RESUMEN
OBJECTIVES: To compare the postoperative mortality of our hospital to that of others. PATIENTS AND METHOD: Retrospectively, we studied patients who died after surgery in 1994, defining postoperative mortality as death occurring in the hospital after surgery. The variables studied were age, sex, preoperative disease, ASA, type of surgery, anesthetic technique, intraoperative complications and place, cause and time of death. RESULTS: One hundred six (1.63%) of the 6,485 surgical patients died. The highest proportion were cardiovascular surgery patients (3.36%) and the smallest proportion (0%) had undergone eye surgery. Of patients receiving general anesthesia 2.16% died, while 0.59% of those receiving local-regional anesthesia did so. Most of those who died were male (55.66%); were over 55 years of age (87.73%); were ASA IV (67.03%); had associated medical disease (79.24%), mainly arterial hypertension; or had undergone emergency surgery (54.71%). Most who died had received general anesthesia (87.73%). Half of all deaths occurred in patients who presented some type of complication during surgery; this was the case with all who received intradural anesthesia, in 47.89% of those who had received general anesthesia and 20% of those receiving local anesthesia. The most common intraoperative complication in all anesthetic techniques was post-induction arterial hypotension. Over half of deaths occurred on the ward, after the first postoperative week, and the most frequent cause of death was sepsis (19.81%). We considered a death occurring on the hospital ward within the first 24 hours after surgery as possibly being associated with anesthesia (1.54/10,000). CONCLUSIONS: Risk factors for postoperative mortality established in other studies (advanced age, male sex, emergency surgery and ASA IV-V) were relevant in most of the deaths studied. Our mortality rate is similar to that reported by other authors for the first 24 to 48 hours after surgery, but is higher 30 days after surgery and later. Some of the 13 patients who died on the hospital ward in the first 48 hours after surgery probably did not receive the care that would have been provided in the postoperative intensive care unit.
Asunto(s)
Mortalidad Hospitalaria , Procedimientos Quirúrgicos Operativos/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Anestesia/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Femenino , Hospitales Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/mortalidad , Procedimientos Quirúrgicos Otorrinolaringológicos/mortalidad , Periodo Posoperatorio , Estudios Retrospectivos , Procedimientos Quirúrgicos Torácicos/mortalidad , Procedimientos Quirúrgicos Urológicos/mortalidadRESUMEN
OBJECTIVE: To study the effect of ondansetron administered during cardio-pulmonary bypass surgery, in terms of mean arterial pressure, systemic vascular resistance and venous system capacitance. PATIENTS AND METHOD: Twenty patients scheduled for non coronary cardiac surgery were randomly assigned to 2 groups. The study group received 4 mg ondansetron during the bypass and the control group received the same volume of physiological saline solution. The following parameters were recorded during the 10 minutes following administration of either substance: mean arterial pressure, calculated systemic vascular resistance, and the venous reservoir volume at the beginning and end of the study period. RESULTS: Increased mean arterial pressure and systemic vascular resistance were recorded in both groups from the time of injection, with the highest levels recorded at 10 minutes. There were no statistical differences between the 2 groups. No changes in venous system capacitance were observed in either group, as there were no significant changes in venous reservoir volume of the extracorporeal circulation pump. CONCLUSIONS: Ondansetron at the dose used has no effect on arterial or venous vessels. The increased resistance recorded in both groups can be attributed to the release of catecholamines during non pulsatile extracorporeal circulation with a non pulsatile flow.