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1.
Obes Surg ; 29(4): 1281-1286, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30610676

RESUMEN

BACKGROUND: Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS: Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS: Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION: Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.


Asunto(s)
Hallazgos Incidentales , Complicaciones Intraoperatorias , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias , Adulto , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Cirugía Bariátrica/estadística & datos numéricos , Femenino , Hernia Hiatal/epidemiología , Hernia Hiatal/cirugía , Hernia Ventral/epidemiología , Hernia Ventral/cirugía , Humanos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/epidemiología , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adherencias Tisulares/epidemiología , Adherencias Tisulares/cirugía
2.
Rev. bras. ter. intensiva ; 29(3): 325-330, jul.-set. 2017. tab, graf
Artículo en Portugués | LILACS | ID: biblio-899528

RESUMEN

RESUMO Objetivo: Comparar a incidência de complicações e a duração da hospitalização de pacientes submetidos à cirurgia bariátrica internados na unidade de terapia intensiva ou de internação pós-cirúrgica. Métodos: Estudo observacional, retrospectivo, que incluiu 828 pacientes admitidos entre janeiro de 2010 e fevereiro de 2015 em pós-operatório imediato de cirurgia bariátrica em um hospital. Os dados foram coletados em prontuários eletrônicos. As variáveis contínuas foram comparadas utilizando-se o teste de Mann-Whitney e as categóricas, o qui quadrado. Resultados: Os pacientes dos dois grupos possuíam características demográficas semelhantes, sem diferença significativa dos dados antropométricos e comorbidades. Comparando-se as complicações entre os dois grupos, não houve diferença significativa. No entanto, o grupo admitido na unidade de terapia intensiva teve maior tempo de internação (mediana de 3 dias versus 2 dias; p < 0,05) e custo hospitalar 8% maior. Conclusão: O presente estudo não encontrou nenhum benefício na internação rotineira de pacientes submetidos à cirurgia bariátrica em unidade de terapia intensiva. Esta prática aumentou o tempo de internação e o custo hospitalar, desperdiçando recursos. É necessária a criação de critérios objetivos para identificar pacientes que necessitem de internação em unidade de terapia intensiva após cirurgia bariátrica.


ABSTRACT Objective: To compare the incidence of complications and the duration of hospitalization of patients undergoing bariatric surgery admitted to the intensive care unit or a post-surgical hospitalization unit. Methods: This retrospective observational study included 828 patients admitted between January 2010 and February 2015 during the immediate postoperative period of bariatric surgery in a hospital. Data were collected via electronic medical records. The Mann-Whitney test was used to compare continuous variables, and the chi-square was used to compare categorical variables. Results: Patients in both groups had similar demographic characteristics, with no significant differences in anthropometric data and comorbidities. There was no significant difference in the comparison of complications between the two groups. However, the group admitted to the intensive care unit had longer hospitalization times (median of 3 days versus 2 days, p < 0.05), and hospital costs were 8% higher. Conclusion: The present study found no benefit in the routine admittance of patients to the intensive care unit after undergoing bariatric surgery. This practice increased hospitalization time and hospital costs, which wasted resources. It is necessary to create objective criteria to identify patients requiring intensive care unit admission after bariatric surgery.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Adulto Joven , Complicaciones Posoperatorias/epidemiología , Cirugía Bariátrica/efectos adversos , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Complicaciones Posoperatorias/economía , Incidencia , Estudios Retrospectivos , Costos de Hospital , Estadísticas no Paramétricas , Hospitalización/economía , Tiempo de Internación , Persona de Mediana Edad
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