Reexploración de urgencia en el Servicio de Cirugía Cardiovascular del Hospital Hermanos Ameijeiras entre 2008 y 2009
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Universidad Industrial de Santander
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Introducción: aproximadamente entre el 5% y el 10% de los pacientes sometidos a cirugía cardiovascular requieren de una reexploración deurgencia. Es el sangrado postoperatorio la primera causa de reintervención de urgencia en un paciente operado de cirugía cardiovascular.El presente trabajo pretende mostrar el comportamiento de la reexploración en pacientes operados de cirugía cardíaca en el servicioy determinar cuáles fueron los principales factores de riesgo asociados a este proceder así como la evolución y el comportamiento delos costos. Objetivos: determinar los factores de riesgo de reintervención de urgencia en cirugía cardiovascular y evaluar los costoshospitalarios por reintervención. Materiales y Métodos: se realizó un estudio retrospectivo de casos (n=47) y controles (n=916) en elServicio de Cirugía Cardiovascular del Hospital Hermano Ameijeiras en el período comprendido entre enero de 2008 a diciembre de 2009.Se compararon variables como: edad, sexo, peso, talla, antecedentes, medicación preoperatoria, necesidad de sangre y hemoderivados,horas de ventilación mecánica, estadio hospitalario, evolución, mortalidad y costos hospitalarios. Resultados: se encontró como factorespredisponentes el sexo masculino, la cardiopatía isquémica, la fiebre reumática, la endocarditis infecciosa, las hepatopatías, antecedentesde accidentes vasculares encefálicos y niveles elevados de creatinina. La ingestión preoperatoria de diuréticos, anticoagulantes yantiagregantes plaquetarios se relacionó con un mayor número de reintervenciones. La reexploración se relacionó con un aumento de:consumo de sangre y hemoderivados, tiempo de circulación extracorpórea, tiempo de ventilación mecánica, estadía en Unidad de CuidadosIntensivos Quirúrgicos y Hospitalaria, tasa de infecciones, mortalidad y un incremento de los costos. El 81% de las reintervenciones no teníanuna causa quirúrgica. Conclusiones: existe un grupo de parámetros que se comportan como factores de riesgo para la reexploración deurgencia. Los pacientes reintervenidos presentaron una mayor morbimortalidad y representaron un mayor costo para el sistema de salud.La utilización de un tromboelastógrafo representaría un ahorro anual de 350 mil dólares. (MÉD.UIS. 2012;25(1):11-7).
Rescan emergency cardiovascular surgery service Ameijeiras Brothers Hospital between 2008 and 2009.Introduction: approximately between 5% and 10% of the subjected patients to cardiovascular surgery require of an urgent reexploratión.It is the postoperative bleeding the first cause of reintervention of urgency in an operated patient of cardiovascular surgery. The presentwork seeks to show the behavior of the reexploratión in operated patients of heart surgery in the service and to determine which themain factors of risk were associated to this to proceed as well as the evolution and the behavior of the costs. Objective: determinethe risk factors of emergency reintervention in cardiovascular surgery and to evaluate the hospital costs of reintervention. Materialsand Methods: it was performed a retrospective case-control study (cases n=47, controls n=916) in the Cardiovascular Surgery Serviceof the Hospital “Hermanos Ameijeiras” on the period between January 2008 and December 2009. We compared variables such as: age,sex, weight, height, background, preoperative medication, use of blood and blood products, hours of mechanical ventilation, hospitalstay, development, mortality and hospital costs. Results: we found predisposing factors such as male gender, ischemic cardiomyopathy,rheumatic fever, infective endocarditis, hepatopathies, history of stroke and elevated creatinine levels.Preoperative intake of diuretics,anticoagulants and antiplatelet agents was associated with an increased number of reinterventions. Reintervention was associated withincreased consumption of blood and blood products, longer cardiopulmonary bypass, longer mechanical ventilation, increasedUCIQ andHospital stay, higher rate of infections, increased mortality and increasedcosts. 81% of the reoperations did not have a surgical cause.Conclusions: there is a set of parameters that act as risk factors for emergency reintervention. Reoperated patients had higher morbidityand mortality, and represented a greater cost to the health system. The use of a thromboelastograph would represent an annual savingof $ 350 000.(MÉD.UIS. 2012;25(1):11-7).
Rescan emergency cardiovascular surgery service Ameijeiras Brothers Hospital between 2008 and 2009.Introduction: approximately between 5% and 10% of the subjected patients to cardiovascular surgery require of an urgent reexploratión.It is the postoperative bleeding the first cause of reintervention of urgency in an operated patient of cardiovascular surgery. The presentwork seeks to show the behavior of the reexploratión in operated patients of heart surgery in the service and to determine which themain factors of risk were associated to this to proceed as well as the evolution and the behavior of the costs. Objective: determinethe risk factors of emergency reintervention in cardiovascular surgery and to evaluate the hospital costs of reintervention. Materialsand Methods: it was performed a retrospective case-control study (cases n=47, controls n=916) in the Cardiovascular Surgery Serviceof the Hospital “Hermanos Ameijeiras” on the period between January 2008 and December 2009. We compared variables such as: age,sex, weight, height, background, preoperative medication, use of blood and blood products, hours of mechanical ventilation, hospitalstay, development, mortality and hospital costs. Results: we found predisposing factors such as male gender, ischemic cardiomyopathy,rheumatic fever, infective endocarditis, hepatopathies, history of stroke and elevated creatinine levels.Preoperative intake of diuretics,anticoagulants and antiplatelet agents was associated with an increased number of reinterventions. Reintervention was associated withincreased consumption of blood and blood products, longer cardiopulmonary bypass, longer mechanical ventilation, increasedUCIQ andHospital stay, higher rate of infections, increased mortality and increasedcosts. 81% of the reoperations did not have a surgical cause.Conclusions: there is a set of parameters that act as risk factors for emergency reintervention. Reoperated patients had higher morbidityand mortality, and represented a greater cost to the health system. The use of a thromboelastograph would represent an annual savingof $ 350 000.(MÉD.UIS. 2012;25(1):11-7).