Dehiscencia de la laparotomía y su impacto en la mortalidad, la estancia y los costes hospitalarios / Postoperative dehiscence of the abdominal wound and its impact on excess mortality, hospital stay and costs

RESUMEN

INTRODUCCIÓN: Los objetivos de este estudio fueron el análisis de los factores asociados a la incidencia de dehiscencia postoperatoria de la laparotomía y el impacto de esta última en la mortalidad, las estancias y los costes hospitalarios. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes intervenidos mediante laparotomía recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. RESULTADOS: Se estudiaron 323.894 ingresos por cirugía abdominal, entre los cuales hubo 2.294 pacientes con DPL. Los pacientes de mayor edad, varones, con ingreso urgente, con trastornos por alcohol, tabaco y drogas, y con más comorbilidades presentaron mayor incidencia. Además, aquellos con DPL presentaron un incremento de mortalidad (107,5%), una estancia mas prolongada (15,6 días) y un exceso de costes (14.327 euros). CONCLUSIONES: Hay una asociación entre ciertas variables demográficas, conductuales y comorbilidades, y la incidencia de DPL, y esta complicación aumenta la mortalidad, la duración de la estancia y su coste. Medidas preventivas podrían disminuir su incidencia y su impacto sanitario y económico

ABSTRACT

INTRODUCTION: The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. MATERIAL AND METHODS: Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. RESULTS: From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. CONCLUSIONS: The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered