RESUMO
OBJECTIVES: To determine the risk factors, morbidity and mortality rates and the types of postoperative complications in patients undergoing surgery for ileal typhoid perforation. MATERIAL AND METHODS: This retrospective study evaluated 126 patients with anatomohistological diagnosis of ileal typhoid perforation treated at the Belen Hospital, Trujillo, Peru between 1966 and 2000. RESULTS: The average age of the total series was of 21.39 + 13.4 years (range 1 to 57 years); of which, 97 (76.98%) were male and 29 (23.02%) women (proportion M:F, 3.3:1). By means of univariate analysis, the morbidity was related with the absence of previous medical treatment (p = 0.035). The mortality was associated to time of perforation exceeding 48 hours (p = 00001); digestive hemorrhages (p = 0.003), leukocyte count (p = 0.021) fecaloid peritoneal secretion (p = 0.007) number of perforations (p = 0.001) and the surgical technique, that presented major mortality was the resection and ileostomy (48.3%; p = 0.001). The group of patients that presented post-surgical complications was 80.16%, of which 19.8% of them died. The most frequent complications were wound infections (67.3%) and sepsis (27.7%). In the multivariate analysis two parameters were evidenced in relation to morbidity: previous medical treatment (p < 0.05; OR = 2.9) and number of perforations (p = 0.01; OR = 6.4). With regard to mortality the significant statistical parameters were: low digestive hemorrhages (p = 0.02; OR = 11.4) leukocyte count (p < 0.008; OR = 7.9) type of operation (p = 0.03; OR = 1.8) peritoneal secretion (p < 0.04; OR = 3.02) and number of perforations (p = 0.008; OR = 4.6). CONCLUSIONS: The risk factors identified in the present series can be useful to elaborate a risk scale to predict a small, moderate or greater probability of complications and postoperative mortality.
Assuntos
Doenças do Íleo/complicações , Doenças do Íleo/mortalidade , Perfuração Intestinal/complicações , Perfuração Intestinal/mortalidade , Febre Tifoide/complicações , Febre Tifoide/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Doenças do Íleo/microbiologia , Doenças do Íleo/cirurgia , Lactente , Perfuração Intestinal/microbiologia , Perfuração Intestinal/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Febre Tifoide/cirurgiaRESUMO
OBJETIVOS: Determinar los factores de riesgo y tasas de morbimortalidad en pacientes sometidos a cirugía por perforación tífica ileal, así como los tipos de complicaciones postoperatorias. MATERIAL Y MÉTODOS: El presente estudio retrospectivo evaluó 126 pacientes con diagnóstico anatomopatológico de perforación tífica ileal atendidos en el Hospital Belén de Trujillo, Perú entre 1966 y 2000. RESULTADOS: La edad media de la serie total fue de 21.39 + 13.4 años (límites, 1 a 57 años), de los cuales 97 (76.98 por ciento) fueron varones y 29 (23.02 por ciento) mujeres (proporción M:F, 3.3:1). Mediante análisis univariado la morbilidad estuvo relacionada con la ausencia de tratamiento médico previo (p=0.035). La mortalidad estuvo asociada a tiempo de perforación mayor de 48 horas (p=00001); hemorragia digestiva (p=0.003), recuento leucocitario (p=0.021), secreción peritoneal fecaloidea (p=0.007), número de perforaciones (p=0.001) y a la técnica quirúrgica, siendo la que presentó mayor mortalidad la resección mas ileostomía (48.3 por ciento; p=0.001). El grupo de pacientes que presentaron complicaciones post-quirúrgicas fue de un 80.16 por ciento, de éstos 19.8 por ciento fallecieron. La complicación más frecuente fue infección de herida (67.3 por ciento) y sepsis (27.7 por ciento). En el análisis multivariado se evidenciaron dos parámetros en relación a morbilidad: tratamiento médico previo (p menor que 0.05; OR=2.9) y número de perforaciones (p=0.01; OR=6.4). Con respecto a mortalidad fueron parámetros significativamente estadísticos: hemorragia digestiva baja (p=0.02; OR=11.4), recuento leucocitario (p menor que 0.008; OR= 7.9), tipo de operación (p=0.03; OR=1.8), secreción peritoneal (p menor que 0.04; OR= 3.02) y número de perforaciones (p=0.008; OR= 4.6). CONCLUSIONES: A partir de los factores de riesgo identificados en la presente serie puede establecerse una escala de riesgo para predecir una menor, moderada o mayor probabilidad de presentar complicaciones y mortalidad postoperatorias.
OBJECTIVES: To determine the risk factors, morbidity and mortality rates and the types of postoperative complications in patients undergoing surgery for ileal typhoid perforation. MATERIAL AND METHODS: This retrospective study evaluated 126 patients with anatomohistological diagnosis of ileal typhoid perforation treated at the Belen Hospital, Trujillo, Peru between 1966 and 2000. RESULTS: The average age of the total series was of 21.39 mayor menor 13.4 years (range 1 to 57 years); of which, 97 (76.98 per cent) were male and 29 (23.02 percent) women (proportion M:F,3.3:1). By means of univariate analysis, the morbidity was related with the absence of previous medical treatment (p=0.035). The mortality was associated to time of perforation exceeding 48 hours(p=00001); digestive hemorrhages (p=0.003), leukocyte count (p=0.021) fecaloid peritoneal secretion (p=0.007) number of perforations (p=0.001)and the surgical technique, that presented major mortality was the resection and ileostomy (48.3 percent; p=0.001). The group of patients that presented post-surgical complications was 80.16 percent, of which 19.8 percent of them died. The most frequent complications were wound infections (67.3 percent)and sepsis (27.7 percent). In the multivariate analysis two parameters were evidenced in relation to morbidity: previous medical treatment (p menor que 0.05; OR=2.9)and number of perforations (p=0.01; OR=6.4).With regard to mortality the significant statistical parameters were: low digestive hemorrhages (p=0.02;OR=11.4)leukocyte count (p percent 0.008;OR=7.9) type of operation (p=0.03; OR=1.8) peritoneal secretion (p percent 0.04; OR =3.02) and number of perforations (p=0.008; OR = 4.6). CONCLUSIONS:The risk factors identified in the present series can be useful to elaborate a risk scale to predict a small, moderate or greater probability of complications and postoperative mortality.