RESUMEN
OBJECTIVE: To establish the accuracy of frozen section examination in identifying tumor spread through air spaces (STAS), as well as to propose a reproducible technical methodology for frozen section analysis. We also aim to propose a method to be incorporated into the decision making about the need for conversion to lobectomy during sublobar resection. METHODS: This was a nonrandomized prospective study of 38 patients with lung cancer who underwent surgical resection. The findings regarding STAS in the frozen section were compared with the definitive histopathological study of paraffin-embedded sections. We calculated a confusion matrix to obtain the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy. RESULTS: The intraoperative frozen section analysis identified 7 STAS-positive cases that were also positive in the histopathological examination, as well as 3 STAS-negative cases that were positive in the in the histopathological examination. Therefore, frozen section analysis was determined to have a sensitivity of 70%, specificity of 100%, PPV of 100%, NPV of 90.3%, and accuracy of 92% for identifying STAS. CONCLUSIONS: Frozen section analysis is capable of identifying STAS during resection in patients with lung cancer. The PPV, NPV, sensitivity, and specificity showed that the technique proposed could be incorporated at other centers and would allow advances directly linked to prognosis. In addition, given the high accuracy of the technique, it could inform intraoperative decisions regarding sublobar versus lobar resection.
Asunto(s)
Secciones por Congelación , Neoplasias Pulmonares , Sensibilidad y Especificidad , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Reproducibilidad de los Resultados , Periodo Intraoperatorio , Valor Predictivo de las Pruebas , Anciano de 80 o más Años , Invasividad Neoplásica , Adulto , Cuidados Intraoperatorios/métodos , Neumonectomía/métodosRESUMEN
PURPOSE: This study aimed to analyze variations in intraoperative corneal thickness during corneal cross-linking in patients with keratoconus and to investigate its possible correlation with presurgical maximal keratometry (Kmax) and pachymetry. METHODS: This was a prospective case series. We used a method similar to the Dresden protocol, with the application of hydroxypropyl methylcellulose 0.1% hypo-osmolar riboflavin in corneas between 330 and 400 µm after epithelium removal. Corneal thickness was measured using portable calipers before and immediately after epithelium removal, and 30 and 60 min after the procedure. RESULTS: The 30 patients in this study were followed up for one year. A statistically significant difference was observed in pachymetry values during the intraoperative period (p<0.0001) and an increase of 3.05 µm (95%C1: 0.56-5.54) for each diopter was seen after epithelium removal (p0.019). We found an average Kmax difference of -2.12 D between men and women (p0.013). One year after treatment, there was a statistically significant reduction in pachymetry (p<0.0001) and Kmax (p0.0170) values. CONCLUSIONS: A significant increase in pachymetry measurements was seen during the procedure, and most patients showed a regression in Kmax and pachymetry values one year after surgery.
Asunto(s)
Córnea , Paquimetría Corneal , Reactivos de Enlaces Cruzados , Derivados de la Hipromelosa , Queratocono , Fármacos Fotosensibilizantes , Riboflavina , Humanos , Riboflavina/uso terapéutico , Femenino , Queratocono/tratamiento farmacológico , Masculino , Paquimetría Corneal/métodos , Estudios Prospectivos , Adulto , Reactivos de Enlaces Cruzados/uso terapéutico , Adulto Joven , Córnea/diagnóstico por imagen , Córnea/patología , Córnea/cirugía , Córnea/efectos de los fármacos , Derivados de la Hipromelosa/uso terapéutico , Fármacos Fotosensibilizantes/uso terapéutico , Adolescente , Resultado del Tratamiento , Factores de Tiempo , Periodo Intraoperatorio , Valores de Referencia , Topografía de la Córnea/métodos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: this study aimed at estimating and comparing the reliability of temperature measurements obtained using a peripheral infrared temporal thermometer, a central cutaneous thermometer ("Zero-Heat-Flux Cutaneous thermometer") and an esophageal or nasopharyngeal thermometer among elective surgical patients in the intraoperative period. METHOD: a longitudinal study with repeated measures carried out by convenience sampling of 99 patients, aged at least 18 years old, undergoing elective abdominal cancer surgeries, with anesthesia lasting at least one hour, with each patient having their temperature measured by all three methods. RESULTS: the intraclass correlation coefficient showed a low correlation between the measurements using the peripheral temporal thermometer and the central cutaneous (0.0324) and esophageal/nasopharyngeal (-0.138) thermometers. There was a high correlation (0.744) between the central thermometers evaluated. CONCLUSION: the data from the current study do not recommend using infrared temporal thermometers as a strategy for measuring the body temperature of patients undergoing anesthetic-surgical procedures. Central cutaneous thermometers and esophageal/nasopharyngeal thermometers are equivalent for detecting intraoperative hypothermia.
Asunto(s)
Temperatura Corporal , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Longitudinales , Anciano , Termómetros/normas , Adulto , Periodo Intraoperatorio , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/instrumentaciónRESUMEN
Objetivo: Verificar el riesgo de úlceras por presión en pacientes sometidos a cirugía de columna y analizar los factores de riesgo asociados. Método: Investigación de campo descriptiva-exploratoria, transversal, con análisis cuantitativo, realizada en dos etapas (preoperatoria e intraoperatoria), con 55 pacientes sometidos a cirugía de columna, en un hospital privado de São Paulo, mediante la aplicación de un formulario de caracterización del participante y de la cirugía y aplicación de la Escala de Evaluación de Riesgos para el Desarrollo de Lesiones Derivadas del Posicionamiento Quirúrgico (ELPO). Resultados: Según la ELPO, 33 de los 55 pacientes (60,0%) tuvieron una puntuación de riesgo mayor para lesiones por presión. Los pacientes de mayor riesgo tenían una edad promedio de 50,2 años, clasificados como con sobrepeso y obesidad, y un tiempo quirúrgico promedio de 2 horas y 45 minutos. Hubo diferencias estadísticas significativas entre los grupos de mayor y menor riesgo, relacionadas con: edad, peso, índice de masa corporal y tiempo de cirugía. El riesgo del paciente de desarrollar una lesión por presión aumenta proporcionalmente con la edad, el peso, el índice de masa corpo-ral y la duración de la cirugía. A medida que aumentan estos factores, aumenta el riesgo del paciente de desarrollar lesiones por presión. Conclusión: El riesgo de lesiones por presión relacionadas con procedimientos quirúrgicos de columna fue significativo, revelando una realidad en la que corresponde al enfermero perioperatorio planificar medidas preventivas, con el fin de mitigar la aparición de tales lesiones y garantizar la seguridad del paciente. (AU)
Objective: To verify the risk of pressure injury in patients undergoing spine surgery and analyze the associated risk factors. Method: This is a descriptive-exploratory, cross-sectional field research, with quantitative analysis carried out in two stages (pre-operative and intraoperative), with 55 patients undergoing spine surgery, in a private hospital in São Paulo, Brazil, through the application of a characterization form of the participant and the surgery and the application of the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO). Results: According to ELPO, 33 of the 55 patients (60.0%) had a higher risk score for pressure injury. Patients at highest risk had an average age of 50.2 years, classified as overweight and obese, and had a mean surgery time of 2 hours and 45 minutes. There were significant statistical differences between the higher and lower risk groups, related to: age, weight, body mass index, and surgery time. The patient's risk of developing a pressure injury increases proportionally with increasing age, weight, body mass index, and surgery duration. As these factors increase, the patient's risk of developing pressure injury increases. Conclusions: The risk of pressure injury related to spinal surgical procedures was significant, evidencing a reality in which the perioperative nurse is res-ponsible for planning preventive measures to mitigate the occurrences of such injuries and ensure patient safety. (AU)
Objetivo: Verificar o risco de lesão por pressão em pacientes submetidos a cirurgias de coluna e analisar os fatores de risco associados. Método:Pesquisa de campo descritivo-exploratória, transversal, com análise quantitativa, realizada em duas etapas (pré-operatório e transoperatório), com 55 pacientes submetidos à cirurgia de coluna, em hospital privado de São Paulo, por meio da aplicação de um formulário de caracterização do participante e da cirurgia e aplicação da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico (ELPO). Resultados: De acordo com a ELPO, 33 dos 55 pacientes (60,0%) apresentaram escore de maior risco para lesão por pressão. Os pacientes que apresentaram maior risco tinham idade média de 50,2 anos, classificados como sobrepeso e obesidade e tempo médio de cirurgia de 2 horas e 45 minutos. Houve diferenças estatísticas significativas entre os grupos de maior e menor risco, relacionadas com: idade, peso, índice de massa corpórea e tempo de cirurgia. O risco de o paciente desenvolver lesão por pressão aumenta proporcionalmente conforme o aumento da idade, do peso, do índice de massa corpórea e a dura-ção da cirurgia. Com o aumento desses fatores, aumenta o risco de o paciente desenvolver lesão por pressão. Conclusão: O risco de lesão por pressão relacionado ao procedimento cirúrgico de coluna foi significativo, revelando uma realidade na qual cabe ao enfermeiro perioperatório planejar medidas preventivas, no intuito de mitigar as ocorrências de tais lesões e garantir a segurança do paciente. (AU)
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Anciano , Úlcera por Presión , Posicionamiento del Paciente , Periodo Intraoperatorio , Procedimientos OrtopédicosRESUMEN
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.
Asunto(s)
Perforación Intestinal , Peritonitis , Complicaciones Posoperatorias , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Perforación Intestinal/mortalidad , Perforación Intestinal/cirugía , Peritonitis/mortalidad , Peritonitis/cirugía , Peritonitis/etiología , Índice de Masa Corporal , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Periodo Preoperatorio , Diverticulitis/cirugía , Diverticulitis/complicaciones , Diverticulitis/mortalidad , Índice de Severidad de la Enfermedad , Factores de Edad , Comorbilidad , Periodo Intraoperatorio , MorbilidadRESUMEN
PURPOSE: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations. METHODS: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected. RESULTS: The median age of the patients was 54 years old, with 67% (219) being male. The most prevalent ABO blood type was O, accounting for 48% (155) of cases. The leading causes of liver disease were hepatitis C (113 cases, 34.6%) and alcohol-related liver disease (97 cases, 29.7%). Out of the 327 liver transplants, allogeneic red blood cell transfusions were administered in 110 cases (34%) with a median of two units of red blood cells per case. Cell salvage was employed in 237 transplants (73%), and successful blood recovery was achieved in 221 cases (93%). Among the group that recovered more than 200 mL of blood, the median volume of recovered blood was 417 mL, with no transfusion of allogeneic blood required. A total of 90 transplants was performed without utilizing cell salvage, and, among these cases, 19 required blood transfusions, with a median of zero units transfused. CONCLUSIONS: This study suggests that routine cell salvage is unnecessary for all liver transplantations. The most suitable indication for its use is in patients presenting with portal vein thrombosis and abnormal creatinine levels.
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Hepatopatías , Trasplante de Hígado , Humanos , Masculino , Persona de Mediana Edad , Femenino , Transfusión de Sangre Autóloga , Trasplante de Hígado/efectos adversos , Transfusión Sanguínea , Periodo Intraoperatorio , Hepatopatías/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Intraoperative cytology (IC) is an alternative to frozen-section (FS) diagnosis. We present our experience with and the diagnostic value of IC during a 7-year period when FS was not available in a Peruvian Cancer Center. MATERIAL AND METHODS: This 7-year retrospective single-arm review study includes IC procedures performed by three pathologists between 2012 and 2018. These IC reports were reviewed independently by one pathologist and were correlated with the histologic diagnoses, which were used as the gold standard. All IC preparations (imprint, scrape, and crush smears) were stained with hematoxylin and eosin. IC interpretations were categorized as: malignant, benign, atypical, and "deferred to permanent sections." Sensitivity, specificity, and positive and negative predictive values were calculated by use of standard methods. RESULTS: A total of 1814 IC cases prepared from various organs obtained from 887 patients were reviewed. Malignant, benign, atypical, and "deferred to permanent sections" IC diagnoses were 26.3%, 68.9%, 3.7%, and 1.9%, respectively. Atypical and deferred cases were excluded from the statistical analysis; thus 1712 cases were found to be eligible. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were 91.6%, 97.7%, 94.1%, 96.7%, and 96%, respectively. CONCLUSION: In experienced hands, IC is a rapid, cost-effective, and accurate alternative diagnostic modality for intraoperative diagnosis when FS is not available.
Asunto(s)
Citodiagnóstico , Neoplasias , Humanos , Estudios Retrospectivos , Perú , Citodiagnóstico/métodos , Valor Predictivo de las Pruebas , Secciones por Congelación/métodos , Sensibilidad y Especificidad , Periodo IntraoperatorioRESUMEN
Objetivo: Conhecer as estratégias utilizadas por instrumentadores para o controle de materiais e instrumental cirúrgico no intraope-ratório. Método: Estudo descritivo e qualitativo, realizado em hospital privado. Participaram 13 instrumentadores cirúrgicos. Os dados foram coletados entre agosto e setembro de 2022 por meio de entrevistas gravadas em áudio. Como instrumento para coleta dos dados, utilizou-se um roteiro estruturado, contendo sete perguntas, e questões referentes ao perfil da amostra. Foram incluídos técnicos de enfermagem forma-dos, atuantes como instrumentadores cirúrgicos. Foram excluídos instrumentadores ausentes no período da coleta de dados. Os dados foram analisados por meio da análise de conteúdo. Resultados: Com base na análise dos dados, emergiram quatro categorias: protocolo de cirurgia segura; controle de materiais e instrumentais; desafios no seguimento do protocolo de cirurgia segura; facilitadores do seguimento do proto-colo de cirurgia segura. Conclusão: Pôde-se conhecer as estratégias utilizadas por instrumentadores cirúrgicos para o controle dos materiais dispostos na mesa de instrumentação durante o intraoperatório. Pressa de profissionais, falta de adesão e o não seguimento de rotinas insti-tucionais caracterizam-se como desafios para o seguimento das etapas do protocolo de cirurgia segura
Objective: To know the strategies used by surgical technologists to control materials and surgical instruments in the intraopera-tive period. Method: This qualitative descriptive study was carried out in a private hospital. A total of 13 surgical technologists participated in the research. Data were collected during audio-recorded interviews between August and September 2022. The data collection instrument was a structured questionnaire consisting of seven questions, as well as items related to the sample profile. We included trained nursing technicians, working as surgical technologists. Those who were absent during data collection were excluded. Data were analyzed by con-tent analysis. Results: The data analysis produced four categories: surgical safety checklist; control of materials and instruments; challenges in following the surgical safety checklist; facilitators to following the surgical safety checklist. Conclusions: The study allowed us to know the strategies used by surgical technologists to control the materials arranged on the instrument table during the intraoperative period. The haste of professionals, lack of adherence, and non-compliance with institutional routines are regarded as challenges in following the steps of the surgical safety checklis
Objetivo: Conocer las estrategias utilizadas por instrumentistas para el control de materiales e instrumental quirúrgico en el intraope-ratorio. Método: Estudio descriptivo y cualitativo, realizado en hospital privado. Participaron 13 instrumentistas quirúrgicos. Los datos fueron colectados entre agosto y septiembre de 2022 por medio de entrevistas grabadas en audio. Como instrumento para colecta de los datos, se utilizó um guion estructurado, conteniendo siete preguntas, y cuestiones referentes al perfil de la muestra. Fueon incluidos técnicos de enfermería egre-sados, actuantes como instrumentistas quirúrgicos. Fueron excluidos instrumentistas ausentes en el período de la colecta de datos. Los datos fue-ron analizados por medio del análisis de contenido. Resultados: Con base en el análisis de los datos, emergieron cuatro categorías: protocolo de cirugía segura; control de materiales e instrumentales; desafíos en el seguimiento del protocolo de cirugía segura; facilitadores del seguimiento del protocolo de cirugía segura. Conclusión: Se pueden conocer las estrategias utilizadas por instrumentistas quirúrgicos para el control de los materiales dispuestos en la mesa de instrumentación durante el intraoperatorio. Prisa de profesionales, falta de adhesión y el no seguimiento de rutinas institucionales se caracterizan como desafíos para el seguimiento de las etapas del protocolo de cirugía segura
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Medidas de Seguridad , Instrumentos Quirúrgicos/normas , Enfermería Perioperatoria/normas , Periodo Intraoperatorio , Investigación CualitativaRESUMEN
Introducción: Existe poca evidencia respecto de la concordancia entre el plan preoperatorio mediante artroplastia total de rodilla asistida por robot y el plan posterior al balance protésico realizado por el cirujano. El objetivo de este trabajo es evaluar el grado de concordancia entre la planificación preoperatoria de la artroplastia total de rodilla con asistencia robótica semiactiva (Mako) y la planificación efectuada por el traumatólogo durante la cirugía. Materiales y métodos: estudio retrospectivo y descriptivo de prótesis primarias instaladas entre octubre de 2018 y junio de 2019 con planificación preoperatoria realizada por el software MAKOplasty®. Se excluyeron las prótesis no colocadas por el sistema robótico o con información clínica incompleta. Esto se comparó con la planificación intraoperatoria del traumatólogo. Variables analizadas: alineación coronal y sagital, rotación y tamaño de los componentes e inserto. Los datos se analizaron con el softwareSTATA v.16.0. Se realizó un análisis descriptivo univariante cualitativo, con un intervalo de confianza del 95%. Resultados: se incluyeron cincuenta y una rodillas operadas de cuarenta y nueve pacientes, el 69% fueron mujeres. El nivel de concordancia para el componente femoral fue: axial 86.3% (IC = 73.7 - 94.2), coronal 88.2% (IC = 76.1 - 95.5), sagital 88.2% (IC = 76.1 - 95.5). Componente tibial: axial 98% (IC = 89.5 99.9), coronal 96.1% (IC = 86.5 99.5), sagital 96.1% (IC = 86.5 99.5). Tamaño del componente: fémur 94.1% (IC = 83.7 98.7), tibia 84.3% (IC = 71.4 92.9), inserto 27.4% (IC = 15.8 41.7). Conclusión: la planificación preoperatoria mediante el uso de la asistencia robótica semiactiva de Mako presenta un buen nivel de concordancia con la planificada intraoperatoriamente, a excepción del tamaño del inserto. El traumatólogo es determinante en la modificación del plan preoperatorio. Nivel de Evidencia: III
Introduction: There is little evidence regarding the concordance between the preoperative plan using robotic-assisted total knee arthroplasty and that after the prosthetic balance by the surgeon. Our aim is to evaluate the level of agreement between the preoperative planning of total knee arthroplasty with semiactive robotic assistance (Mako) and the planning made by the orthopedic surgeon during the surgery. Materials and methods: descriptive study of prostheses installed between October 2018 and June 2019 with preoperative planning performed by the MAKOplasty® software. This was compared with intraoperative planning by the Orthopedic Surgeon. Variables analyzed: coronal and sagittal alignment, rotation and size of the components and insert. The data was analyzed with the STATA v.16.0 software. A qualitative univariate descriptive analysis was performed, with a 95% confidence interval. Results: fifty-one operated knees from forty-nine patients were included, 69% were women. The level of agreement was: Femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI = 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]. Tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI = 86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]. Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert 27.4% [CI = 15.8 - 41.7]. Conclusion: preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The orthopedic surgeon is decisive in modifying the preoperative plan. Level of Evidence: III
Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Artroplastia de Reemplazo de Rodilla , Cirugía Asistida por Computador , Periodo Preoperatorio , Periodo Intraoperatorio , Articulación de la Rodilla/cirugíaRESUMEN
El método de Ilizarov, con sus diferentes variantes y mediante la utilización de su aparato, desarrollado en la década del 50, continúa vigente, sobre todo en el tratamiento de las complicaciones de fracturas, principalmente aquellas vinculadas a la infección y a las dificultades de la consolidación. Reportamos 2 pacientes adultos con diagnóstico de pseudoartrosis hipertrófica, rígida, con deformidad, sin infección activa y sin dismetría, tratados mediante el método de distracción y compresión realizado con el aparato de Ilizarov. En ambos casos se logró la alineación y consolidación del miembro con escasas complicaciones.
The Ilizarov method, with its different variants and using its apparatus, developed in the 1950s, is still valid, especially in the treatment of fracture complications, mainly those linked to infection and consolidation difficulties. We report 2 adult patients with a diagnosis of hypertrophic, rigid nonunion, with deformity, without active infection and without dysmetria, treated by the distraction and compression method performed with the Ilizarov device. In both cases, the alignment and consolidation of the limb was achieved with few complications.
O método de Ilizarov, com suas diferentes variantes e pelo uso de seu aparato, desenvolvido na década de 1950, ainda é válido, principalmente no tratamento de complicações de fraturas, principalmente aquelas ligadas à infecção e dificuldades de consolidação. Relatamos 2 pacientes adultos com diagnóstico de pseudoartrose hipertrófica, rígida, com deformidade, sem infecção ativa e sem dismetria, tratados pelo método de distração e compressão realizado com o dispositivo de Ilizarov. Em ambos os casos, o alinhamento e a consolidação do membro foram alcançados com poucas complicações.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Seudoartrosis/cirugía , Fracturas de la Tibia/cirugía , Técnica de Ilizarov , Periodo Posoperatorio , Fracturas de la Tibia/complicaciones , Estudios de Seguimiento , Resultado del Tratamiento , Periodo IntraoperatorioRESUMEN
RESUMO Objetivo: analisar a perspectiva das enfermeiras sobre as repercussões da hipotermia na saúde de recém-nascidos cirúrgicos. Método: estudo descritivo, exploratório, com abordagem qualitativa. Desenvolvido no período de setembro de 2020 a fevereiro de 2021, tendo como participantes 13 enfermeiras assistenciais de uma unidade neonatal localizada na capital baiana. Os dados foram coletados por meio da entrevista semiestruturada e investigados pela técnica de análise de conteúdo temática, à luz da teoria ambientalista e evidências científicas atuais. Resultados: na percepção das enfermeiras, a hipotermia tem repercussões sistêmicas na saúde do neonato, devido ao estresse compensatório causado, interferindo, assim, desfavoravelmente no pré, no transoperatório e no retardo e complicação da recuperação cirúrgica; repercutindo, sobretudo, na morbimortalidade do recém-nascido cirúrgico. Conclusão: a hipotermia no recém-nascido cirúrgico se caracteriza como um evento adverso grave, por apresentar riscos, danos e agravos à saúde, o que favorece a elevação dos índices de morbimortalidade neonatal. Além disso, a partir da discussão dos resultados, foi possível refletir sobre a importância da aplicabilidade da teoria ambientalista no gerenciamento e na assistência ao quadro hipotérmico.
RESUMEN Objetivo: analizar el punto de vista de las enfermeras sobre las repercusiones de la hipotermia en la salud de los recién nacidos quirúrgicos. Método: estudio descriptivo y exploratorio con un enfoque cualitativo. Desarrollado en el período de septiembre de 2020 a febrero de 2021, con la participación de 13 enfermeras de cuidados de una unidad neonatal, ubicada en la capital de Bahía. Los datos se recopilaron mediante una entrevista semiestructurada y se investigaron con la técnica de análisis del contenido temático a la luz de la teoría ambientalista y las pruebas científicas actuales. Resultados: según la percepción del personal de enfermería, la hipotermia tiene repercusiones sistémicas en la salud del recién nacido, debido al estrés compensatorio que provoca, interfiriendo desfavorablemente en los periodos preoperatorio y transoperatorio, y en el retraso y las complicaciones de la recuperación quirúrgica, afectando especialmente a la morbilidad y mortalidad de los recién nacidos quirúrgicos. Conclusión: la hipotermia en los recién nacidos quirúrgicos se caracteriza por ser un evento adverso grave, ya que supone riesgos, daños y empeoramiento de la salud, lo que favorece el aumento de las tasas de morbilidad y mortalidad neonatal. Además, a partir de la discusión de los resultados, se pudo reflexionar sobre la importancia de la aplicación de la teoría ambiental en el manejo y asistencia de la hipotermia.
ABSTRACT Objective: to analyze the nurses' perspective on the repercussions of hypothermia on the health of surgical newborns. Method: descriptive, exploratory study with a qualitative approach. Developed from September 2020 to February 2021, with the participation of 13 nurses from a neonatal unit located in the capital of Bahia, Brazil. Data were collected through semi-structured interviews and investigated using thematic content analysis technique, in the light of environmental theory and current scientific evidence. Results: in the nurses' perception, hypothermia has systemic repercussions on the health of the neonate, due to the compensatory stress caused, thus interfering unfavorably in the preoperative, intraoperative period and in the delay and complication of surgical recovery; impacting, above all, on the morbidity and mortality of the surgical newborn. Conclusion: hypothermia in surgical newborns is characterized as a serious adverse event, as it presents risks, damages, and health problems, which favors an increase in neonatal morbidity and mortality rates. In addition, from the discussion of the results, it was possible to reflect on the importance of the applicability of the environmental theory in the management and assistance to the hypothermic condition.
Asunto(s)
Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Factores de Riesgo , Enfermería Neonatal , Hipotermia , Personal de Enfermería en Hospital , Percepción , Procedimientos Quirúrgicos Operativos/efectos adversos , Indicadores de Morbimortalidad , Periodo IntraoperatorioRESUMEN
Objetivo: Conhecer a percepção dos enfermeiros de centro cirúrgico sobre a evolução de enfermagem do período intraoperatório. Método: Estudo exploratório com abordagem qualitativa, realizado por meio de entrevistas online com enfermeiros que trabalham em centro cirúrgico, entre junho e julho de 2021. Amostra intencional, não probabilística, constituída de 12 enfermeiras. Dados avaliados pela análise de conteúdo de Bardin e pelo software MAXQDA 2020®. Resultados: Identificaram-se as palavras da classe de substantivos de maior frequência no corpus das entrevistas: paciente, sala, tempo, cirurgia e cirurgias. Emergiram três categorias temáticas: sobrecarga de trabalho e disponibilidade de tempo dos enfermeiros de centro cirúrgico; atuação assistencial do enfermeiro no intraoperatório; efeitos da pandemia de COVID-19. Conclusão: As enfermeiras percebem a realização da evolução de enfermagem intraoperatória como uma ferramenta que aproxima o enfermeiro da atuação assistencial e qualifica a prática perioperatória. Contudo as fragilidades organizacionais impactam a dedicação desses profissionais no cuidado direto ao paciente.
Objective: To know the perception of surgical center nurses about the evolution of nursing in the intraoperative period. Method: Exploratory study with a qualitative approach, carried out through online interviews with nurses working in a surgical center, between June and July 2021. Intentional, non-probabilistic sample consisting of 12 nurses. Data evaluated by Bardin's content analysis and MAXQDA 2020® software. Results: The most frequent nouns were identified in the corpus of the interviews: patient, room, time, surgery, and surgeries. Three thematic categories emerged: work overload and time availability of surgical center nurses; nurses' assistance in the intraoperative period; effects of the COVID-19 pandemic. Conclusion: Nurses perceive the development of intraoperative nursing as a tool that brings nurses closer to care work and qualifies perioperative practice. However, organizational weaknesses impact the dedication of these professionals in direct patient care.
Objetivo: Conocer la percepción de los enfermeros de quirófano sobre la evolución de la enfermería en el intraoperatorio. Método: Estudio exploratorio con enfoque cualitativo, realizado a través de entrevistas online con enfermeras que trabajan en un centro quirúrgico, entre junio/julio de 2021. Muestra intencional, no probabilística compuesta por 12 enfermeras. Datos evaluados a partir del análisis de contenido de Bardin y el software MAXQDA 2020®. Resultados: Se identificaron las palabras de la clase de sustantivos más frecuentes en el corpus de las entrevistas: paciente, habitación, tiempo, cirugía y cirugías. Emergieron tres categorías temáticas: sobrecarga de trabajo y disponibilidad de tiempo de los enfermeros de CQ; asistencia de enfermeras en el período intraoperatorio; y efectos de la pandemia de COVID-19. Conclusión: Las enfermeras perciben el desarrollo de la enfermería intraoperatoria como una herramienta que acerca al enfermero al trabajo de cuidado y cualifica la práctica perioperatoria. Sin embargo, las debilidades organizativas impactan en la dedicación de estos profesionales en la atención directa al paciente.
Asunto(s)
Humanos , Centros Quirúrgicos , Periodo Intraoperatorio , Enfermeras y Enfermeros , Quirófanos , Atención al Paciente , Atención de EnfermeríaRESUMEN
RESUMO Objetivo avaliar a adesão às medidas recomendadas para prevenção de infecção do sítio cirúrgico no período perioperatório em pacientes submetidos às cirurgias limpas. Método estudo observacional e de coorte prospectivo realizado em 2019 em um hospital geral de ensino com 287 pacientes, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados por meio de dois instrumentos: caracterização sociodemográfica e clínica e verificação da adesão às recomendações. Empregaram-se análises descritiva e regressão linear múltipla. Resultados a adesão geral às medidas de prevenção de infecção do sítio cirúrgico obteve média de 59,5. O tempo anestésico-cirúrgico (p<0,001) e o escore da American Society of Anesthesiologists (p=0,045) influenciaram na adesão geral. Conclusão foi observada maior adesão às medidas recomendadas para prevenção de infecção do sítio cirúrgico no período pré-operatório, porém há fragilidades quanto a adesão às medidas fortemente recomendadas pelos guidelines nos períodos intra e pós-operatório.
RESUMEN Objetivo evaluar el cumplimiento de las medidas recomendadas para prevenir la infección de la zona quirúrgica en el período perioperatorio en pacientes sometidos a cirugías limpias. Método estudio observacional y de cohorte prospectivo realizado en 2019, en un hospital general de enseñanza junto a 287 pacientes, previa aprobación del Comité de Ética en Investigación. La recolección de datos se realizó mediante dos instrumentos: caracterización sociodemográfica y clínica y verificación del cumplimiento de las recomendaciones. Se utilizó el análisis descriptivo y la regresión lineal múltiple. Resultados la adherencia general a las medidas de prevención de infecciones de la zona quirúrgica obtuvo el promedio de 59,5. El tiempo anestésico-quirúrgico (p <0,001) y el puntaje de la American Society of Anesthesiologists (p = 0,045) influyeron en la adherencia general. Conclusión se observó una mayor adherencia a las medidas recomendadas para prevenir la infección de la zona quirúrgica en el período preoperatorio, sin embargo, existen debilidades en cuanto a la adherencia a las medidas fuertemente recomendadas por los guidelines en los periodos intra y posoperatorio.
ABSTRACT Objective to evaluate adherence to recommended measures for preventing surgical site infections during the perioperative period in patients undergoing clean surgeries. Method this prospective, observational, cohort study was conducted in 2019 with 287 patients at a general teaching hospital, after approval by the research ethics committee. Data were collected using two instruments for sociodemographic and clinical particulars and for assessing adherence to recommendations. Descriptive analysis and multiple linear regression were used. Results adherence to surgical site infection prevention measures averaged 59.5 overall. Anesthetic-surgical time (p < 0.001) and the American Society of Anesthesiologists score (p = 0.045) influenced overall adherence. Conclusion greater adherence to recommended surgical site infection prevention measures was observed in the preoperative period, but there were weaknesses in adherence to measures strongly recommended by the guidelines in the intra- and postoperative periods.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infección de la Herida Quirúrgica/prevención & control , Control de Infecciones , Seguridad del Paciente , Infección de la Herida Quirúrgica , Estudios de Cohortes , Procedimientos Quirúrgicos Electivos , Periodo Perioperatorio/enfermería , Periodo IntraoperatorioRESUMEN
Objetivo: Identificar e mapear os cuidados de enfermagem no período perioperatório para com o paciente submetido a cirurgias oncológicas robóticas. Método:Revisão de escopo, com base nas recomendações do Joanna Briggs Institute, realizada entre outubro e dezembro de 2020 nas bases de dados Biblioteca Virtual em Saúde (BVS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine (PubMed) e Scopus. A delimitação temporal dos estudos foi de 2010 a 2020. Resultados: Foram identificadas 84 publicações, tendo-se incluído oito na amostra. Os resultados apontaram a importância da avaliação de enfermagem pré-operatória e do esclarecimento dos efeitos colaterais da cirurgia. No transoperatório, houve recomendações acerca do registro do processo de enfermagem, da prevenção da hipotermia periope-ratória e de lesões relativas ao posicionamento, bem como da educação continuada da equipe. Os achados evidenciaram o papel da enfermagem nas disfunções do assoalho pélvico e na identificação de déficits no autocuidado e no domínio sexual, especialmente no pós-operatório de pacientes submetidos a prostatectomias. Conclusão: As reco-mendações identificadas são capazes de minimizar os impactos negativos das cirurgias oncológicas e, consequentemente, melhorar a assistência de enfermagem perioperatória.
Objective: To identify and map perioperative nursing care for patients submitted to robotic cancer surgeries. Method: This is a scoping review based on recommen-dations from the Joanna Briggs Institute, held between October and December 2020 in the following databases: Virtual Health Library (VHL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine (PubMed), and Scopus. The study time frame spans from 2010 to 2020. Results: We identified 84 publications and included eight in the sample. The results indicated the importance of preoperative nursing evaluation and clarification of surgery side effects. Recommendations for the intraoperative period included recording the nursing process, preventing perioperative hypothermia and positioning injuries, as well as continuing education for the team. The findings evidenced the role of nursing in pelvic floor dysfunctions and in identifying deficits in self-care and sexuality, especially in the postoperative period of patients submitted to prostatectomies. Conclusions: The recommendations identified can minimize the negative impacts of cancer surgeries and, consequently, improve perioperative nursing care.
Objetivo: Identificar y mapear los cuidados de enfermería en el período perioperatorio de los pacientes sometidos a cirugía robótica oncológica. Método:Revisión del alcance, en base a las recomendaciones del Instituto Joanna Briggs, realizada entre octubre y diciembre de 2020, en las bases de datos Biblioteca Virtual en Salud (BVS), CINAHL, PubMed y Scopus. La delimitación temporal de los estudios fue de 2010 a 2020. Resultados: Se identificaron 84 publicaciones, incluidas ocho en la muestra. Los resultados mostraron la importancia de la evaluación de enfermería preoperatoria y el esclarecimiento de los efectos secundarios de la cirugía. Durante el transoperatorio, hubo recomendaciones en cuanto al registro del proceso de enfermería, prevención de hipotermia perioperatoria y lesiones relacionadas con el posicionamiento, así como la educación continua del equipo. Los hallazgos evidenciaron el papel de la enfermería en los trastornos del suelo pélvico y en la identifica-ción de déficits en el autocuidado y en el dominio sexual, especialmente en el postoperatorio de pacientes sometidas a prostatectomías. Conclusión: Las recomenda-ciones identificadas son capaces de minimizar los impactos negativos de las cirugías oncológicas y, en consecuencia, mejorar la atención de enfermería perioperatoria.
Asunto(s)
Humanos , Procedimientos Quirúrgicos Robotizados , Oncología Médica , Atención de Enfermería , Periodo Posoperatorio , Periodo Perioperatorio , Periodo IntraoperatorioRESUMEN
Introducción: Las técnicas de anestesia y analgesia regional en la población pediátrica garantizan la estabilidad hemodinámica y respiratoria. El uso de la anestesia caudal ha aumentado enormemente sobre todo para cirugías de abdomen inferior lo que ofrece ventajas sobre la anestesia general. Objetivo: Argumentar sobre la base de la mejor evidencia científica, la opinión de los autores en relación a la efectividad del uso de la anestesia caudal en los pacientes neonatos. Método: El marco inicial de búsqueda bibliográfica se constituyó por los artículos publicados acerca de la utilización de la anestesia caudal en neonatos. Las fuentes de información que se utilizaron fueron: Registro Cochrane central de ensayos clínicos controlados, Pubmed, LILACS, SciELO, Ebsco, Science, Google académico. Resultados: El bloqueo caudal es la aplicación de un anestésico local en el espacio peridural, pero a nivel sacro, lo que ocasiona un bloqueo de conducción en las raíces nerviosas que cubre la analgesia, no solo el período intraoperatorio sino también el posoperatorio, lo cual permite una adecuada estabilidad hemodinámica, reduce el sangrado, evita el uso de opioides, anestésicos generales y relajantes musculares. La necesidad de asistencia respiratoria se ve reducida. Conclusiones: Es una técnica segura y económica en ocasiones subvalorada en el recién nacido. Esto, junto a una más rápida recuperación, lleva a considerar la anestesia regional como una alternativa a la anestesia general(AU)
Introduction: Regional anesthesia and analgesia techniques in the pediatric population guarantee hemodynamic and respiratory stability. The use of caudal anesthesia has increased enormously, especially for lower abdominal surgeries, which offers advantages over general anesthesia. Objective: To argue, based upon the best scientific evidence, the opinion of the authors regarding the effectiveness of the use of caudal anesthesia in neonatal patients. Method: The initial framework for the bibliographic search consisted of the articles published about the use of caudal anesthesia in neonates. The sources of information were the Cochrane Central Register of Controlled Trials, Pubmed, LILACS, SciELO, Ebsco, Science, Google Scholar. Results: Caudal block is the application of a local anesthetic into the epidural space, but at the sacral level, which causes a conduction block in the nerve roots that covers analgesia, not only in the intraoperative period but also in the postoperative one, which allows adequate hemodynamic stability, reduces bleeding, avoids the use of opioids, general anesthetics and muscle relaxants. The need for respiratory support is reduced. Conclusions: It is a safe and economical technique, sometimes undervalued in the newborn. This, together with a faster recovery, leads to considering regional anesthesia as an alternative over general anesthesia(AU)
Asunto(s)
Humanos , Recién Nacido , Analgésicos Opioides , Anestesia y Analgesia , Anestesia Caudal/métodos , Periodo Intraoperatorio , Neonatología/educaciónRESUMEN
BACKGROUND: Cefazolin is routinely recommended as the first-line agent for surgical antibiotic prophylaxis because it prevents more surgical site infections than second-line antibiotics. Clinicians often avoid administering cefazolin to patients who are labeled as penicillin allergic due to concerns of cross-reactivity. The aim of this study was to compare the incidence of hypersensitivity reactions between cefazolin and the second-line antibiotics vancomycin and clindamycin. METHODS: This retrospective study included patients who were labeled as penicillin allergic and received either cefazolin, clindamycin, or vancomycin as preoperative antibiotics. The primary outcome was intraoperative hypersensitivity reactions. RESULTS: A total of 734 surgical procedures in 690 patients were included. Fifteen immediate hypersensitivity reactions were identified. Probable hypersensitivity reactions occurred in 3 (0.9%) patients in the cefazolin group, 4 (1.4%) in the clindamycin group, and 1 (1.1%) in the vancomycin group. Seven of 8 patients reported allergies to additional medications beyond penicillin. There were seven cases of possible hypersensitivity reactions, 3 (0.9%) in the cefazolin group, 1 (1.1%) in the vancomycin group, and 3 (1.0%) in the clindamycin group. CONCLUSION: Our data suggest that perioperative hypersensitivity reactions are uncommon in patients labeled as penicillin allergic. The frequency of immediate hypersensitivity reactions was not different between patients receiving cefazolin, clindamycin, or vancomycin. Avoiding cefazolin in patients labeled as penicillin allergic may not be warranted.
Asunto(s)
Antibacterianos/efectos adversos , Profilaxis Antibiótica/efectos adversos , Cefazolina/efectos adversos , Clindamicina/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad Inmediata/inducido químicamente , Penicilinas/efectos adversos , Vancomicina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Cefazolina/uso terapéutico , Clindamicina/uso terapéutico , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Vancomicina/uso terapéuticoRESUMEN
Objetivo: Conhecer as publicações científicas relacionadas aos diagnósticos de enfermagem (DEs) no período perioperatório do paciente cirúrgico. Método: Revisão integrativa nas bases de dados Web of Science, Scopus, Wiley Online Library e na plataforma da Revista SOBECC Nacional. Descritores utilizados na busca: "nursing diagnosis" e "surgery". Critérios de inclusão: estudos publicados entre 2014 e 2019, disponíveis em português, inglês ou espanhol, e responder à questão norteadora. Resultados: Selecionados 15 artigos, sendo oito publicados em periódicos internacionais, entretanto todos produzidos por pesquisadores brasileiros. Seis publicações identificaram os principais DEs no perioperatório, os demais pesquisaram um DE específico. Evidenciou-se o pós-operatório como o período mais pesquisado. Os estudos foram classificados conforme níveis de evidência (NE): seis com NE 4, seis com NE 5 e três com NE 6. Conclusão: O pós-operatório foi o período mais relacionado aos DEs. Apenas um estudo abordou o DE especificamente no intraoperatório. Constatou-se que a população mais estudada foi a de pacientes submetidos à cirurgia cardíaca.
Objective: To assess scientific publications related to nursing diagnoses (NDs) for surgical patients in the perioperative period. Method: This is an integrative review conducted in the Web of Science, Scopus, and Wiley Online Library databases and in the platform of the National SOBECC Journal. The keywords used in the search were: "nursing diagnosis" and "surgery". The inclusion criteria were: studies published between 2014 and 2019, available in Portuguese, English, or Spanish, and that answered the guiding question. Results: We selected 15 articles, of which 8 were published in international journals, even though all studies were produced by Brazilian researchers. Six publications identified the main NDs in the perioperative period, while the others investigated a specific ND. The postoperative period was the most studied. Studies were classified according to their level of evidence (LE): six with LE 4, six with LE 5, and three with LE 6. Conclusion: The postoperative period was the one most associated with NDs. Only one study addressed NDs specifically in the intraoperative period. The most studied population was that of patients submitted to cardiac surgery.
Objetivo: Conocer las publicaciones científicas relacionadas con los Diagnósticos de Enfermería (DEs) en el período perioperatorio del paciente quirúrgico. Método: Revisión integrativa en las bases de datos de Web of Science, SCOPUS, Wiley Online Library y la plataforma de Revista SOBECC Nacional. Descriptores utilizados en la búsqueda: "diagnóstico de enfermería" y "cirugía". Criterios de inclusión: estudios publicados entre 2014 y 2019, disponibles en portugués, inglés o español y que respondan a la pregunta orientadora. Resultados: Se seleccionaron 15 artículos, ocho de los cuales fueron publicados en revistas internacionales, sin embargo, todos producidos por investigadores brasileños. Seis publicaciones identificaron los principales DEs en el período perioperatorio, las otras investigaron un DE específico. El postoperatorio se convirtió en el período más investigado. Los estudios se clasificaron según niveles de evidencia (NE): seis con NE 4, seis con NE 5 y tres con NE 6. Conclusión: El postoperatorio fue el período más relacionado con la DE. Solo un estudio abordó la DE específicamente durante la operación. Se encontró que la población más estudiada fueron los pacientes sometidos a cirugía cardíaca.
Asunto(s)
Humanos , Periodo Posoperatorio , Periodo Perioperatorio , Periodo Intraoperatorio , Cirugía Torácica , Diagnóstico de EnfermeríaRESUMEN
PURPOSE: The administration of a dose boost to the tumor bed after breast-conserving surgery has proven to reduce local recurrence. Intra-operative electron radiotherapy (IOERT) offers an alternative method to deliver a boost with several advantages, such as direct visualization of the tumor bed, less inter- and intrafraction motion and a reduction in the number of medical appointments. The objective of our study is to assess chronic toxicity and long-term outcome for our patients after IOERT boost. MATERIAL AND METHODS: Forty-six patients treated at our institution between July 2013 and June 2020 with IOERT boost during Breast-Conserving Surgery and consecutive whole breast irradiation were prospectively analyzed. A 10-12 Gy boost was prescribed to 42 patients and 4 patients received a 20 Gy boost. An analysis for overall survival, local relapse and distant progression was performed. Acute and chronic toxicity was assessed by CTCAE 4.0. RESULTS: The median age was 64.5 years (40-90). The median follow-up was 62 months (4-86). We had no local recurrences but 2 patients (4.3%) presented a distant recurrence. Mean pathological tumor size was 16 mm (6-52). 84.8% (39) of the patients had invasive ductal carcinoma. 52.2% (24) presented histological grade II. 52.2% (24) were Luminal A like, 21.7% (10) Luminal B like, 13% (6) HER2 positive, 13% (6) triple negative. No Grade 3-4 chronic toxicity was observed. Grade 1-2 fibrosis was evidenced in 13% (6) of the patients, 4.3% (2) patients presented fat necrosis, 6.5% (3) presented seroma, 4.3% (2) had localized pain, 2.2% (1) presented localized hematoma and 2.2% (1) presented localized edema. CONCLUSIONS: IOERT boost in breast cancer treatment during BCS is a safe option with low chronic toxicity. The recurrence rates are comparable to published data and emphasize that IOERT as boost is an effective treatment.
Asunto(s)
Neoplasias de la Mama/radioterapia , Mama/efectos de la radiación , Carcinoma Ductal de Mama/radioterapia , Electrones/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/secundario , Carcinoma Ductal de Mama/cirugía , Femenino , Fibrosis/patología , Humanos , Periodo Intraoperatorio , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Complicaciones Posoperatorias , Estudios Prospectivos , Traumatismos por Radiación/patología , Dosificación Radioterapéutica , Resultado del TratamientoRESUMEN
SUMMARY: Accurate implant sizing is one of the major determinants in defining the success of total knee arthroplasty (TKA). Current TKA implants are based on Caucasian knee morphometry which is well documented to be larger than Asian knees. Even more, with regards to sizing, implant mismatch tends to be more evident in the female population. This study was designed to evaluate the distal femur dimensions of Malaysian female patients who underwent TKA in our institution and to compare them with the current prosthetic system in use. A total of 199 female patients (207 knees) who underwent TKA were enrolled in this study. Intraoperatively, the AP dimensions (medial and lateral condyles) and mediolateral (ML) width were measured. Known dimension of the femoral component of the prosthetic knee system currently in use were compared with the morphological data. The average femoral component overhang was 2.11 mm (SD 3.94 mm). There was significant difference between the mean ML width of the resected femur and the femoral component (p<0.01). Analysis also revealed a significant positive and weak relationship between both, AP (medial and lateral) and ML dimension. The aspect ratio (ML/AP) of the native femur was generally smaller than the implant aspect ratio which is likely to cause overhang in our population. In general, this study shows that the knees of our female sub-population are even narrower than the other Asian female knees from previous studies. Implants should be designed based on the morphological data of the local population. Implant manufactures should tailor them to accommodate a smaller change in ML width for an increment in the AP length and provide several ML widths for one AP length to obtain a better fitting prosthesis hence curbing the problem of ML overhang.
RESUMEN: El tamaño exacto del implante es uno de los principales determinantes para definir el éxito de la artroplastía total de rodilla (ATR). Los implantes de TKA se basan en la morfometría de rodilla caucásica, cuyo tamaño está reportado como mayor que las rodillas asiáticas. Más aún, en lo que respecta al tamaño, el desajuste de los implantes tiende a ser más evidente en la población femenina. Este estudio fue diseñado para evaluar las dimensiones del fémur distal de pacientes mujeres malasias que se sometieron a ATR en nuestra institución y compararlas con el sistema protésico actual. En este estudio se incluyeron un total de 199 pacientes (207 rodillas) que se sometieron a ATR. Intraoperatoriamente, se midieron las dimensiones AP (cóndilos medial y lateral) y el ancho mediolateral (ML). Se comparó la dimensión conocida del componente femoral del sistema protésico de rodilla actualmente en uso con los datos morfológicos. El voladizo o sobresaliencia del componente femoral fue de 2,11 mm (DE 3,94 mm). Hubo una diferencia significativa entre el ancho ML medio del fémur resecado y el componente femoral (p <0,01). El análisis también reveló una relación significativa positiva y débil entre las dimensiones AP (medial y lateral) y ML. La relación de aspecto (ML / AP) del fémur nativo fue más pequeña que la relación de aspecto del implante, lo que probablemente cause un voladizo en nuestra población. En general, este estudio muestra que las rodillas de nuestra subpoblación femenina son incluso más estrechas que otras rodillas de mujeres asiáticas reportadas en estudios anteriores. Los implantes deben ser diseñados en base a los datos morfológicos de la población local. Los fabricantes de implantes deben adaptarlos a un cambio más pequeño en el ancho de ML para un incremento en la longitud AP y proporcionar varios anchos ML para una longitud AP con el objetivo de obtener una prótesis de mejor ajuste y frenar el problema del voladizo ML.