4%. La media del tiempo quirúrgico fue inferior en la serie endoscópica (70,8 min), (Cirugía convencional 89,8 min), fueron convertidos 2 pacientes para un RR 3,54. La media aritmética de la estadía hospitalaria en la serie endoscópica fue 4,9 días, y 10,1 en la serie convencional. En la serie endoscópica se inició la alimentación de manera precoz (5,1 horas), y la reincorporación laboral se produjo a los 17,6 días. La cirugía de mínimo acceso permitió reintervenir con seguridad a pacientes de todas las edades, aplicando las mismas técnicas quirúrgicas, con un tiempo quirúrgico ligeramente inferior a la cirugía convencional, se redujeron los gastos hospitalarios por concepto de estadía y la incorporación precoz a las actividades sociales y productivas.
ABSTRACT Despite the development reached in the endoscopic era, there are skeptics to the practice of reoperations due to minimal access surgery (MAS). In order to evaluate the outcome of the minimally invasive surgery in the reinterventions, a comparative, prospective, quasi-experimental study was performed in patients reoperated by conventional surgery (N = 64) and minimal access surgery (N = 32). , attended at the Provincial Teaching Surgical Clinical Hospital "Celia Sánchez Manduley" of Manzanillo, Cuba between 2013 and 2017. The evolution time for both series was similar, with 60% of patients in the first three days. The coleperitoneum (28.1%) and the hemothorax (28.1%) were the most represented conditions in the endoscopic cases, with aspiration and lavage being performed. 66.7% of the cases reoperated by MAS were initially treated by open surgery. a favorable evolution in 94.4%. The average surgical time was lower in the endoscopic series (70.8 min), (conventional surgery 89.8 min), 2 patients were converted to RR 3.54. The arithmetic mean of the hospital stay in the endoscopic series was 4.9 days, and 10.1 in the conventional series. In the endoscopic series, feeding was started early (5.1 hours), and labor reincorporation occurred at 17.6 days. The minimal access surgery allowed patients of all ages to safely undergo surgery, applying the same surgical techniques, with a surgical time slightly inferior to conventional surgery, hospital expenses were reduced due to the stay and early incorporation into social activities and productive.
RESUMO Apesar do desenvolvimento foi alcançado em endoscópica há céticos reoperação prática para a cirurgia de acesso mínimo (CMA). A fim de avaliar o resultado de cirurgia de acesso mínimo em re-operações, uma comparativo, prospectivo, quaseexperimental foi realizada em pacientes reoperados por cirurgia convencional (N = 64) e a cirurgia minimamente invasiva (N = 32) ele participou no Hospital Provincial Clínica Ensino cirúrgico "Celia Sanchez" de Manzanillo, Cuba entre 2013 e 2017. a evolução no tempo para ambas as séries foi semelhante, com 60% dos pacientes nos primeiros três dias. O coleperitoneo (28,1%) e hemotórax (28,1%) eram condições mais representados nos casos endoscópicos, realizando aspiração e lavagem. 66,7% dos casos reoperados por CMA foram inicialmente tratadas por cirurgia aberta, houve uma tendência positiva em 94,4%. O tempo operatório médio era mais baixo na série endoscópica (70,8 min), (cirurgia convencional de 89,8 min), 2 pacientes foram convertidos para um RR 3,54. A média aritmética de permanência no hospital em série endoscópica foi de 4,9 dias e 10,1 na série convencional. Na alimentação série endoscópica precoce (5,1 horas) foi iniciado, e retorno ao trabalho ocorreu em 17,6 dias. A cirurgia de acesso mínimo permitido reoperação com segurança a pacientes de todas as idades, aplicando as mesmas técnicas cirúrgicas, com um tempo cirúrgico ligeiramente menor do que a cirurgia convencional, despesas hospitalares para estadia e incorporação precoce nas atividades sociais foram reduzidos e produtiva.
RESUMO
INTRODUCTION: Efficient patient transportation by ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) to a trauma center is vital for optimal care. We investigated differences between the modes of transport in terms of demographics, injury, scene location, and outcome. SETTING: Morristown Medical Center (MMC), Morristown, NJ METHODS: All 903 trauma admissions in 2016 by advanced life support (ALS) to MMC, a Level I Trauma Center, were retrospectively analyzed. RESULTS: 22% of admissions were HEMS and 78% were GEMS. HEMS patients had higher Injury Severity Scores (ISS) (p<0.001); however, mortality and length of stay were not statistically different. The percentage of pediatric patients transported by HEMS that were discharged home after emergency department evaluation was greater than the older populations (p<0.001). Older age and higher ISS had the largest impact on mortality (p<0.001). CONCLUSION: We believe our current use of HEMS is adequate since patient outcomes between HEMS and GEMS was similar, even though HEMS patients have higher ISS. However, helicopter use in the pediatric population was over-utilized, possibly due to the scarcity of hospitals capable of managing pediatric traumas. Implementation of the Air Medical Prehospital Triage scoring system may also help correct for these unnecessary HEMS transports.