Correlação entre os escores Surgical Risk Calculator e Safety Zone no pré-operatório de cirurgias não cardíacas

Contexto: A TEV é uma complicação comum em pacientes hospitalizados. Assim, a estratificação do risco tromboembólico é essencial para minimizar complicações e otimizar a condição pré-operatória do paciente antes de cirurgias eletivas. Objetivo:Investigar a correlação entre o escore ACS NSQIP Surgical Risk Calculator e o TEV Safety Zone na avaliação ambulatorial pré-operatória do risco tromboembólico em cirurgias não cardíacas.Métodos: Estudo observacional transversal retrospectivo com análise de prontuários eletrônicos de pacientes atendidos em um ambulatório multidisciplinar de medicina e enfermagem perioperatória no período compreendido entre Janeiro e Dezembro de 2017. Correlacionou-se o escore de risco tromboembólico TEV Safety Zone já aplicado no ambulatório com o risco de tromboembolismo venoso obtido pela calculadora de risco ACS NSQIP Surgical Risk Calculator. Resultados:Foi coletada uma amostra de 416 prontuários. Destes, 197 (47,6%) resultaram em risco equivalente entre os dois escores e 219 divergiram nos resultados. Obteve-se um p<0,001 através do teste de Wilcoxon.Conclusões: Houve correlação entre o ACS NSQIP Surgical Risk Calculator e o TEV Safety Zone (p<0,001).

Impact of multiple factors on the incidence of developmental dysplasia of the hip: risk assessment tool

Introduction: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. Not treated DDH leads to disability, gait abnormalities, limb shortening and chronic pain. Our study aims to determine the impact of multiple risk factors on the occurrence of DDH and develop an interactive risk assessment tool.Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of University Hospital. The Graf classification system was used for ultrasonographic universal screening. In total, 3102 infants met the eligibility criteria (n =6204 hip joints). Results: The incidence of DDH was 4.45%. In multivariate analysis, risk factors for DDH were weight (OR = 2.17 (1.41-3.32)), week of delivery (OR = 1.18 (1.00-1.37)), gender (OR = 8.16 (4.86-13.71)), breech delivery presentation (OR = 5.92 (3.37-10.40)), symptoms of DDH (25.28 (8.77-72.83)) and positive family history in siblings (5.74 (2.68-12.31)). Multivariate logistic regression predictive model was used to construct the interactive risk calculator.Conclusion: We confirmed well-known DDH risk factors in the studied population. Our results support the recent hypothesis that preterm infants (37 < week) have lower rate of DDH. The DDH risk calculator was built but needs external validation in prospective study before being used in a clinical setting.Level of Evidence: Retrospective cohort study: Level III

ACS NSQIP Surgical Risk Calculator e escores IRCR de Lee e ACP/Detsky: avaliação pré-operatória cardiovascular

Introdução: os eventos cardíacos pré e pós-operatórios são a maior causa de morbidade e mortalidade em cirurgias eletivas não cardíacas. Assim, a estratificação de risco cardiovascular pré operatória é essencial para identificar o risco e minimizar suas possíveis complicações. Objetivo: investigar a correlação entre o escore ACS NSQIP Surgical Risk Calculator e os escores tradicionalmente utilizados (ACP modificado por Detsky e IRCR por Lee) na avaliação ambulatorial pré-operatória do risco cardiovascular em cirurgias não cardíacas. Métodos: estudo observacional transversal retrospectivo com análise de registros eletrônicos de pacientes atendidos em um ambulatório multidisciplinar de medicina e enfermagem Perioperatória no período compreendido entre janeiro e dezembro de 2017. Correlacionou-se o escore de risco cardiovascular de Lee e ACP/Detsky já aplicado no ambulatório com o risco cardíaco obtido pela calculadora de risco ACS NSQIP Surgical Risk Calculator. Resultados: foi coletada uma amostra de 416 prontuários. Destes, 195 (47%) resultaram em risco equivalente entre os dois escores e 221 casos divergiram nos resultados. Obteve-se um p<0,001 através do teste de Wilcoxon. Conclusões: houve correlação entre o ACS NSQIP Surgical Risk Calculator e os escores de Lee e ACP/Detsky (p<0,001).

A Risk Calculator for Post-Operative Urinary Retention (POUR) Following Vaginal Pelvic Floor Surgery: Multivariable Prediction Modelling

Objective: To determine the peri-operative characteristics associated with an increased risk of post-operative urinary retention (POUR) following vaginal pelvic floor surgery. Design: A retrospective cohort study using multivariable prediction modelling. Setting: A tertiary referral urogynaecology unit. Population: Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020. Methods: Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the one with the largest c-index from internal cross-validation. This was then externally validated using a separate data set (n=94) from another surgical centre. Main Outcome Measures: diagnosis of POUR following surgery while the patient was in hospital. Results: Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Pre-operative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage, and uroflow parameters. Significant peri-operative factors included estimated blood loss, amount of intravenous fluid administered, operative time, length of stay, and specific procedures including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy, and colpocleisis. The lasso logistic regression model had the best combination of internally cross-validated c-index (0.73) and accurate calibration curve. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/). Conclusions: This POUR risk calculator will allow physicians to counsel patients pre-operatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options.