Revista Do Colegio Brasileiro De Cirurgioes[JOURNAL]
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200 papers
Erratum.
Rev Col Bras Cir · 2022 Dec · PMID 36515334 · Full text
[This corrects the article doi: 10.1590/0100-6991e-20213332].
[This corrects the article doi: 10.1590/0100-6991e-20213332].
Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy.
Leite ALDS, Rocha FTR, Oliveira MJC … +11 more , Barros AV, Santos SMLD, Silva AMRD, Silvestre DWA, Folha Filho EAC, Ferro CC, Bezerra TS, Fachin LP, Santos DC, Fraga CAC, Sales-Marques C
Rev Col Bras Cir · 2022 · PMID 36515333 · Full text
OBJECTIVE: Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefor...
OBJECTIVE: Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefore, we seek to study regional anesthesic techniques that can minimize this effect, such as the interpectoral block (PECS). METHODS: randomized controlled study with 82 patients with breast cancer who underwent mastectomy with lymphadenectomy from January 2020 to October 2021 in oncology hospital. INTERVENTIONS: two randomized groups (control - exclusive general anesthesia and PECS group - received PECS block with levobupivacaine/ropivacaine and general anesthesia). We applied a questionnaire with Numeric Rating Scale for pain 24h after surgery. We used Shapiro-Wilk, Mann-Whitney and Chi-square tests, and analyzed the data in R version 4.0.0 (ReBEC). RESULTS: in the PECS group, 50% were pain-free 24h after surgery and in the control group it was 42.86%. The majority who presented pain classified it as mild pain (VAS from 1 to 3) - (42.50%) PECS group and (40.48%) control group (p=0.28). Only 17.50% consumed opioids in the PECS group, similar to the control group with 21.43%. (p=0.65). There was a low rate of complications such as PONV in both groups. In the subgroup analysis, there was no statistical difference between the groups that used levobupivacaine or ropivacaine regarding postoperative pain and opioid consumption. DISCUSSION: the studied group had a low rate of pain in the postoperative period and it influenced the statistical analysis. There wasn´t difference in postoperative pain in groups. CONCLUSION: was not possible to demonstrate better results with the association of the PECS block with total intravenous analgesia. Need further studies to assess the efficacy of the nerve block.
Ultrashort anisoperistaltic end-to-side ureteroureterostomy in renal transplantation.
Leão CS, Foinquinos RA, Leao ALS … +2 more , Capela ICKO, Mello MJG
Rev Col Bras Cir · 2022 · PMID 36515332 · Full text
The improvement of surgical techniques in kidney transplantation aims to reduce the incidence of post-transplant complications, contributing to the reduction of hospital stay, related costs, morbidity and mortality, in a...
The improvement of surgical techniques in kidney transplantation aims to reduce the incidence of post-transplant complications, contributing to the reduction of hospital stay, related costs, morbidity and mortality, in addition to improving the quality of life of patients. The choice of the best technique is influenced by several factors and the most common technique for urinary tract reconstruction in transplants is performed with implantation of the ureter of the graft in the caudal position, with the anastomosis performed in the bladder. However, the kidney pole can be inverted and the graft ureter anastomosis can be performed directly on the recipient's ureter, facilitating venous and ureteral anastomoses and reducing urological complications.
Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study.
Silva AAD, Ströher GR, Teixeira HM … +3 more , Cordeiro MVG, Olandoski M, VON-Bahten LC
Rev Col Bras Cir · 2022 · PMID 36515331 · Full text
OBJECTIVE: to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (f...
OBJECTIVE: to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (flags), as well as compare the results with the pre-pandemic period. METHODS: a cross-sectional study was performed, with probability sampling, in a trauma center in Brazil. Medical records of patients involved in traffic accidents from June 2020 to May 2021 were evaluated. Aside from epidemiological characteristics, variables such as the current flag, the trauma mechanism, the resulting injuries, and the Revised Trauma Score (RTS) were also considered. Data were compared between three different flag periods and the proportion of consultations during the pandemic was compared with that from pre-pandemic time (December 2016 to February 2018). RESULTS: it was observed that 62.2% of the patients were victims of motorcycle accidents, 77.5% were male, and the mean age was 33 ± 12.4 years. The mean and median RTS were 7.5 and 7.8, respectively. Statistical difference was stated when comparing the number of visits per day between the yellow and red flags (p=0.001) and orange and red flags (p=0.016). A significantly lower number of consultations for traffic accidents was observed in the pandemic when compared to the pre-pandemic period. CONCLUSIONS: the epidemiological profile of the study consisted mostly of young men who were victims of motorcycle accidents. There was a lower incidence of admissions during red flag periods and a lower proportion of consultations throughout the survey when compared to the pre-pandemic period.
CT scan in the evaluation of pediatric abdominal trauma.
Perin I, Guetter CR, Klüppel LE … +2 more , Fachin CG, Pimentel SK
Rev Col Bras Cir · 2022 · PMID 36515330 · Full text
OBJECTIVE: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. METHODS: observational retrospective study with patients under 18 years old victims of blunt or pe...
OBJECTIVE: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. METHODS: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. RESULTS: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. CONCLUSION: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.
Overview of general surgery medical residency programs and prerequisite program in basic surgical area in Brazil: Historical review and update.
Santos EGD, Peterle VCU, Sanches MM … +7 more , Neser A, Bonifacio MD, Bahten LCV, Tallo F, Ribeiro M, Melo RL, Corsi PRGD
Rev Col Bras Cir · 2022 · PMID 36449946 · Full text
OBJECTIVE: to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). METHOD: descriptive, quali-quant...
OBJECTIVE: to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). METHOD: descriptive, quali-quantitative, cross sectional study conducted from document analysis from National Commission of Medical Residency (CNRM). RESULTS: in 2018, after evaluation of the General Surgery Services for adequacy of the number of vacancies (DS), the PRACB was instituted as a modality of access to surgical specialties until definitive change in the time of the formation of the general surgeon for three years, in 2022. In the first addition of vacancies in 2018, 127 PRMCG were authorized with 736 vacancies of R1 and 290 PRACB (2 years) with 1.286 vacancies offered for R1. In the second addition in 2021, 423 PRM were authorized with 1.564 R1 vacancies in PRMCG. DISCUSSION: the regulation of the offer of vacancies for the formation of specialties in Brazil should align the evaluation of practice scenarios with the profile of skills. The PRACB modality was instituted for a certain time for budgetary preparation and practice scenarios until the complete transition to training in 3 years. CONCLUSION: Brazil by 2018 was the only country to grant the Board Certification to General Surgeon with only 2 years of training. After a transitional period the same analysis methodology for adding and regulating vacancies was applied to services.
Determinants of success in treating acute ischemic cerebral and ocular ischemia through carotid revascularization. An observational study of a case series.
Ristow AV, Santos M, Vescovi A … +4 more , Massière B, Demier B, Sartori P, Niemeyer Filho P
Rev Col Bras Cir · 2022 · PMID 36449945 · Full text
OBJECTIVE: stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. T...
OBJECTIVE: stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. The sooner the treatment is undertaken, complete recovery chances are greater with less recurrences. But, historically, intervention in the acute setting was catastrophic. Objective: Identify determinants of success when carotid revascularization after a recent cerebral ischemic event is performed. MATERIALS AND METHODS: A cohort of 50 subjects underwent carotid revascularization after ischemic symptoms, within a period of 71 months. The currently diagnostic tools were used, and the symptoms stratified by the Rankin scale. The extension of the cerebral lesion and the source location the source of the event was analyzed. RESULTS: indications were based on the Rankin Scale (R0: 35.4%; R1: 45.8%; R2:18.8% and R3: zero), on the location of the source and the absence of ischemic areas greater than 15mm. An early surgical approach was adopted in all patients. Extreme care was applied to control arterial pressure. At discharge, no additional deficits were observed. CONCLUSIONS: carotid revascularization after ischemic events can be achieved without additional morbidity and no recurrences, using the most appropriate therapy in the shortest time, in patients with Rankin Scale up to 2, absence of intracranial hemorrhage and single or multiple ischemic intracerebral areas, with 15mm or less in their greater dimension.
Valproic acid and bladder healing: an experimental study in rats.
Biondo-Simões MLP, Dall'antonia MO, Goehr MP … +3 more , Biondo-Simões R, Ioshii SO, Robes RR
Rev Col Bras Cir · 2022 · PMID 36449944 · Full text
PURPOSE: to recognize the effects of valproic acid (VPA), an epigenetic drug, on the bladder healing process, in rats. METHOD: twenty male Wistar rats were divided in two groups: experimental (A), treated with VPA (150mg...
PURPOSE: to recognize the effects of valproic acid (VPA), an epigenetic drug, on the bladder healing process, in rats. METHOD: twenty male Wistar rats were divided in two groups: experimental (A), treated with VPA (150mg/Kg/day), and control (B) with 0.9% sodium chloridrate. Healing was analyzed on the third and seventh days, evaluating the inflammatory reaction, collagen synthesis and angiogenesis. RESULTS: inflammatory reaction on the third day was minimal and acute in both groups. On the seventh day, it was subacute in both groups, moderate intensity in group A and minimal in group B (p=0.0476). Collagen III intensity, marked by immunohistochemistry, was similar in both groups. Collagen I intensity on the third day was similar in both groups, but on the seventh day it was higher in experimental than control (p=0.0476). Collagen evaluation by picrosiriusred allowed to verify that the presence of collagen III was similar in both groups (p=0.3312) on the third day, and it was higher in control on the seventh day (p=0.0015). Collagen I showed similarity on the third day (p=0.3100), and it was higher in control on the seventh day (p=0.0015). Vessel marked with anti-SMA counting showed fewer vessels on the third (p=0.0034) and seventh day (p=0.0087) in experimental group. The lower intensity of angiogenesis was confirmed with anti-CD34, on the third day (p=0,0006) and on the seventh day (p=0,0072). CONCLUSION: VPA determined alterations in the bladder healing process, in rats, with lower collagen density and less angiogenic activity, but without compromising the integrity of the organ.
Experience of a resident physician in general surgery basic area on board of an expedition in the amazon river.
Milani MFL, Silvestre D, Marim J
Rev Col Bras Cir · 2022 · PMID 36449943 · Full text
Located in areas of difficult access, the riverside population of the upper Amazon River has a great demand for health care, whether in the scope of basic health promotion or in general or specialized medical care, surgi...
Located in areas of difficult access, the riverside population of the upper Amazon River has a great demand for health care, whether in the scope of basic health promotion or in general or specialized medical care, surgical procedures, dental and pharmaceutical care. Taking this to consideration, the Barco Hospital Papa Francisco project was conceived and implemented, which aims to provide health care to riverside communities through expeditions that safely transfer health resources to populations located on the banks of the river. Having participated in one of the expeditions, it was possible to carry out a survey of data regarding the attendance and writing of a personal report on the impact on the professional activity. The expedition allowed the performance of a large number of surgical procedures in a condensed period, covering a wide variety of technical approaches essential to the performance of the general surgeon, among them, we can mention inguinal and incisional hernioplasties, umbilical and inguinal herniorrhaphy, postectomy and tubal ligation, lipoma excision, sebaceous cyst excision, nevi excision, among others (data available in the vessels Wareline® system).
Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis.
Dias VE, Castro PASV, Padilha HT … +8 more , Pillar LV, Godinho LBR, Tinoco ACA, Amil RDC, Soares AN, Cruz GMGD, Bezerra JMT, Silva TAMD
Rev Col Bras Cir · 2022 · PMID 36449942 · Full text
INTRODUCTION: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patie...
INTRODUCTION: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. METHODS: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. RESULTS: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). CONCLUSIONS: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.
The role of autopsy on the diagnosis of missed injuries and on the trauma quality program goal definitions: study of 192 cases.
Gonçalves AC, Parreira JG, Gianvecchio VAP … +4 more , Lucarelli-Antunes PS, Pivetta LGA, Perlingeiro JAG, Assef JC
Rev Col Bras Cir · 2022 · PMID 36449941 · Full text
OBJECTIVE: to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. METHOD: Retrospective analysis of autopsy reports and patient's charts. Injuries present i...
OBJECTIVE: to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. METHOD: Retrospective analysis of autopsy reports and patient's charts. Injuries present in the autopsy, but not in the chart, were defined as "missed". MI were characterized using Goldman's criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney's U and Pearson's chi square for statistical analysis, considering p<0.05 as significant. RESULTS: We included 192 patients, with mean age of 56.8 years. Blunt trauma accounted for 181 cases, and 28.6% were due to falls from the same level. MI were diagnosed in 39 patients (20.3%). Using Goldman's criteria, MI were categorized as Class I in 3 (1.6%) and Class II in 11 (5.6%). MI were more often diagnosed in the thoracic segment (25 patients, 64.1% of the MI). The variables significantly associated (p<0.05) to MI were: time of hospitalization < 48 h, severe trauma mechanism, and not undergoing surgery or computed tomography. At autopsy, the values of ISS and NISS were higher in patients with MI. CONCLUSION: the review of the autopsy report allowed diagnosis of MIs, which did not influence outcome in their majority. Many opportunities of improvement in quality of care were identified.
Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries.
Belangero WD, Fogagnolo F, Kojima KE … +12 more , Miguel GC, Bidolegui F, Bertune AD, Lombardo E, Dias AL, Torres JBM, Coutinho BP, Silva JDS, Leonhardt MC, Pereira PS, Mariolani JRL, Giordano V
Rev Col Bras Cir · 2022 · PMID 36449940 · Full text
INTRODUCTION: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed defi...
INTRODUCTION: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). METHODS: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. RESULTS: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. CONCLUSIONS: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.
Impact of proper surgical treatment on the survival of patients with epithelial ovary cancer.
Faria FH, Lage APD, Rodrigues AN … +1 more , Wainstein AJA
Rev Col Bras Cir · 2022 · PMID 36449939 · Full text
OBJECTIVE: to evaluate the quality of surgical treatment of ovarian cancer patients and assess the impact of adequate surgical oncological treatment on disease-free survival and overall survival of patients with advanced...
OBJECTIVE: to evaluate the quality of surgical treatment of ovarian cancer patients and assess the impact of adequate surgical oncological treatment on disease-free survival and overall survival of patients with advanced epithelial ovarian cancer. METHODS: this is an observational, retrospective study with quantitative analysis, with the collection of data in medical records of a temporal convenience sample of patients diagnosed with ovarian cancer admitted to a High Complexity Oncology Unit, in Belo Horizonte, from the period of 2014 to 2020. RESULTS: a total of 91 patients diagnosed with ovarian cancer were evaluated, with the epithelial histopathological type being the most frequent (85%). Of this total, 68 patients (74.7%) had advanced-stage ovarian cancer. Appropriate surgical treatment was performed in 30.9% of patients with advanced epithelial ovarian cancer and the type of performed surgery was statistically significant for overall survival. This low proportion of appropriate surgical oncological treatment was not related to surgical specially or surgeon competence, but mainly to advanced disease related to patient flow at UNACON. It was not possible to confirm if the advanced-stage disease was related to tumor biology or losing time from diagnosis to oncological surgery. CONCLUSION: overall survival of advanced-stage epithelial ovarian cancer patients is directly influenced by appropriate surgical treatment, however, in this study, the percentage of advanced ovarian cancer receiving adequate surgical treatment was much lower than the rates reported in the literature. To improve these outcomes, we believe that surgeons should keep following patients during neoadjuvant chemotherapy to point to a better time for surgery, and clinical oncologists should better consider adequate oncological surgery as one of the pillars of ovarian cancer treatment and get more involved in facilitating surgeries.
Medical advertising in social networks: awareness and medical school education.
Purim KSM, Andrade FA, Lehmkuhl F … +1 more , Bernardes ABS
Rev Col Bras Cir · 2022 · PMID 36350882 · Full text
OBJECTIVE: this study analyzed medicine students' knowledge regarding medical advertising on social media. METHOD: this is a cross-sectional study carried out between January and May 2022 with 179 medical students from p...
OBJECTIVE: this study analyzed medicine students' knowledge regarding medical advertising on social media. METHOD: this is a cross-sectional study carried out between January and May 2022 with 179 medical students from public and private institutions from Curitiba - PR, using a structured questionnaire with nine problem situations on medical advertising. It was established as "sufficient" knowledge ≥70% of the problem-situations based on current professional codes and resolutions. RESULTS: five questions had the highest percentage of correct answers resulting from the acquisition of knowledge from different sources. Most students did not learn about medical marketing in their undergraduate course (84.9%), having already shared patients' pictures on social media (89.9%), and fell the lack of discussions about medical advertising (96.6%). CONCLUSION: there is a need to direct undergraduate education towards the ethical use of advertising in order to better prepare them for professional practice.
Trends in bariatric surgeries in the Brazilian Federative Units, 2009-2019: a descriptive study.
Oliveira VDS, Chaves VB, Aboud AAN … +3 more , Bunholli AM, Macedo RM, Pinto RM
Rev Col Bras Cir · 2022 · PMID 36350881 · Full text
OBJECTIVE: our objective is to describe the epidemiological distribution of hospitalizations and postoperative deaths, as well as the trends of bariatric surgeries performed by SUS in all Brazilian federative units (FUs)...
OBJECTIVE: our objective is to describe the epidemiological distribution of hospitalizations and postoperative deaths, as well as the trends of bariatric surgeries performed by SUS in all Brazilian federative units (FUs) from an analysis of the period from 2009 to 2019. METHODS: This is an observational, descriptive ecological time-series study with quantitative and descriptive analysis, based on secondary data. The period analyzed was from 2009 to 2019. We collected, from DATASUS, data from obese men and women who were hospitalized after undergoing bariatric surgery. Prais-Winsten regression was performed to identify the trends. RESULTS: In the period, 83,829 bariatric surgeries were performed, of which 161 resulted in death, representing 0.19% of the procedures. We found an increasing trend in the number of surgeries for Brazil (β=0.04; p<0.001), but 11 FUs showed a stationary trend and three, decreasing ones (six UFs did not have enough data to enter the analysis). In the North and Northeast regions, stationary trends prevailed, while in the Center-West, the decreasing trends, and in the South and Southeast, the increasing ones. CONCLUSIONS: we found an evident disparity between regions, suggesting deficiencies in access to health. By demonstrating which FUs and demographic characteristics have the lowest rates of surgeries, our study is able to direct public policies towards a more egalitarian Brazilian public health.
Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds.
Kristem L, Wietzycoski CR, Mazzini GDS
Rev Col Bras Cir · 2022 · PMID 36228199 · Full text
INTRODUCTION: the use of telepresence grows with the advancement of technology integration into medical practice. Regarding surgery, effective distance communication can translate into better perioperative care. Though,...
INTRODUCTION: the use of telepresence grows with the advancement of technology integration into medical practice. Regarding surgery, effective distance communication can translate into better perioperative care. Though, the patients' perception about this modality needs to be critically evaluated. Structured questionnaires using objective scales are the instruments of choice for measuring subjective aspects. However, there are no such questionnaires available in Portuguese. Our objective was, thus, translate and adapt into Portuguese a specific questionnaire evaluating the use of telepresence robots during post-operatory ward rounds. METHODS: search on PubMed and selection of a set of validated questionnaires in English, translation into Portuguese according to the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures. The original author approved the final version. RESULTS: three questionnaires that assess ward rounds assisted by a telepresence robot were translated. Questionnaires are directed to the patient who receives the visit via telepresence or face-to-face visit and to the medical team accompanying the visit. The questionnaires use the Likert scale and contain thirteen questions that address 5 spheres: Communication; Dignity and Confidentiality; Contents; Time; General Impressions. CONCLUSIONS: this is the first instrument in Portuguese designed to assess the impression of patients and professionals involved in ward rounds using a telepresence robot. It has the potential to be used in clinical studies involving the use of this technology in care.
Clinical-epidemiological changes in patients with non-traumatic acute abdomen during the COVID-19 pandemic: a retrospective study.
Castro GRA, Zwierzikowski TA, Lemes JGDS … +3 more , Yuki VMG, Gouveia KO, Roginski-Guetter C
Rev Col Bras Cir · 2022 · PMID 36228198 · Full text
OBJECTIVE: we intend to demonstrate the clinical alterations and the postoperative evolution in patients with acute abdomen non-traumatic in conservative or surgical treatment during the pandemic compared to a similar pe...
OBJECTIVE: we intend to demonstrate the clinical alterations and the postoperative evolution in patients with acute abdomen non-traumatic in conservative or surgical treatment during the pandemic compared to a similar period in the last year. METHOD: a single-center retrospective study, including patients who received clinical-surgical treatment at Hospital do Trabalhador diagnosed with acute abdomen between March and August 2020 and a similar period in 2019.Variables studied ranged from demographic data to indices of social isolation. RESULTS: 515 patients were included, 291 received treatment in a pre-pandemic period and 224 during. There was not statistical difference in relation to comorbidities (p=0.0685), time to diagnosis and seeking medical help. No statistical differences were observed in terms of days of hospitalization (p = 0.4738) and ICU need (p=0.2320). Regarding in-hospital deaths, there was statistical relevance in the age above 60 years (p=0.002) and there were more deaths during the pandemic period (p=0.032). However, when we analyze the factors associated with the number of days until diagnosis by a physician, there was no statistical difference. CONCLUSION: the analyzed data showed that the pandemic period and age over 60 years were the variables that increased the odds ratio for the in-hospital death outcome. However, the length of stay, days in intensive care unit and postoperative surgical complications showed no significant difference.
Learning curve of semi-rigid ureteroscopy for small calculi: how many cases are necessary?
Ilias D, Passerotti CC, Pontes Junior J … +5 more , Fakhouri F, Faria STDR, Maximiano LF, Otoch JP, DA-Cruz JAS
Rev Col Bras Cir · 2022 · PMID 36228197 · Full text
INTRODUCTION: semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. OBJECTIVE: To describe an estimate of the learning curve fo...
INTRODUCTION: semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. OBJECTIVE: To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. METHODS: this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. RESULTS: all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). CONCLUSION: after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.
Safety and efficacy of roux-en-y gastric bypass in older aged patients.
Quintero JHR, Grosser R, Velez GR … +7 more , Ramos-Santillan VO, Pereira X, Flores FM, Choi J, Moran-Atkin E, Camacho D, Lima DL
Rev Col Bras Cir · 2022 · PMID 36197347 · Full text
INTRODUCTION: laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has been a revolutionary intervention for weight loss with reduction of up to 60-70% of excess body weight. However, these outcomes are not as well validated at...
INTRODUCTION: laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has been a revolutionary intervention for weight loss with reduction of up to 60-70% of excess body weight. However, these outcomes are not as well validated at the extremes of age, where the safety of the intervention still has some caveats. The aim of this study is to assess the efficacy and safety of primary LRYGB among different age groups. METHODS: the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried for patients who underwent primary LRYGB from January 2014 to December 2017 at a single institution. Four groups were created and compared by dividing our sample by age quartiles. The primary outcome was percent excess weight loss (%EWL) at 1 year. Additional operative outcomes and complications were also compared across groups. RESULTS: a total of 1013 patients underwent non-revisional LRYGB during the study period. Mean %EWL at one year was 55%. When compared between quartiles, there was a statistically significant difference in %EWL: 1st 62%, 2nd 57%, 3rd 54% and 4th 47% (p=0.010). The differences in the secondary outcomes between age groups did not demonstrate statistical significance. CONCLUSIONS: though patients in the fourth age quartile (range) did not demonstrate a statistically significant increase in adverse outcomes, they did lose less weight compared to other cohorts. The %EWL at one year after RYGB varied by age in our cohort. Goals after bariatric surgery should be individualized as weight loss is less robust with aging.
The impact of the COVID-19 pandemic on unilateral inguinal hernioplasty surgery in Brazil.
Garcia GSB, Ferreira KCDS, Wanderley LS … +3 more , Pinheiro JMMM, Korsack IM, Frigotto KG
Rev Col Bras Cir · 2022 · PMID 36197346 · Full text
OBJECTIVE: to analyze data from patients hospitalized for unilateral inguinal hernioplasty in Brazil in the year before the COVID-19 pandemic, and during the period of the pandemic. METHODS: this is a descriptive study,...
OBJECTIVE: to analyze data from patients hospitalized for unilateral inguinal hernioplasty in Brazil in the year before the COVID-19 pandemic, and during the period of the pandemic. METHODS: this is a descriptive study, using data referring to hospitalizations for the surgical procedure of unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020, comparing with data from March 2020 to February 2021. Data were collected from the Hospital Information System (SIH/SUS) and the selected variables were: number of hospitalizations, average hospital stay rate and mortality rate. RESULTS: in all, 119,312 hospitalizations were performed for unilateral inguinal hernioplasty in Brazil from March 2019 to February 2020. During the pandemic period, 53,445 hospitalizations were recorded for this procedure. The average hospital stay increased compared to the previous year. The mortality rate recorded in the year before the pandemic was 0.11, while in the period of the pandemic, it was 0.20. CONCLUSION: It was observed that during the period of the COVID-19 pandemic in Brazil, the number of hospitalizations for unilateral inguinal hernioplasty was reduced by 55,21%. However, there was a significant increase in the mortality rate of this procedure. These results can be explained by the increase in mortality in patients infected with the SARS-CoV-2 virus, and also by the restriction of performing elective surgeries, prioritizing emergency situations, which are more complicated, and consequently, with higher mortality.
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