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The COVID-19 pandemic has triggered a global crisis in health systems worldwide. Emergency care services have been overloaded, and there have been different changes in the patient's profile and the most frequent diagnoses. The aim of the study was to compare the number of emergency surgeries in the Hand and Microsurgery group of the quaternary hospital (IOT-FMUSP) from March 2020 to February 2022, the pandemic period, with the previous two years, March 2018 to February 2020. Two hundred and seventy-two patients were evaluated, with a mean age of 39.54 ± 17 years (range 1 to 90 years), 12.50% (n = 34) women and 87.50% (n = 238) men. Between March 2018 and February 2020, 142 (52.21%) emergency upper limb surgeries were performed; between March 2020 and February 2022, 130 surgeries were performed (47.79%). There was a reduction in upper limb surgeries in patients between 26-45 years and blunt injury surgeries. There was also an increase in surgeries in patients over 46, amputations, fractures, re-implantation procedures, and open fracture fixation. Level of evidence III, Retrospective Comparative Study.

A pandemia por COVID-19 desencadeou uma crise global nos sistemas de saúde ao redor do mundo. Serviços de atendimento de urgência sofreram sobrecarga e diferentes mudanças no perfil do paciente atendido bem como dos diagnósticos mais frequentes. O objetivo do estudo foi comparar o número de cirurgias de urgência, no grupo de Mão e Microcirurgia, do hospital quaternário (IOT-FMUSP) ocorridos de março de 2020 a fevereiro de 2022, período pandêmico; com os dois anos anteriores, de março de 2018 a fevereiro de 2020. No total foram avaliados 272 pacientes com idade média de 39,54 ± 17 anos (variação 1 a 90 anos), sendo 12,50% (n = 34) de mulheres e 87,50 % (n = 238) de homens. Entre março de 2018 a fevereiro de 2020 foram realizadas 142 (52,21%) cirurgias de urgência em membro superior e de março de 2020 a fevereiro de 2022, 130 cirurgias foram realizadas (47,79%). Identificou-se redução do número de cirurgias em membro superior em pacientes entre 26-45 anos e do número de cirurgias por ferimentos corto contusos. Além do aumento no número de cirurgias em pacientes acima de 46 anos, número de casos de amputações, fraturas, procedimentos de reimplante e fixação por fraturas expostas. Nível de evidência III, Estudo restrospectivo comparativo.

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Glomerular filtration rate (GFR) impairment is common both intraoperatively and in the early postoperative period of major surgeries, even elective ones. In some patients, such impairment is subtle and short-lasting, not even detected by increases in serum creatinine (sCr) and, consequently, not of sufficient magnitude to fulfill acute kidney injury (AKI) sCr-based criteria. In patients with a GFR decrease of greater magnitude, significant increases in sCr will occur but, unfortunately, usually at a late time in its progression. Both urinary and serum biomarkers have been proposed to be capable of anticipating AKI development but they are not widely available nor cost-effective in most centers. In this context, a urine biochemical approach using urinary sodium concentration (NaU) and the fractional excretion of potassium (FeK) has been proposed, anticipating the level of renal microcirculatory stress and decreases in GFR. An educational postoperative case example is presented highlighting the relevance that this approach can have in the correct interpretation of sCr values, bringing more dynamism to renal function monitoring. How to cite this article: Maciel AT. Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach-Time to Bring More Dynamism to Serum Creatinine Evaluation! Indian J Crit Care Med 2024;28(8):729-733.

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Purpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic. Patients and Methods: Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality. Results: There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2). Conclusion: Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.

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BACKGROUND: Caesarean delivery on maternal request (CDMR) is an increasing delivery option among women. As such, we aimed to understand the reasons that led pregnant women to request a caesarean delivery. METHODS: A phenomenological study was conducted with semi-structured interviews, in a convenience sample, for women who had undergone a CDMR between March and June 2023, in a public reference university hospital in Campinas, Brazil. The interviews were recorded, transcribed and subjected to thematic analysis, supported by Nvivo®, and Reshape®. RESULTS: We interviewed eighteen women between 21 and 43 years of age. The reasons for C-section as their choice were: 1) fear of labour pain, 2) fear for safety due to maternal or fetal risks, 3) traumatic previous birth experiences of the patient, family or friends 4) sense of control, and 5) lack of knowledge about the risks and benefits of C-section. CONCLUSIONS: The perception of C-section as the painless and safest way to give birth, the movement of giving voice and respecting the autonomy of pregnant women, as well as the national regulation, contribute to the increased rates of surgical abdominal delivery under request. Cultural change concerning childbirth and better counseling could support a more adequate informed decision-making about delivery mode.

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BACKGROUND: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.

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Objetivo: Identificar cómo se informó a los pacientes sometidos a cirugías oncológicas electivas sobre la preparación antes de la cirugía y, con base en esta información, desarrollar una lista educativa de pautas preoperatorias. Método: Investigación retrospectiva y transversal desarrollada en una institución de oncología del interior de São Paulo. Se utilizaron dos cuestionarios, uno para datos sociodemográficos y de perfil de salud, y otro para identificar retrospectivamente pautas preoperatorias. Se realizó análisis estadístico descriptivo. Resultados: De las 38 pacientes, el 65,8% eran mujeres y el 42% fueron sometidas a mastectomía. Prevaleció la orientación brindada de forma verbal y presencial, especialmente en lo que respecta al examen solicitado por el cirujano y la documentación personal, que presentó el mismo porcentaje, 78,9%. Hubo lagunas en la información brindada sobre la posibilidad de utilizar sonda, drenajes o tubos para el 63,2%. Conclusión: Los autoinformes de los pacientes sobre las guías preoperatorias revelaron fallas en la forma en que se transmitió esa información y apoyaron la construcción de la lista de guías educativas, destacando la importancia de herramientas escritas estructuradas para el equipo multidisciplinario que puedan mejorar la calidad y seguridad de las guías preoperatorias y la atención quirúrgica.Palabras clave: Oncología Quirúrgica, Procedimientos Quirúrgicos Electivos, Lista de Verificación, Seguridad del Paciente, Enfermería Perioperatoria. (AU)

Objective: To identify how patients who underwent elective oncological surgeries were informed about preparation before surgery and, based on this information, develop an educational checklist of preoperative guidelines. Method: This is a retrospective and cross-sectional research developed at an oncology institution in a small city in the state of São Paulo, Brazil. Two questionnaires were used, one for sociodemographic and health profile data, and the other to retrospectively identify preoperative guidelines. Descriptive statistical analysis was performed. Results: Of the 38 patients, 65.8% were women, with 42% undergoing mastectomy. The guidance provided verbally and in person prevailed, especially regarding the examination requested by the surgeon and personal documentation, which presented the same percentage: 78.9%. There were gaps in information provided about the possibil-ity of using a probe, drains, or tubes for 63.2%. Conclusion: Patients' self-reports on preoperative guidelines showed flaws in the way this information was passed on and supported the development of the checklist of educational guidelines, highlighting the importance of structured written tools for the multidisciplinary team that can improve the quality and safety of preoperative care.

Objetivo: Identificar como os pacientes que passaram por cirurgias oncológicas eletivas foram informados sobre o preparo antes da cirurgia e, com base nessas informações, elaborar uma lista educativa de orientações pré-operatórias. Método: Pesquisa retrospectiva e transversal desenvolvida em uma instituição de oncologia no interior de São Paulo. Dois questionários foram utilizados, um para os dados do perfil sociodemográfico e de saúde, e outro para identificar retrospectivamente as orientações pré-operatórias. Realizada análise estatística descritiva. Resultados: Dos 38 pacientes, 65,8% eram do sexo feminino, sendo 42% submetidas à mastectomia. Prevaleceram as orientações fornecidas de maneira verbal e presencial, especialmente sobre o exame solicitado pelo cirurgião e a documentação pessoal, que apresentaram o mesmo percentual: 78,9%. Houve lacunas de informação for-necida sobre a possibilidade de uso de sonda, drenos ou tubos para 63,2%. Conclusão: O autorrelato dos pacientes sobre as orientações pré-operatórias revelou falhas na forma de transmissão dessas informações e fundamentaram a construção da lista de orientações educativas, ressaltando a importância de ferramentas estruturadas de modo escrito para equipe multiprofissional que podem aprimorar a qualidade e a segurança do cuidado pré-cirúrgico. (AU)

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OBJECTIVE: Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. CONCLUCION: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. LEVEL OF EVIDENCE: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).

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Resumo Objetivo Identificar os efeitos mediadores do medo e ansiedade pré-operatórios sobre a intensidade da dor pós-operatória em pessoas submetidas a cirurgias eletivas até seis meses após cirurgia. Métodos Estudo observacional e longitudinal de análise quantitativa foi realizado com 172 pacientes adultos internados em uma instituição hospitalar e submetidos a cirurgias eletivas. Os instrumentos usados foram: formulário para caracterização de variáveis sociodemográficas, clínicas e cirúrgicas; Escala Hospitalar de Ansiedade e Depressão; Escala de Medos Relacionados a Cirurgia e Escala de Categoria Numérica para dor. As entrevistas foram realizadas no período pré-operatório, 48 horas após a cirurgia e mensalmente até completar seis meses do pós-operatório. Para a análise estatística descritiva das variáveis explanatórias, foram usadas as frequências absoluta e relativa, média, desvio padrão, mediana e os valores mínimo e máximo. A relação entre as variáveis estudadas foi analisada usando as medidas de correlação e dos efeitos mediadores (modelo de equações estruturais; método de máxima verossimilhança). Resultados No período pós-operatório (6 meses), a média de dor variou de 4,86 a 1,19. As médias de ansiedade (7,62) e medo (25,2) relacionados à cirurgia foram calculadas. A análise das variáveis mostrou correlação positiva tanto do medo como da ansiedade pré-operatórios com os níveis de dor mais elevados avaliados em distintos momentos do período pós-operatório. Além disso, a ansiedade pré-operatória exerceu um efeito mediador na relação entre o medo relacionado à cirurgia, manifestado no período pré-operatório, e a dor pós-operatória nas primeiras 48 h após a cirurgia. Conclusão As variáveis psicológicas, medo e ansiedade pré-operatórios, influenciaram a intensidade da dor pós-operatória em pessoas submetidas a cirurgias eletivas. Intervenções de enfermagem voltadas para ansiedade e medo podem ser úteis aos pacientes cirúrgicos.

Resumen Objetivo Identificar los efectos mediadores de la ansiedad y del miedo preoperatorio sobre la intensidad del dolor posoperatorio en personas que realizaron cirugías electivas hasta los seis meses posteriores a la cirugía. Métodos Se realizó un estudio observacional y longitudinal de análisis cuantitativo con 172 pacientes adultos internados en una institución hospitalaria y sometidos a cirugías electivas. Los instrumentos utilizados fueron: formulario para caracterización de variables sociodemográficas, clínicas y quirúrgicas; Escala Hospitalaria de Ansiedad y Depresión; Escala de Miedos Relacionados con Cirugías y Escala de Categoría Numérica del Dolor. Las entrevistas se realizaron en el período preoperatorio, 48 horas después de la cirugía y mensualmente hasta completar seis meses de posoperatorio. Para el análisis estadístico descriptivo de las variables explicativas, se utilizaron las frecuencias absoluta y relativa, promedio, desviación típica, mediana y valores mínimo y máximo. La relación entre las variables estudiadas se analizó utilizando las medidas de correlación y de los efectos mediadores (modelo de ecuaciones estructurales, método de máxima verosimilitud). Resultados En el período posoperatorio (6 meses), el promedio del dolor varió de 4,86 a 1,19. Se calculó el promedio de ansiedad (7,62) y miedo (25,2) relacionado con la cirugía. El análisis de las variables demostró correlación positiva tanto de la ansiedad como del miedo preoperatorio con niveles de dolor más altos evaluados en distintos momentos del período posoperatorio. Además, la ansiedad preoperatoria tuvo un efecto mediador en la relación entre el miedo relacionado con la cirugía (manifestado en el período preoperatorio) y el dolor posoperatorio en las primeras 48 horas después de la cirugía. Conclusión Las variables psicológicas, ansiedad y miedo preoperatorio, influyeron en la intensidad del dolor posoperatorio en personas que realizaron cirugías electivas. Las intervenciones de enfermería orientadas hacia la ansiedad y el miedo pueden ser útiles para pacientes quirúrgicos.

Abstract Objective To identify the mediating effects of preoperative fear and anxiety on postoperative pain intensity in people undergoing elective surgeries up to six months after surgery. Methods This is an observational and longitudinal study with quantitative analysis, carried out with 172 adult patients admitted to a hospital and undergoing elective surgeries. The instruments used were: form for characterizing sociodemographic, clinical and surgical variables; Hospital Anxiety and Depression Scale; Surgical Fear Questionnaire; and Numeric Rating Scale for pain assessment. The interviews were carried out during the preoperative period, 48 hours after surgery and monthly until six months after surgery. For the descriptive statistical analysis of the explanatory variables, the absolute and relative frequencies, mean, standard deviation, median and minimum and maximum values were used. The relationship between the variables studied was analyzed using measures of correlation and mediating effects (structural equation model, maximum likelihood method). Results During the postoperative period (6 months), the mean pain ranged from 4.86 to 1.19. The means for anxiety (7.62) and fear (25.2) related to surgery were calculated. The analysis of variables showed a positive correlation between both preoperative fear and anxiety with the highest pain levels assessed at different moments in the postoperative period. Furthermore, preoperative anxiety exerted a mediating effect on the relationship between fear related to surgery, manifested in the preoperative period, and postoperative pain in the first 48 hours after surgery. Conclusion Psychological variables, such as preoperative fear and anxiety, influenced postoperative pain intensity in people undergoing elective surgeries. Nursing interventions aimed at anxiety and fear may be useful for surgical patients.

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ABSTRACT The COVID-19 pandemic has triggered a global crisis in health systems worldwide. Emergency care services have been overloaded, and there have been different changes in the patient's profile and the most frequent diagnoses. The aim of the study was to compare the number of emergency surgeries in the Hand and Microsurgery group of the quaternary hospital (IOT-FMUSP) from March 2020 to February 2022, the pandemic period, with the previous two years, March 2018 to February 2020. Two hundred and seventy-two patients were evaluated, with a mean age of 39.54 ± 17 years (range 1 to 90 years), 12.50% (n = 34) women and 87.50% (n = 238) men. Between March 2018 and February 2020, 142 (52.21%) emergency upper limb surgeries were performed; between March 2020 and February 2022, 130 surgeries were performed (47.79%). There was a reduction in upper limb surgeries in patients between 26-45 years and blunt injury surgeries. There was also an increase in surgeries in patients over 46, amputations, fractures, re-implantation procedures, and open fracture fixation. Level of evidence III, Retrospective Comparative Study.

RESUMO A pandemia por COVID-19 desencadeou uma crise global nos sistemas de saúde ao redor do mundo. Serviços de atendimento de urgência sofreram sobrecarga e diferentes mudanças no perfil do paciente atendido bem como dos diagnósticos mais frequentes. O objetivo do estudo foi comparar o número de cirurgias de urgência, no grupo de Mão e Microcirurgia, do hospital quaternário (IOT-FMUSP) ocorridos de março de 2020 a fevereiro de 2022, período pandêmico; com os dois anos anteriores, de março de 2018 a fevereiro de 2020. No total foram avaliados 272 pacientes com idade média de 39,54 ± 17 anos (variação 1 a 90 anos), sendo 12,50% (n = 34) de mulheres e 87,50 % (n = 238) de homens. Entre março de 2018 a fevereiro de 2020 foram realizadas 142 (52,21%) cirurgias de urgência em membro superior e de março de 2020 a fevereiro de 2022, 130 cirurgias foram realizadas (47,79%). Identificou-se redução do número de cirurgias em membro superior em pacientes entre 26-45 anos e do número de cirurgias por ferimentos corto contusos. Além do aumento no número de cirurgias em pacientes acima de 46 anos, número de casos de amputações, fraturas, procedimentos de reimplante e fixação por fraturas expostas. Nível de evidência III, Estudo restrospectivo comparativo.

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Introduction: The pandemic caused by the spread of the SARS-CoV-2 virus posed unprecedented challenges to health systems and societies worldwide. Among the greatest challenges was the importance of balancing the treatment of patients with potentially lethal diseases alongside the pandemic. Treatment for breast cancer, a time-dependent disease, was also compromised, as financial resources, supplies, medicines, and, especially, hospital beds needed to be allocated to assist those infected with the new coronavirus. Surgeries were suspended and surgical centers closed. To compare the number of breast surgical procedures before and during the pandemic and assess their impact on the proportional number of surgeries performed. Methods: This is a retrospective cohort study, reviewing procedures recorded from January 2015 to June 2021. Results: A total of 899 patients were included, the majority of whom were female; 58.5% of cases were oncological. The most prevalent surgery in both periods was conservative oncology (sectorectomy or quadrantectomy). There was a significant difference in the number of procedures performed before and during the COVID-19 outbreak, with a 43% drop during the pandemic. There was no significant difference in the pattern of surgeries. Conclusion: The pandemic caused a significant reduction in the total number of elective surgical interventions in the period analyzed ­ a delay that the literature identifies as a potential risk factor for disease progression and increased death rates. (AU)

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Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. Methods We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. Results We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. Conclucion Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidence How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series)

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Introduction: Patients with colonic obstruction are at risk for emergency resection, which is a risk factor for increased mortality and morbidity. In left-sided obstructive colon cancer, the principle of bridge-to-surgery is already recommended to reduce complications. From this treatment strategy, the obstruction treatment is derived. In this treatment strategy, bowel wall distention is reduced by minimizing stool production through laxatives and dietary measures. Short-term outcomes have already shown promising results. This study aims to evaluate long-term outcomes in patients treated with this obstruction treatment. Methods: This is a multicenter prospective study that included patients who presented with symptomatic colonic obstruction and radiologic confirmation of obstruction between May 2019 and August 2020 in the contributing hospitals. Patients with malignant and benign colonic obstruction were included. Follow-up in this study consisted of at least 36 months. Endpoints of the study included 1- and 3-year stoma and mortality rates. Results: Ninety-eight patients were included in this study. For the overall cohort complication, reoperation, and readmission rates after one year were 37%, 14%, and 10% respectively. Overall, 3-year mortality was 21%. The presence of a stoma after 1 year was 18%, and after 3 years 17% in this cohort. Conclusion: Long-term results of this study indicate that obstruction treatment has acceptable long-term outcomes in terms of mortality and stoma rates, compared to literature on emergency surgery and bridge-to-surgery alternatives. Permanent stoma rates are lower, compared to the literature on other treatment strategies in bowel obstruction. (AU)

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Objetivo:Classificar o risco de desenvolvimento de lesão por posicionamento cirúrgico. Método: Estudo observacional, longitudinal, prospectivo, de abordagem quantitativa realizado em hospital público, com 135 pacientes submetidos à cirurgia eletiva. Utilizaram-se instrumentos contendo caracterização sociodemográfica, clínica e cirúrgica e escala de avaliação de risco para desenvolvimento de lesões decorrentes do posicionamento cirúrgico. Empregaram-se análise descritiva, teste exato de Fisher ou teste χ2 e a medida de associação odds ratio, conforme apropriado. Resultados: A maioria dos participantes era do sexo masculino (51,11%), adulta (52,59%) e foi classificada como maior risco para o desenvolvimento de lesões por posicionamento cirúrgico (51,85%). Ser idoso, hipertensão, diabetes mellitus e cirurgias urológicas foram estatisticamente significativos (p < 0,05) para maior risco de desenvolvimento de lesões. A incidência de lesão por pressão foi de 0,74%, com observação apenas na região sacra. Conclusão: Verificou-se maior risco para desenvolvimento de lesão em decorrência do posicionamento cirúrgico e baixa incidência de lesão por pressão. A enfermagem perioperatória deve incorporar à prática assistencial ferramentas validadas de mensuração de risco para um cuidado seguro, individualizado e de qualidade aos pacientes cirúrgicos.

Objective:To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher's exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p < 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients,

Objetivo:Clasificar el riesgo de desarrollar lesión por posicionamiento quirúrgico. Método: Estudio observacional, longitudinal, prospectivo, con abordaje cuantitativo, realizado en un hospital público, con 135 pacientes sometidos a cirugía electiva. Se utilizaron instrumentos que contenían características sociodemográficas, clínicas y quirúrgicas y una Escala de Evaluación de Riesgo para el Desarrollo de Lesiones por Posicionamiento Quirúrgico. Se utilizó el análisis descriptivo, la prueba exacta de Fisher, o chi-cuadrado y la medida de asociación odds ratio, según corresponda. Resultados: La mayoría de los participantes eran hombres (51,11 %), adultos (52,59 %) y se clasificaron con mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico (51,85 %). Ancianos, hipertensión, diabetes mellitus y cirugías urológicas fueron estadísticamente significativos (p ˂ 0,05) para mayor riesgo de desarrollar lesiones. La incidencia de lesiones por presión fue del 0,74%, observándose solo en la región sacra. Conclusión: Hubo un mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico y una baja incidencia de lesión presión. La enfermería perioperatoria debe incorporar herramientas validadas de medición del riesgo en la práctica asistencial para una atención segura, individualizada y de calidad a los pacientes quirúrgicos.

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Objetivo: evaluar el desperdicio generado por el procesamiento de instrumental quirúrgico consignado en cirugías ortopédicas electivas y proponer un modelo para el cálculo del desperdicio asociado al procesamiento de instrumental quirúrgico consignado. Método: estudio de caso, cuantitativo, descriptivo-exploratorio, realizado en un hospital universitario grande, en dos fases: (1) retrospectiva, mediante la consulta de registros administrativos de cirugías ortopédicas electivas canceladas, con previsión de uso de materiales consignados, para identificar las subespecialidades con mayor demanda; y (2) prospectiva, por medio de observaciones directas, no participantes, del procesamiento de instrumental quirúrgico consignado preparado para las cirugías identificadas, y de la propuesta de un modelo para el cálculo del desperdicio asociado al procesamiento de estos materiales. Resultados: se identificaron las cirugías de artroplastia de cadera, artrodesis de columna y artroplastia de rodilla con mayor demanda, resultando en 854 cajas de instrumental quirúrgico consignado procesado y sin uso. El desperdicio del procesamiento se estimó en R$ 34.340,18 (US$ 6,359.30). Conclusión: la ecuación propuesta permitió calcular el desperdicio relacionado con la producción y la no utilización de cajas de instrumental quirúrgico consignado para procedimientos ortopédicos, y puede equipar a los enfermeros para la planificación basada en datos institucionales, asistenciales y financieros, con el objetivo de aprovechar mejor los recursos por medio de la identificación del desperdicio.

Objective: to evaluate the waste generated from processing surgical instruments consigned in elective orthopedic surgeries and propose a model for calculating waste associated with processing consigned surgical instruments. Method: a quantitative, descriptive-exploratory case study carried out in a large university hospital in two phases: (1) retrospective by consulting administrative records of canceled elective orthopedic surgeries, with provision for the use of consigned materials for identification of the sub-specializations with the greatest demand; and (2) prospective through direct, non-participant observations of processing consigned surgical instruments prepared for the identified surgeries and proposition of a model for calculating waste associated with processing these materials. Results: hip arthroplasty, spine arthrodesis and knee arthroplasty surgeries were identified as presenting the greatest demand, resulting in 854 boxes of consigned surgical instruments processed and unused. Processing waste was estimated at R$34,340.18 (US$6,359.30). Conclusion: the proposed equation made it possible to calculate the waste related to the production and non-use of boxes of surgical instruments consigned for orthopedic procedures and can equip nurses for planning based on institutional, care and financial data, aiming to make better use of resources through waste identification.

Objetivo: avaliar o desperdício gerado pelo processamento de instrumentais cirúrgicos consignados em cirurgias ortopédicas eletivas e propor um modelo de cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados. Método: estudo quantitativo, descritivo-exploratório, do tipo estudo de caso, realizado em hospital universitário de grande porte, em duas fases: (1) retrospectiva pela consulta aos registros administrativos de cirurgias ortopédicas eletivas canceladas, com previsão de uso de materiais consignados para identificação das subespecialidades com maior demanda e (2) prospectiva por meio de observações diretas, não participantes, do processamento de instrumentais cirúrgicos consignados preparados para as cirurgias identificadas e proposição de modelo de cálculo de desperdício associado ao processamento desses materiais. Resultados: foram identificadas as cirurgias de artroplastia de quadril, artrodese de coluna e artroplastia de joelho, com maior demanda, resultando em 854 caixas de instrumentais cirúrgicos consignados processados e não utilizados. O desperdício do processamento foi estimado em R$ 34.340,18 (US$ 6,359.30). Conclusão: a equação proposta permitiu calcular o desperdício relacionado à produção e não utilização de caixas de instrumentais cirúrgicos consignados para procedimentos ortopédicos e pode instrumentalizar os enfermeiros para o planejamento pautado em dados institucionais, assistenciais e financeiros, visando ao melhor aproveitamento dos recursos através da identificação do desperdício.

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Introducción: Los pacientes quirúrgicos geriátricos tienen afectación funcional y enfermedades asociadas, lo cual aumenta su riesgo quirúrgico con la edad. Objetivo: Determinar el comportamiento del uso de los antibióticos en pacientes geriátricos que requieren cirugía electiva atendidos en el Hospital Vladimir Ilich Lenin del 2018 al 2022. Métodos: Se realizó un estudio descriptivo, observacional, analítico y transversal a pacientes intervenidos por cirugía electiva con tratamiento con antibiótico. Los datos se obtuvieron de las historias clínicas y la entrevista aplicada. Se analizaron variables como edad, sexo, enfermedades asociadas, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, evolución, filtrado glomerular y dosis antibiótica perioperatoria. Resultados: El empleo de antibióticos fue más utilizado en los grupos de edades de 60 a 64 años y el sexo femenino; las comorbilidades que predominaron fueron la diabetes mellitus, la hipertensión arterial y la cardiopatía isquémica. Los motivos de consulta más frecuentes fueron por litiasis vesicular y por hernias dentro del grupo ASA I de la American Society of Anesthesiologists. Los antibióticos fundamentales fueron con dosis ajustada. Conclusiones: Se necesita de un trabajo diferenciado en cuanto a la atención al adulto mayor. La utilización de un protocolo o algoritmo de trabajo es necesario en la práctica diaria, sobre todo ante la necesidad de una cirugía electiva(AU)

Introduction: Geriatric surgical patients have functional impairment and associated diseases, which increases their surgical risk with age. Objective: To determine the behavior of antibiotic use in geriatric patients requiring elective surgery attended at Hospital Vladimir Ilich Lenin Hospital from 2018 to 2022. Methods: A descriptive, observational, analytical and cross-sectional study was conducted on patients undergoing elective surgery with antibiotic treatment. The data were obtained from medical records and the applied interview. The analyzed variables included age, sex, associated diseases, preoperative diagnosis, surgical time, complications, evolution, glomerular filtration and perioperative antibiotic dose. Results: Antibiotic use was more frequent in the age group 60 to 64 years and in the female sex; the most frequent comorbidities were diabetes mellitus, arterial hypertension and ischemic heart disease. The most frequent reasons for consultation were vesicular lithiasis and hernias within the ASA I group of the American Society of Anesthesiologists. The fundamental antibiotics were adjusted by doses. Conclusions: An individualized work is needed in terms of care of the older adult. The use of a working protocol or algorithm is necessary in daily practice, especially when elective surgery is required(AU)

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Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery, leading to the cancellation and postponement of various health services, including surgery. Numerous countries closed their borders and established laws mandating the use of face masks and social distancing and enforced lockdowns, and various activities were constrained. Brazil, the largest and most populous country in Latin America, also experienced a rapid and sustained surge in infections and deaths. Brazil was the most severely impacted nation in Latin America. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aimed to assess the impact of the COVID-19 pandemic on surgical services throughout the entire period. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022 and compared the following indicators: (1) number of hospital admissions, (2) length of hospital stay (LOS) (in days), and (3) volume of urgent and elective procedures. Data was divided into four time periods, pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the number of admissions and LOS based on surgical procedures performed by stratifying according to region, sex, age, and type of surgery (urgent versus elective). Results The number of admissions for surgical procedures ranged between 859,646 and 4,015,624 for 2019, 686,616 and 3,419,234 for 2020, 787,791 and 3,829,019 for 2021, and 760,512 and 3,857,817 for 2022 for the category of region; 4,260,900 and 5,991,775 for 2019, 3,594,117 and 4,984,710 for 2020, 4,182,640 and 5,590,808 for 2021, and 4,077,651 and 5,561,928 for 2022 for the category of sex; and 2,170,288 and 3,186,117 for 2019, 1,516,830 and 2,825,189 for 2020, 1,748,202 and 3,030,272 for 2021, and 1,900,023 and 2,859,179 for 2022 for the category of age. The variable age showed a comparable trend, albeit with an expressive decline for surgeries in the age range of 0-19 years. The LOS (in days) for surgical procedures ranged between 110,157 and 910,846 for 2019, 58,562 and 897,734 for 2020, 67,926 and 904,137 for 2021, and 100,467 and 823,545 for 2022. Thoracic surgery indicated no statistically significant difference in the number of admissions and LOS. Elective surgeries had a decline in the number of admissions and LOS, a 13% and 9.3% decline between 2019 and 2020, respectively. Urgent surgeries experienced a slight decrease in admissions and LOS, with a decline of 2.4% and 2.8% between 2019 and 2020, respectively. Conclusions Population characteristics, such as age, sex, and region, showed decreased hospital admissions during the pandemic, followed by a recovery toward pre-pandemic levels afterward. The number of surgical admissions and the length of hospital stays decreased during the pandemic but gradually returned to pre-pandemic levels in the recovery and post-pandemic phases. Notably, thoracic surgery remained statistically consistent across all periods, indicating its emergency nature compared to other surgeries. Thus, we conclude that the pandemic had minimal impact on thoracic surgery cases, contributing to a stable trend.

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Introducción: El proceso de formación de alumnos ayudantes exige nuevas concepciones teóricas y metodológicas, que permitan el desarrollo integral de los futuros profesionales de la salud. Esto mediante acciones específicas que influyan educativamente en la ejecución de los planes y programas de la carrera de Medicina, desde una proyección científica y pedagógica. Objetivo: Diseñar un curso electivo para la formación pedagógica de los alumnos ayudantes en la carrera de Medicina de la Filial Universitaria de Ciencias Médicas, del municipio Cárdenas. Materiales y métodos: La investigación se sustenta desde la concepción dialéctico materialista. Los métodos teóricos fueron: histórico-lógico, análisis documental, sistematización, sistémico estructural funcional y modelación. Entre los métodos empíricos se emplearon: revisión de documentos, encuestas a alumnos ayudantes y tutores. También se realizó observación al desempeño de los alumnos ayudantes. La población fue conformada por 103 alumnos ayudantes y 38 tutores. Resultados: Las insuficientes acciones pedagógicas para la formación de alumnos ayudantes, se constatan como problema en los tres indicadores de la dimensión cognitiva y en dos de los indicadores de las dimensiones procedimental y actitudinal. En el diseño del programa del curso electivo se abordan los temas a desarrollar, para potenciar la formación pedagógica en los alumnos ayudantes. Conclusiones: Se presenta un curso electivo para la formación pedagógica de alumnos ayudantes en la carrera de Medicina.

Introduction: The process of training assistant students requires new theoretical and methodological concepts that allow the comprehensive development of future health professionals. This by means of specific actions that educationally influence the execution of plans and programs of medicine studies, from a scientific and pedagogical projection. Objective: To design an elective course for the pedagogical training of assistant students in the medicine undergraduate studies of University Campus of Medical Sciences, in the municipality of Cardenas. Materials and methods: The research is based on the dialectical materialist conception. The theoretical methods were: historical-logical, documentary analysis, systematization, systemic structural functional and modeling. Among empirical methods used were: documentary review, surveys of the assistant students and tutors. Observation of the performance of assistant students was also carried out. The population consisted of 103 assistant students and 38 tutors. Results: Insufficient pedagogical actions for the training of assistant students are found as problems in the three indicators of the cognitive dimension and in two of the indicators of the procedural and attitudinal dimensions. In the design of the program of the elective course, the topics to be developed to enhance the pedagogical training of the assistant students are addressed. Conclusions: An elective course for the pedagogical training of assistant students in the Medicine undergraduate studies is presented.

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Introducción: La COVID-19 significó un gran reto para los servicios de cirugía a nivel mundial, lo que trajo como consecuencia modificaciones, incluso la suspensión de la actividad quirúrgica en algunos casos con el objetivo de garantizar seguridad tanto para el paciente como para el personal de salud. Objetivo: Describir acciones que contribuyan a garantizar condiciones de bioseguridad en ambientes quirúrgicos durante la pandemia de COVID-19. Métodos: Se realizó una revisión bibliográfica para la cual se usaron 37 referencias bibliográficas en inglés y español. Se consultaron fuentes científicas como PubMed/Medline, SciELO, Scopus, ScienceDirect y fuentes oficiales como la Organización Mundial de la Salud. Desarrollo: Ante la reanudación de la cirugía electiva se crearon protocolos de actuación. Deben clasificarse los pacientes en 3 grupos según la posibilidad de padecer COVID-19: individuos sanos, portadores asintomáticos y pacientes con síntomas. Además, debe darse prioridad a los pacientes cuyos procedimientos fueron cancelados. Se preconiza crear circuitos independientes y separados para evitar el contacto de casos sospechosos o confirmados de COVID-19 con el resto de pacientes. Para garantizar mayor seguridad debe entrenarse al personal médico en la forma correcta de utilizar los medios de protección personal. La inducción anestésica de estos pacientes debe garantizar su seguridad y prevenir el contagio. Una vez concluida la cirugía, se llevará a cabo la recuperación inicial del paciente dentro del propio quirófano y este será higienizado estrictamente. Conclusiones: Los profesionales sanitarios deben estar adecuadamente entrenados y conocer las medidas de bioseguridad y protocolos sanitarios tanto del hospital como del país en que se encuentren(AU)

Introduction: COVID-19 posed a great challenge to surgical services worldwide, resulting in modifications, including the suspension of surgical activity in some cases with the aim of ensuring safety for both the patient and the health personnel. Objective: To describe actions that contribute to guarantee biosafety conditions in surgical environments during the COVID-19 pandemic. Methods: A bibliographic review was carried out using 37 bibliographic references in English and Spanish. Scientific sources, such as PubMed/Medline, SciELO, Scopus and ScienceDirect, were consulted; as well as official sources, such as the World Health Organization. Development: When elective surgery was resumed, action protocols were created. Patients should be classified into 3 groups, according to the possibility of having COVID-19: healthy individuals, asymptomatic carriers, and patients with symptoms. In addition, priority should be given to patients whose procedures have been cancelled. Independent and isolated wards are recommended to be created in order to avoid contact between suspected or confirmed COVID-19 cases and the rest of the patients. To ensure greater safety, the medical personnel should be trained in the correct use of personal protective equipment. The anesthetic induction of these patients should ensure their safety and prevent contagion. Once the surgery is over, the initial recovery of the patient will be carried out inside the operating room itself, which shall be strictly sanitized. Conclusions: Healthcare professionals must be adequately trained and be aware of the biosecurity measures and healthcare protocols of both the hospital and the country where they are located(AU)

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Objectives This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. In addition to radiographic progressions, this study described the quality of life of these patients. Methods This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed. Results When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median value of 10°. In secondary curves, we observed an increase in angles from the proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317). Conclusion The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

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Objective To analyze the profile and perception of patients on the waiting list for total hip arthroplasty (THA) about performing elective surgeries during the COVID-19 pandemic. Methods From July to November 2021, patients on the THA waiting list were interviewed during outpatient consultations. To compare the groups regarding categorical variables, the Chi-square test or Fisher's exact test was applied, and for quantitative variables the Mann-Whitney test was applied. The results were calculated using the Statistica program version 7. Results 39 patients answered the questionnaire. The mean age was 58.95 years, with 53.85% male. Approximately 60% expressed concern about contracting or transmitting COVID-19 to their family members after hospitalization for THA. 58.9% of patients felt hampered by the delay in scheduling elective surgeries during the pandemic. 23% lost or had a family member who lost their job during the pandemic, with a statistical difference for the group under 60 years old (p = 0.04). Conclusion Most patients were concerned about becoming infected and exposing family members to COVID-19 after surgery and noted damage due to suspensions and delay in scheduling elective surgeries. The economic impact of the pandemic was revealed by the rate of 23% of respondents who lost or had a family member who lost their job during the pandemic, being higher in patients under 60 years of age (p = 0.04).