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).

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).

Surgical risk assessment in Hiv-infected patients treated within the penitentiary system of Kemerovo region

Aim. To assess the surgical risk in HIV-infected patients who received the surgical treatment within the penitentiary system of Kemerovo Region.Materials and Methods. We retrospectively analysed the physical status and the extent of surgical risk in 296 HIV-infected patients who underwent elective (n = 201) or emergency (n = 95) surgery in Hospital №1 (Kemerovo) from 2015 to 2018. Physical status was assessed according to American Society of Anesthesiologists (ASA) Physical Status Classification System. Surgical risk was scored according to Moscow Scientific Society of Anesthesiologists and Critical Care.Results. The majority of patients had 3 (48.4 and 36.3% in emergency and elective patients, respectively) or 4a (30.5 and 45.8% in emergency and elective patients, respectively) stages of HIV infection. Opportunistic infections were diagnosed in 49.3% of patients and were always accompanied by superficial mycoses. Physical status of most patients (47.4% and 63.7% in emergency and elective patients, respectively) corresponded to ASA physical status class 3. Emergency patients mainly had surgical risk class 3 (n = 50, 52.6%) while elective patients often had surgical risk class 2 (n = 106, 52.7%). The prevalence of postoperative complications, most often impaired wound healing, was 9.8%.Conclusion. More than 80% of HIV-infected patients who underwent surgical interventions within the penitentiary system of Kuzbass were at III or IV stages of HIV infection, entailing a high frequency of opportunistic diseases such as superficial mycoses and dictating the need to include antifungal treatment into the surgical treatment. Impaired wound healing was the most frequent postoperative complication.

A case report of late physiologic repair of congenitally corrected transposition of the great arteries and pulmonary stenosis in a severely cyanotic patient: better late than never

Background Patients with congenitally corrected transposition of great arteries (ccTGA) not infrequently seek medical attention for the first time late in life. Optimal management of natural history ccTGA is debated and must be tailored. Case summary A 38 years old male patient was referred to our centre because of severe cyanosis and worsening dyspnoea. Investigations disclosed: situs solitus, mesocardia, double discordance, large ventricular septal defect (VSD), severe pulmonary stenosis, no significant atrioventricular valves regurgitation. The patient underwent physiologic repair: VSD closure, placement of a left ventricle to pulmonary artery conduit and epicardial atrio-biventricular pacemaker implantation. The conduit was intentionally undersized to promote tricuspid valve continence. Postoperative course was uneventful, trans-thoracic echocardiography showed good biventricular function without significant tricuspid regurgitation. At one month after discharge the patients is in NYHA class II. Discussion Management of late presenter patients with ccTGA depends on the associated lesion and estimation of surgical risk. In selected patients markedly symptomatic physiologic repair is a rationale option, providing a normal saturation and biventricular circulation with a significantly lower surgical risk as compared with anatomic repair.

Preoperative nutritional score predicts underlying liver status and surgical risk of hepatocellular carcinoma

Background: Given the scarce evidence regarding the impact of preoperative nutritional status on surgical outcomes of patients with hepatocellular carcinoma, predictive powers of nutritional/inflammatory scores for short-term surgical outcomes in patients with hepatocellular carcinoma were investigated. Methods: Outcomes of 1272 patients with hepatocellular carcinoma were reviewed, and predictive powers of nine nutritional/inflammatory scores for short-term surgical outcomes were compared using the receiver-operating characteristic curve analysis. Clinical relevance of the best nutritional score was then studied in detail to clarify its utility as an alternative predictive measure for surgical risk of patients with hepatocellular carcinoma. Results: Receiver-operating characteristic curve analysis showed the controlling nutritional status score has the best performance in prediction of morbidity after hepatectomy for hepatocellular carcinoma (area under the curve, 0.593; 95% confidence interval: 0.552–0.635; p < 0.001), and multivariate analysis confirmed its correlation with the risk of any morbidity (odds ratio per +1 point, 1.17; 95% confidence interval: 1.08–1.27; p < 0.001) and major morbidity (odds ratio per +1 point, 1.14; 95% confidence interval: 0.99–1.27; p = 0.052). The undernutrition grade based on the controlling nutritional status score showed strong correlation with the degree of fibrosis in the liver ( p < 0.001), platelet count ( p < 0.001), and indocyanine green retention rate at 15 min ( p < 0.001). In addition, the controlling nutritional status undernutrition grade well stratified the risk of postoperative morbidity especially in cirrhotic subpopulation (odds ratio, 1.17 per +1 point; 95% confidence interval: 1.05–1.29 for any morbidity and odds ratio, 1.20 per +1 point; 95% confidence interval: 1.03–1.40 for major morbidity). Conclusion: The controlling nutritional status score could be an alternative measure for underlying liver injury and the surgical risk of hepatocellular carcinoma.