RESUMO
Background: Simultaneous pancreas-kidney transplantation (SPKT) is a complex and demanding procedure with a considerable risk of morbidity and mortality. Advances in surgical techniques and organ preservation have introduced changes in care protocols. Two cohorts of patients receiving SPKT with two different protocols were compared to determine overall survival and pancreatic and renal graft failure-free survival. Methods: This retrospective observational study was conducted in two cohorts of SPKT recipient patients that underwent surgery between 2001 and 2021. Outcomes were compared in transplant patients between 2001 and 2011 (cohort 1; initial protocol) and 2012-2021 (cohort 2; improved protocol). In addition to the temporality, the cohorts were defined by a protocolization of technical aspects and medical management in cohort 2 (improved protocol), compared to a wide variability in the procedures carried out in cohort 1 (initial protocol). Overall survival and pancreatic and renal graft failure-free survival were the primary outcomes. These outcomes were determined using Kaplan-Meier survival analysis and the log-rank test. Results: Fifty-five SPKT were performed during the study period: 32 in cohort 1 and 23 in cohort 2. In the survival analysis, an average of 2546 days (95% CI: 1902-3190) was found in cohort 1, while in cohort 2, it was 2540 days (95% CI: 2100-3204) (p > 0.05). Pancreatic graft failure-free survival had an average of 1705 days (95% CI: 1037-2373) in cohort 1, lower than the average in cohort 2 (2337 days; 95% CI: 1887-2788) (p = 0.016). Similarly, renal graft failure-free survival had an average of 2167 days (95% CI: 1485-2849) in cohort 1, lower than the average in cohort 2 (2583 days; 95% CI: 2159-3006) (p = 0.017). Conclusions: This analysis indicates that pancreatic and renal graft failure-free survival associated with SPKT decreased significantly in cohort 2, with results related to improvements in the treatment protocol implemented in that cohort.
Assuntos
Transplante de Rim , Transplante de Pâncreas , Humanos , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , América Latina , Transplante de Pâncreas/efeitos adversos , Transplante de Pâncreas/métodos , Pâncreas , Sobrevivência de Enxerto , Resultado do TratamentoRESUMO
Introducción: el envejecimiento poblacional mundial ha aumentado la incidencia de fracturas de cadera, este cambio genera un alto impacto económico, social y constituye un reto para la salud pública. Este estudio busca evaluar la satisfacción con el manejo posquirúrgico en adultos mayores con fracturas de cadera al año de la intervención y conocer los desenlaces en este tiempo. Materiales y métodos: estudio exploratorio, observacional, descriptivo de corte transversal, mediante encuesta telefónica en adultos de 65 o más años, un año después de intervención quirúrgica por fracturas de cadera en Méderi - Hospital Universitario Mayor, de Bogotá. Se describen variables evaluativas de satisfacción y atención en salud, así como otras relacionadas. Resultados: de 287 pacientes, 116 cumplen los criterios de inclusión y aceptan participar. El rango de edad oscila entre 65 y 99 años, media de 81,3 ± 8,17. Las mujeres y los hombres representan, respectivamente, 76% y 24% de la muestra. Mortalidad anual 28%, por género: 23% mujeres y 43% hombres. 29,3% presenta reingresos hospitalarios, 50% recupera su habilidad para la marcha. 81% considera buena la atención intrahospitalaria por ortopedia. 64% no califica el servicio intrahospitalario por fisioterapia ya que no lo recibe. 70% expresa satisfacción con los servicios ambulatorios de ortopedia y rehabilitación. Conclusiones: estudio novedoso y único que da voz como sujeto activo al paciente para evaluar el sistema de salud, sugiere el grado de dolor como elemento trazador de calidad de vida y obliga a implementar programas y servicios para adultos mayores con fracturas de cadera.
Introduction: World aging increases the incidence of hip fracture in adults over sixty years of age, pathology of economic and social burden being a challenge for public health. This study seeks to assess patient degree of satisfaction with health care services and assess outcomes. Materials and methods: Exploratory, observational, descriptive cross sectional study, with a telephone survey in patients 65 years or older, one year after hip fracture surgical intervention in Méderi - Hospital Universitario Mayor, Bogotá. Results: Of 287 patients 116 met the inclusion-exclusion criteria and accepted to participate. Age ranges between 65 and 99 years with a mean of 81,3 ± 8,17. Women and men represent respectively 76% and 24% of the sample. Mortality a year after is 28%, gender: 23% women and 43% men. 29,3% of the patients reentered the hospital, 50% recovered their previous functional capacity. 81% express as good the inpatient care by orthopedic service. 64% does not grade inpatient care by rehabilitation services because it was not given. 70% are satisfied with the outpatient services of orthopedic and rehabilitation. Conclusions: This study represents a novel and unique approach as it gives voice to the patient allowing assessment of the health services. Suggests the degree of pain as a tracer of quality of life and brings upon compulsory attention to implement health services improvement programs for hip fractures in the elderly.
Introdução: o envelhecimento populacional mundial tem aumentado a incidência de fraturas de quadril, mudanças que gera um alto impacto económico, social e constitui um desafio para a saúde pública. O estudo busca avaliar a satisfação com o manejo pós-cirúrgico em idosos com fraturas de quadril no ano posterior à intervenção e conhecer os desenlaces neste tempo. Materiais e métodos: estudo exploratório, observacional, descritivo, de corte transversal, mediante questionário por telefone em adultos de 65 ou mais anos, um ano após da intervenção cirúrgica por fraturas de quadril em Méderi - Hospital Universitário Mayor, de Bogotá D.C. Descrevem-se variáveis avaliativas de satisfação e atenção em saúde, assim como outras relacionadas. Resultados: de 287 pacientes, 116 cumprem os critérios de inclusão e aceitam participar. O rango de idade oscila entre 65 e 99 anos, média de 81,3 ± 8,17. As mulheres e os homens representam respetivamente 76% e 24% da amostra. Mortalidade anual 28%, por gênero: 23% mulheres e 3% homens. 29,3% apresenta reingressos hospitalários, 50% recupera a sua habilidade para a marcha. 81% considera boa a atenção intra-hospitalar por ortopedia. 64% não qualifica o serviço intra-hospitalar por fisioterapia já que não o recebe. 70% expressa satisfação com os serviços ambulatórios de ortopedia e reabilitação. Conclusões: estudo novo e único que dá voz como sujeito ativo ao paciente para avaliar o sistema de saúde, sugere o grau de dor como elemento traçador de qualidade de vida e obriga a implementar programas e serviços para idosos com fraturas de quadril.