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Nuestro equipo ha aportado su experiencia en la elaboración de diversos artículos científicos. Descubre los avances en distintas áreas de la medicina desarrollados en SOESO SAS
1.Luxación posterior bilateral traumática de hombro: reporte de un caso
1.Luxación posterior bilateral traumática de hombro: reporte de un caso
Autores: Juan Manuel Concha, Carlos Alberto Calvache, Miguel Eduardo Palechor y Diego Armando-Mahe.
Abstract: Introduction: Traumatic posterior dislocation of the shoulder is a rare injury. Bilateral dislocation is even less frequent and is associated with seizures or electrical shock. Case presentation: A 25-year-old man was treated at the Emergency Department of a secondary care hospital in Popayán (Colombia) after crashing his motorcycle into a car. Based on his clinical signs and X-ray and computed tomography findings, the diagnosis of bilateral posterior dislocation of the shoulder was confirmed, and a closed reduction was performed. Rehabilitation began three weeks after the procedure and shoulder function was monitored monthly using the abbreviated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Recovery was satisfactory and no functional limitation or X-ray changes suggestive of osteoarthritis or bone necrosis were observed at 1-year follow-up. Conclusion: Traumatic posterior dislocation of the shoulder is a rare and usually overlooked condition, so it should be considered as a differential diagnosis in patients with shoulder trauma, in order to provide timely treatment and avoid severe functional sequelae. Keywords: Shoulder Dislocation; Closed Fracture Reduction; Case Report (MeSH).
2. Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review
2. Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review
Autores: Gustavo Angel, Cristian Trujillo, Mario Mallama, Pablo Alonso - Coello , Markus Klimek , José A. Calvache.
Abstract: Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown.
3. The lateral supramalleolar flap for the treatment of open foot and ankle fractures
3. The lateral supramalleolar flap for the treatment of open foot and ankle fractures
Autores: Juan Manuel Concha, Pedro Leon Camaro , Anderson David, Carolina Concha.
Abstract: The purpose of this study is to describe the efficacy of lateral supramalleolar flap as an option for soft tissue repair in open fractures of foot and ankle and to present the experience in 2 trauma units: Hospital Susana López de Valencia, Popayán Colombia, and Hospital Universitario de Santander, Bucaramanga Colombia.
This is an observational, case series study including all patients with open fractures of foot and ankle who were treated from January 2016 to June 2021 and who required soft tissue coverage. Patients whose soft tissue injury was located on the anatomical area of the perforating peroneal artery, those with less than 6 months of follow-up and those who refused the proposed treatment were excluded. On the other hand, although literature reports flaps of up to 100 cm2 [1], in our hands, this flap unsuitable for skin defects larger than 60 cm2, and other procedures such as free flaps should be considered in these cases.
Thirteen patients were selected, 9 men and 4 women, with a mean age of 30 years (12–62 years) and mean follow-up duration of 10.3 months [[6], [7], [8], [9], [10], [11], [12], [13], [14]]. In 11 patients, the mechanism of trauma involved a motorcycle accident. Mean flap size was 40 cm2 (30–48 cm2). Ten flaps survived with no acute problems, 2 presented with venous congestion and epidermolysis, which were treated conservatively, and 1 developed complete necrosis requiring reintervention. All interventions were performed by the authors belonging to the orthopedic trauma units from the involved hospitals.
The lateral supramalleolar flap is an excellent alternative for the treatment of coverage defects caused by open foot and ankle fractures, producing satisfactory and predictable results in the hands of orthopedic surgeons with no specific training in microsurgical techniques.
4. Uncommon case of traumatic dislocation of all five metatarsophalangeal joints: Results of treatment after 36 months
4. Uncommon case of traumatic dislocation of all five metatarsophalangeal joints: Results of treatment after 36 months
Autores: Juan Manuel Concha, Humberto Gonzalez, Carolina Concha, Luis Alejandro Rosas.
Abstract: The authors report a rare case of simultaneous dorsal dislocation of all five metatarsophalangeal joints of the right foot after a motorcycle accident. The first MTP joint dislocation was an open injury. A formal debridement was performed under spinal anesthesia. After applying the reduction maneuver to all lesser metatarsophalangeal joints simultaneously, a satisfactory and stable reduction was obtained, fixation with Kirshner wires was not necessary, the leg was immobilized in a short plaster splint, and a full-thickness skin graft was performed five days later. The soft tissues healed adequately, and after three months, the patient had returned to his pre-injury activities. At 36 months follow-up evaluation, the patient had a full painless range of motion and no radiographic evidence of arthrosis.
5.. Traumatic obturator–anterior type dislocation of the hip with an ipsilateral ischial tuberosity and greater trochanter fractures: Case report
5.. Traumatic obturator–anterior type dislocation of the hip with an ipsilateral ischial tuberosity and greater trochanter fractures: Case report
Autores: Juan Manuel Concha, Humberto Gonzalez, Andrea C Montero, Nelsy B Mueses, Heydy Y Muñoz, Andres F Muñoz, Yilena M Ordoñez and Javier S Orozco
Abstract: Anterior hip dislocation is a rare orthopedic emergency, usually following high-energy trauma. This injury is occasionally associated with acetabular fractures, femoral head fractures, or diaphyseal femoral fractures. However, the combination between the anterior hip dislocation and the ipsilateral ischial tuberosity and greater trochanter fractures is extremely rare, and very sparsely reported in the literature. This paper reports a case of an obturator type of anterior hip dislocation associated with a concomitant ipsilateral ischial tuberosity and greater trochanter fracture. The hip dislocation was reduced by closed means under general anesthesia, and the greater trochanter fracture was reduced and internally fixed with tension band in a second stage. Radiological and functional evaluation at 12 months after surgery, using the Harris Hip Score (HHS), was good.
6. Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting
6. Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting
Autores: Jose Andres Calvache, Edison Benavides, Sebastian Echeverry, Francisco Agredo, Robert Jan Stolker, and Markus Klimek.
Abstract: Objective: The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties. Methods: After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated. Results: Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60. Conclusions: Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.
7.. Registro de cáncer de dos instituciones de referenciaen el departamento del Cauca 2011
7.. Registro de cáncer de dos instituciones de referenciaen el departamento del Cauca 2011
Autores: Claudia Milena Orozco Chamorro, Edison Alexander Benavides Hernández, Beatriz Eugenia Bastidas Sánchez y Consuelo Gómez
Abstract: El cáncer es una enfermedad con un importante número de casos en Colombia, evidenciados en
los registros de cáncer poblacional que permiten detallar su aparición y asociarlo a múltiples variables, entre ellas,
su localización anatómica. Objetivo: Establecer el primer registro de cáncer institucional en el departamento
del Cauca, y describir la frecuencia del cáncer en dos centros de referencia: el Hospital Universitario San José (HUSJ) y la Compañía de Patólogos del Cauca (CPC).Métodos: Se llevó a cabo un registro institucional con censo entre enero y diciembre del 2011. Se incluyeron resultados de 1.144 biopsias de pacientes que asistieron a dos centros de referencia del municipio de Popayán y que cumplieron los criterios de inclusión definidos. Se describieron las frecuencias de acuerdo al tipo de cáncer y su distribuciónpor género y localización anatómica. Resultados: La mayoría de los pacientes documentados se encontraba entre los 15 y 39 años. En toda la serie, los tumores más frecuentes fueron: cérvix 23.8%, piel no melanoma 14.1%, estómago 13.2%, mama 9.5% y próstata 6.3%. Los más habituales por género fueron: en hombres, cáncer de estómago (24.8%), piel no melanoma (18.6%) y próstata (17.1%); y en mujeres, cáncer de cérvix (37.6%), mama (15.1%) y piel no melanoma (11.5%).Conclusión: El registro de cáncer ayuda a establecer la distribución anatómica de los tipos de cáncer en una población determinada. En este trabajo se evidenció que los tumores más frecuentes fueron en las mujeres, cérvix y piel no melanoma, y en los hombres el cáncer de estómago
8.. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
8.. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
Autores: Edison Alexander Benavides Hernández, Jose Andres Calvache, Claudia Milena Orozco‐Chamorro, Gustavo Adolfo Angel, Christian Ali Buesaquillo, Jose Andres Calvache, Victor David Olave Montaño, Andrés Sánchez‐Gómez, Daniela Patricia Escalante Ureche, Jairo Martinez Garrido, Emileth Montenegro.
Abstract: Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARSCoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2– 8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
9. Ultrasound guidance for central venous catheterisation. A Colombian national survey
9. Ultrasound guidance for central venous catheterisation. A Colombian national survey
Autores: José Andrés Calvache, Camilo Daza-Perdomo, Julio Gómez-Tamayo, Edison Benavides-Hernández, Andrés Zorrilla-Vaca y Markus Klimek.
Abstract: Quality problem or issue
Ultrasound (US) is a widely propagated medical technology. Anaesthesiologists increase procedural safety by using US techniques, but training and availability are essential for its usage. Although its utility for central venous catheterisation (CVC) is well established, only a paucity of evidence is available regarding its use in low- and middle-income countries. This study is a nationwide survey of Colombian anaesthesiologists designed to explore the current use of US guidance for CVC.
Initial assessment and implementation: Web-based survey at National level. Anaesthesiologists registered in the Colombian Society of Anaesthesiology and Resuscitation database.
Choice of solution: Demographic variables (age and gender), anaesthesia expertise, years of anaesthesiology practice, US availability, use of US during CVC, reasons for not using US and training experience were collected.
Evaluation: Of 351 respondents (12.3% response rate), 45% reported using US sometimes and always for CVC (95% CI 39%–50%) (n = 157). Most anaesthesiologists obtained training in US through external courses (50.4%) or from colleagues (22.8%). Of the total respondents, 62.7% (n = 220) have US equipment available at all time and this factor was independently associated with the use of US for CVC (adjusted odds ratio [OR] = 38.6, P < 0.001).
Lessons learned: US guidance is not a common technique used for CVC by Colombian anaesthesiologists; an important barrier for its use is lack of equipment.
10. Tratamiento de la no unión en fracturas diafisarias de fémur con placa antirrotatoria
10. Tratamiento de la no unión en fracturas diafisarias de fémur con placa antirrotatoria
Autores: Alfredo Martínez Rondanelli, Jenny Patricia Holguín Prieto, Diana Marcela Duque Ospina, Juan Pablo Martínez Cano.
Abstract: Cada año ingresan al Hospital Universitario del Valle 250 pacientes con fracturas de la diáfisis femoral. El índice de no unión es del 10–15% tras el manejo con clavos fresados y bloqueados, similar a la incidencia en el resto del mundo. El tratamiento de la pseudoartrosis sigue siendo un reto, consiguiendo consolidación solamente del 50–80% con las técnicas actuales. Se presenta una técnica novedosa: aumentación con placa antirrotatoria.
Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos en pacientes con no unión de la diáfisis femoral tratados con placa antirrotatoria e injertos óseos en dos hospitales universitarios entre 1997 y 2008. Se evaluaron variables clínicas y radiográficas.
Resultados: Ingresaron al estudio 47 pacientes con 48 fracturas no consolidadas de la diáfisis femoral que habían sido manejados con clavo bloqueado y fresado. De estas, 30 fracturas (62%) habían requerido reducción abierta. La edad promedio fue de 37 años. 44 fracturas (92%) consolidaron clínica y radiológicamente seis meses después del tratamiento con placa antirrotatoria e injertos óseos.
Discusión: La técnica de aumentación con placa e injertos óseos mejora tanto la biología como la estabilidad en el foco de fractura permitiendo así conseguir la consolidación y el retorno a la función en un porcentaje muy alto. Se recomienda su utilización para el tratamiento de la no unión de fémur. Por medio de estudios prospectivos comparativos se pueden confirmar su seguridad y efectividad.
11. Tratamiento del pie equino varo asociado a síndromes. Revisión de conceptos actuales
11. Tratamiento del pie equino varo asociado a síndromes. Revisión de conceptos actuales
Autores: Rodrigo Huertas Tafur, Gilberto Herrera Ortiza, Jenny Holguín, Bárbara Gómez Eslava y Ricardo Méndez
Abstract: El Pie equino varo congénito (PEVC) secundario a síndromes que producen contracturas como son el mielomeningocele y la artrogriposis son un reto por la rigidez de la deformidad y por el alto porcentaje de recidivas. En la literatura hay múltiples estrategias de tratamiento, la mayoría con métodos invasivos y cirugías extensas que pueden generar múltiples alteraciones en la forma y movilidad del pie.
El Método Ponseti se ha posicionado como el tratamiento de referencia para el manejo del PEVC idiopático, en los últimos años, múltiples estudios han mostrado la utilidad del método en las deformidades del pie asociadas con síndromes.
El objetivo de este capitulo es revisar el enfoque actual del PEVC asociados a síndromes que presentan contracturas, con énfasis en los puntos que se deben tener en cuenta antes de iniciar el tratamiento y como aplicar el método Ponseti en este grupo de pacientes.
12. Fractura inestable de pelvis en esqueleto inmaduro. Reporte de caso
12. Fractura inestable de pelvis en esqueleto inmaduro. Reporte de caso
Autores: María Margarita Acosta-Murcia, Jenny Patricia Holguín-Prieto, Alejandro Satizábal, Alejandro Uribe-Rios, Clara Inés Trujillo-Gonzáleze, Jose Antonio Morcuende.
Abstract: La fractura inestable de pelvis es una patología traumática poco frecuente en el paciente pediátrico. La bibliografía describe una incidencia entre el 0,5 y el 2,4% de los pacientes pediátricos en centros de referencia de traumatología, que incluye las fracturas estables y del acetábulo. Se debe actuar rápido en el momento del ingreso en una institución hospitalaria, estabilizar inicialmente al paciente y después obtener suficientes evidencias diagnósticas para la evaluación completa del traumatismo pélvico para establecer la clasificación y el tratamiento. Se presenta el caso de una paciente de 29 meses con politraumatismo, víctima de accidente de tránsito en calidad de peatón, y se muestra el tratamiento quirúrgico realizado en nuestra institución.
13. Augmentative lag screws as a treatment for aseptic hypertrophic nonunion after internal fracture fixation
13. Augmentative lag screws as a treatment for aseptic hypertrophic nonunion after internal fracture fixation
Abstract: Hypertrophic nonunion after intramedullary (IM) nailing and plating is Uncommon and the treatment remained controversial. The aim of this study was to show the result of a simple augmentative lag screws technique for vital non-unions after internal fixation
Patients and methods: We retrospectively reviewed the patients with nonunion after internal fixation between January 2016 to August 2022. Patients with unacceptable shortening or deformity were excluded as well as nonunion septic cases. All the patients were followed up for at least 6 months.
Discussion: Various techniques have been described to treat non-union after intramedullary nailing or plating. The existing nail is frequently removed, and the non-union site is either re-reamed and re-nailed or fixed with a plate or external fixation devices or rechanged by a nail in the case of plates. In our study of non-union, augmentative lag screws were successfully applied to treat eight patients with aseptic nonunion, resulting in the healing of non-union in all cases except one.
Conclusion: Augmentative lag screws represent a simple technique for the management of aseptic hypertrophic nonunion after internal fixation with a significantly shorter operating time.
14. Management of diaphyseal tibial fractures by plate fixation with absolute or relative stability: a retrospective study of 45 patients
14. Management of diaphyseal tibial fractures by plate fixation with absolute or relative stability: a retrospective study of 45 patients
Autores: Juan Manuel Concha Sandoval, José Luis Osma Rueda Y Alejandro Sandoval Daza
Abstract: Background: Fixation of diaphyseal tibial fractures by plates is not considered the best option due to complications that may eventually arise; however, if principles of stability and proper surgical techniques are used, it is possible to obtain fracture consolidation without major risks.
Methods: We conducted a cross-sectional observational descriptive study by retrospectively analyzing medical records of patients with diaphyseal tibial fractures that were treated with plates from the period between June 2011 and June 2014 at San José and Susana López Hospitals in the city of Popayan, Colombia. 3 treatment groups were created and analyzed according to the type of fracture (Association Osteosynthesis/Osteosynthesis Trauma Association AO/OTA): group I: simple fractures 42A/B, absolute stability; group II: simple fractures 42A/B, Minimally Invasive Plate Osteosynthesis (MIPO) technique, relative stability; group III: multifragmentary fractures 42C, MIPO technique, relative stability. A descriptive analysis of patients, fracture consolidation time, and complications in each group were performed.
Results: 45 patients with tibial fractures treated with osteosynthesis plates were analyzed. Group I: 14 patients, 42A (n=13) and 42B (n=1), had an average consolidation time of 16.38 (SD=1.98) and 14 weeks, respectively. In group II: 19 patients, out of which 18 achieved fracture consolidation (42A n=15 and 42B n=3) with an average time of 17.4 (SD=3.33) and 17.3 weeks (SD=6.11), respectively. Finally, in group III: 12 patients all with 42C fractures with a consolidation time of 16.86 (SD=2.93) weeks. The average fracture consolidation time for all 44 patients was 16.86 weeks (SD 2.93).
Conclusions: Osteosynthesis plates are an alternative to intramedullary nailing for diaphyseal tibial fractures and their outcomes can be favorable as long as the management of soft tissues and the proper principle of stability are taken into account.
15. Hoffa Fracture Treated using a Lateral Femoral Epicondylar Osteotomy: Case Report
15. Hoffa Fracture Treated using a Lateral Femoral Epicondylar Osteotomy: Case Report
Autores: Juan Manuel Concha, Humberto González, Julián Andrés Hamdan, Claudia Andrea Jurado, Andrés Felipe Fuentes, Katherine Gómez, Luis Alfonso Gómez, Carlos Andrés Jurado and Andry Dilena Melo
Hoffa fractures of the femoral condyle are uncommon coronally-oriented injuries which extends through either the medial or lateral condyle. Most commonly affecting the lateral condyle. The usual mechanism of injury is a combination of vertical shearing and twisting forces [1]. We report a displaced intrarticular distal femoral fracture (Hoffa Letenneur Type I fracture) that occurred in a in a 15-year-old patient, when he fell from a moving vehicle. Internal fixation using a lateral approach and femoral epicondylar osteotomy was performed. This approach affords direct observation and exposure of the posterior lateral femoral condyle and lateral tibial plateau for open management of intraarticular disorders [2]. The fracture could be anatomically reduced and fixed, the recovery was complete and there were no sequela after one year of follow-up.
16. Factores que retrasan la cirugía en fractura de cadera y sus desenlaces en adultos mayores. Estudio de cohorte
16. Factores que retrasan la cirugía en fractura de cadera y sus desenlaces en adultos mayores. Estudio de cohorte
Autores: Ángela María Merchán1,2, Nelson Fernando Sotelo3, Julián Camilo Velásquez3, David Andrés Muñoz3, Andrés Felipe Solano3, Juan Pablo Caicedo3, Juan Manuel Concha4,José A. Calvache3,5, María José Martínez-Zapata2
Abstract: La fractura de cadera (FC) es una de las formas más prevalentes de lesión traumática con necesidad de manejo quirúrgico en los adultos mayores (1) y constituye una de las principales causas de morbilidad, incapacidad, deterioro funcional y mortalidad en este grupo poblacional (2). El manejo de estas fracturas representa una parte importante de la actividad asistencial de los servicios de traumatología factores asociados con el retraso quirúrgico y evaluar la calidad de vida y mortalidad a 3 meses en pacientes llevados a cirugía por fractura proximal de fémur.
Métodos: Estudio de cohorte prospectiva. Se evaluaron causas médicas y administrativas del retraso quirúrgico. Se aplicó encuesta sociodemográfica y clínica. La calidad de vida fue evaluada por medio del instrumento validado EQ-5D-5L. Se realizó seguimiento de los pacientes a los 30 y 90 días del postoperatorio. Se utilizó estadística descriptiva y la prueba de Wilcoxon para contrastar los desenlaces. Identificador ClinicalTrials.gov: NCT04217642.
Resultados: Se incluyeron 130 pacientes con un promedio de edad de 78.9 años (DE 14.9). La mayoría con clasificación ASA II (53.1%) y con un índice de Charlson promedio de 4.7 (DE 1.9). En el 76.2% la causa de la fractura fue la caída desde la propia altura. El promedio de tiempo desde el ingreso hasta el manejo quirúrgico definitivo fue de 8.5 días (DE 5.1), elevando el riesgo de muerte en 6.9%(p=0.008). La demora en la autorización de la cirugía por su EPS, los eventos médicos generados durante el ingreso, la solicitud de valoración por especialidades médicas adicionales y el sexo estuvieron asociados de manera significativa con un tiempo de retraso de 4.65, 3.29, 3.08 y 2.13 días, respectivamente. La calidad de vida (índice EQ-5D-5L) al ingreso fue en promedio de 0.137, con una tendencia hacia el aumento a los 30 días (0.464) y 90 días (0.586). Se reportó mortalidad en 6 pacientes (6.2%) a los 90 días de seguimiento.
Conclusiones: Los principales factores asociados con el retraso quirúrgico fueron administrativos, como la autorización de la cirugía. A los 3 meses de seguimiento, la calidad de vida mejoró considerablemente respecto a la valoración prequirúrgica y hubo baja mortalidad en la población estudiada.
Palabras clave: Fractura de cadera, mortalidad, complicaciones, retraso quirúrgico (MeSH/DeCS)
17. Patient outcomes after surgery in 17 Latin American countries (LASOS): a 7 day prospective cohort study
17. Patient outcomes after surgery in 17 Latin American countries (LASOS): a 7 day prospective cohort study
Autores: Artículo en Colaboración Edison Alexander Benavides Hernandez* Francisco Agredo Villaquiran Paola Hernández Palomino Ana Valeria Gomez Mosquera y Miguel Eduardo Palechor Garcia
Summary: Background Access to safe surgical treatment across Latin America is limited by underfunded and fragmented health systems. Epidemiological data are required to describe surgical activity and patient outcomes.
Métodos: We did this 7 day prospective cohort study in 17 Latin American countries, collecting data describing inpatient surgery in adults (aged ≥18 years). The primary outcome was in-hospital postoperative complications within 30 days after surgery. Secondary outcomes were in-hospital mortality, duration of hospital stay, and admission to critical care within 30 days after surgery. This study is registered with ClinicalTrials.gov, NCT05169164.
Findings: Between June 1, 2022, and April 30, 2023, we included 22 126 patients (mean age 49·7 years [SD 18·2]; 9260 [41·9%] male and 12866 [58·1%] female; 10180 [46·0%] White) from 284 hospitals. Of the 22126 patients, 657 (3·0%) patients for the outcome of complications and 380 (1·7%) patients for mortality had missing data. Most patients were low risk (American Society of Anesthesiologists [ASA] grade I or II: 17 311 [78·7%] of 21 979 patients), undergoing non-major surgery (14 944 [68·0%] of 21 986 patients), and on an elective basis (14 837 [67·5%] of 21 988 patients). Despite this low-risk profile, 3163 (14·6%) of 21632 patients developed postoperative complications resulting in 477 (2·2%) deaths. The most frequent complication category was infection, affecting 1795 (8·2%) patients. The high mortality from complications (failure to rescue) of 15·1% (477 deaths in 3163 patients with complications) suggests significant problems with postoperative care. 2978 (13·6%) patients were admitted to a critical unit immediately after surgery, but 180 (37·7%) of 477 patients who died never received critical care. Patients with complications had a median hospital stay of 8 days (IQR 3–18), compared with 2 days (1–3) for patients without complications. Postoperative mortality and complications were strongly associated with increasing ASA grade, urgency of surgery, and grade of surgery (intermediate and major).
Interpretation Patients receiving inpatient surgery in Latin America experienced high mortality rates, likely relating to standards of ward care after surgery. Given the rising demand for surgical treatments, resource-efficient measures are urgently needed to improve patient outcomes after surgery across Latin America.
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