Revista do Colegio Brasileiro de Cirurgioes最新文献

Introduction: With the increase in healthcare spending, efficient resource management in surgical hospitals has become essential, especially with regard to managing patient flow to avoid delays. Therefore, tools that can provide instant visibility of the patients location in each sector can be of great value in choices about resource allocation. Therefore, the objective of this study was to evaluate the applicability of indoor location technology in a hospital environment.

Methods: Prospective study, carried out from February to March 2024, in a private surgical hospital, with tertiary structure, specialized in the care of elderly patients. The records of the path of each elective patient were mapped from their arrival to the moment of their discharge, as well as the activities of the professionals involved, through an indoor Bluetooth location device.

Results: 320 patients were analyzed, with an average stay time in the reception of 25 minutes and the time in the preoperative preparation unit of 107 minutes. Urology, mastology, and oncology surgeries represented 50% of the case series. The median transport time for these patients was 19 minutes. Reception (75.6%) and nursing admission (72.5%) were the sectors with the highest percentage of correct execution. The delay rate was 89.9% in the first time slot, and in subsequent times the delay was significantly lower (70.1%) compared to the time scheduled on the map.

Conclusion: Indoor location technology has applicability when used in the intra-hospital environment in the management of surgical patients, facilitating the identification of bottlenecks and their causes.

Introduction: Thyroidectomy, which consists of partial or total removal of the thyroid gland, is a commonly performed surgery to treat various thyroid diseases. In recent years, the trend has been toward partial thyroidectomies, due to their association with lower complication rates and the fact that they may be sufficient for adequate management.

Objective: To evaluate the impact of partial and total thyroidectomy on quality of life.

Methods: This study used the ThyPro questionnaire, which assesses the quality of life of patients with thyroid disorders, to investigate the impact of different thyroidectomy approaches on patients' quality of life.

Results: The postoperative complications were transient unilateral recurrent nerve paralysis (6.5%) and transitory hypoparathyroidism (22.4%). The quality of life outcomes after thyroidectomy were favorable. The extension of the thyroidectomy did not present statistical difference (p = 0.982). Significantly lower scores were associated with female gender and neck dissection.

Conclusion: Quality of life scores were high, with lower scores among women and neck dissection.

Introduction: Robotic surgery has been used in the treatment of various surgical diseases due to its precision and satisfactory outcomes. This study aims to describe the profile of patients undergoing robotic surgery at the Hospital de Clínicas de Passo Fundo and analyze the variables related to the procedure and its outcomes.

Methods: A total of 215 medical records of patients who underwent robotic surgery at the Regional Robotic Surgery Center of the Hospital de Clínicas de Passo Fundo were reviewed, from the start of the program in 2023 until March 2024. Sex, age, comorbidities, and perioperative and postoperative data were evaluated.

Results: The sample had a predominance of males (73.5%). The average age was 61 years. Systemic arterial hypertension was the most prevalent comorbidity (43.7%). Regarding operative time, the first six months had a higher median total time (300 minutes) compared to the last six months (245 minutes) with p≤0.001.

Conclusion: The implementation of a robotic surgery center in the interior of Brazil proved to be feasible, with favorable outcomes, progressive reductions in surgical times, and regional benefits by expanding access to cutting-edge technologies.

Introduction: biofilm is considered a challenge regarding treatment of chronic diseases and, after a detailed observation of cleaning and sterilization processes, it is considered could be a threat to sterility of surgical instruments that are "ready to use". Colored plastic bands (color coding tapes for marking surgical instruments) are frequently used to assist in the assembly of surgical instrument boxes. These bands form a lifting, which makes cleaning the material difficult. Epidemiological data regarding the frequency of surgical site infection in Brazil (up to 24% in Center-West Region) may be suggestive of contamination of operative instruments. The objective of this study is to answer the question: is there a risk of biofilm on ready-to-use surgical instruments?

Methods: narrative literature review.

Results: 296 articles were found and a total of 163 were selected for detailed reading, of which 78 were included. During the survey, four knowledge domains were outlined: microbiology, pathophysiology/epidemiology, technology and management. This review pointed out the risk of the bacterial load prior to autoclaving, the efficiency of the sterilization method regarding the presence of microscopic soils and, under current conditions, the ability of the Material and Sterilization Centers to ensure adequate cleaning.

Conclusion: after working extensively to associate all the collected information, there is a considerable probability of bacterial biofilms in ready-to-use surgical instruments and, therefore further research in this field of microbiology is justified, with an emphasis on improving process quality indicators, giving the potential impact on reduction of surgical site infection rates.

Introduction: diastasis recti surgery has been known worldwide for open surgical techniques involving significant tissue manipulation, skin flap and larger incisions. Traditional methods typically required extended recovery times and posed higher risks of complications and scarring issues. The advent of robotic-assisted surgery has revolutionized the treatment paradigm for abdominal wall defects and its remarkable outcomes encouraged expanding its applications towards diastasis recti pathologies. Better visualization and more ergonomic instruments foster a minimal scarring procedure, allowing surgeons to improve aesthetic and recovery outcomes following diastasis recti correction in a posterior approach. This article describes a robotic surgical technique and results to an unprecedented approach, putting its form of treatment into another perspective.

Technical report: a step-by-step guided technique of this novel technique is described using detailed port placement and figures to assure optimal aesthetic and functional outcomes whenever acting in minimally invasive diastasis recti repair with the da Vinci platform.

Conclusion: The described technique reveals a hidden minimal incisions procedure avoiding skin flaps, scarring issues, and minimizing wound morbidity. Through a step-by-step guide, this report establishes an unprecedent technique description transforming the diastasis recti surgery scenario and its aesthetic outcomes with a safe minimally invasive surgery.

Introduction: Shorter fasting periods before and after surgery have been associated with better postoperative recovery and lower morbidity and mortality. However, it is not always possible to achieve current recommendations in pediatric practice. Therefore, it is essential to study fasting time and its associated factors to implement better care strategies.

Methods: Cohort of 284 pediatric patients admitted for surgery between 2020-2021, Hospital São Paulo, Brazil. Data was collected through interviews and medical records. Simple and multiple linear models and logistic regression models were adjusted to study the associations.

Results: All preoperative patients fasted for a prolonged period and most resumed feeding 6 hours after the end of anesthesia. Preoperative fasting time was shorter for elective surgery than for urgent surgery (p=0.025). Factors associated with a longer preoperative fasting time (minutes) were: older age in years (ß=10; 95% CI=5.2-14.8) and history of previous surgery (ß=76.6; 95% CI=28.0-125.1). Factors associated with postoperative fasting time longer than 6 hours were: no immediate postoperative care in the surgical ward (OR=6.05; 95%CI=2.25-16.22), presence of complications during surgery (OR=3. 53; 95%CI=1.19-10.47), major operation size (OR=3.85; 95%CI=1.49-9.93), abdominal surgery (OR=36.52; 95%CI=13.48-98.91) and vomiting in the first 24 hours (OR=3.44; 95%CI=1.54-7.69).

Conclusion: There are potentially modifiable factors associated with longer fasting times. Education and organization of the healthcare team regarding patient characteristics, care dynamics, and clinical complications may contribute to greater optimization of fasting times in pediatric surgical patients.

Introduction: Severe burns significantly weaken the immune system and disrupt the skin's natural barrier, which increases the likelihood of healthcare-associated infections (HAIs) and raises the risk of mortality.

Methods: Based on CDC criteria, this study retrospectively examines the incidence of HAIs in burn patients hospitalized at a university hospital in São Paulo, Brazil, over five years from 2018 to 2022.

Results: 536 patients were treated during this time, with 130 HAIs recorded in 88 individuals. The average age of the patients was 41 years, and the mean total body surface area (TBSA) affected by burns was 20.4%. The primary causes of burns were flammable liquids (39.7%), electrical injuries (25%), and scalds from heated liquids (14.8%). Burn wound infections were the most frequent HAI (51.5%), followed by bloodstream infections (13.8%), urinary tract infections (13.1%), and ventilator-associated pneumonia (10.7%). Regarding microbiological findings, 141 microorganisms were isolated, with gram-negative bacteria making up 71.6% of the total, gram-positive bacteria accounting for 21.2%, and fungi representing 7.1%. In three cases, no microorganism was identified. The mortality rate among these patients was 13,6%.

Conclusion: Notably, the predominance of gram-negative bacteria in this population, responsible for more than 70% of infections, contrasts with findings from other studies. The findings highlight the importance of infection control to reduce morbidity and mortality in this vulnerable population.

Introduction: The surgical approach to the abdomen via laparoscopy has been widely used for cholecystectomy. This access route has demonstrated advantages, including the reduction in the incidence of incisional hernias. Could this really be a reality?

Objective: This survey aims to show the existence of these hernias and the profile of patients who present them.

Method: Incisional hernias operated from January 2017 to May 2024, at the Complexo Hospital do Trabalhador were reviewed. The inclusion criteria were: age 18 years or older and having undergone laparoscopic cholecystectomy, excluding those operated on in the emergency room and those whose medical records did not allow the data to be analyzed to be obtained.

Results: 71 hernias were identified at the trocar site, all in the umbilical position (12.98% of all incisional hernias). It predominated in women (73.24%) and the average age was 53.99 ± 13.33 years. Weight changes were present in 91.05% of patients and obesity in 52.25%. The diagnosis was clinical and the hernias were complex. Furthermore, 38.03% were diabetic and 42.25% had high blood pressure.

Conclusion: Incisional hernia at the umbilical trocar site in laparoscopic cholecystectomy is highly prevalent, with obesity as the main risk factor.

Introduction: Liver transplantation is a complex and costly surgical procedure funded by the Brazilian public health system. This study analyzed the hospital costs of patients who underwent liver transplantation and their relationship with graft cold ischemia time, as well as evaluated the impact of infection rate, length of hospital stay, and hospital expenses on survival and total costs.

Methods: This is a retrospective economic evaluation study that analyzed 40 medical records of patients who underwent liver transplantation in 2018 at a public hospital in São Paulo. Micro- and macro-costing methodologies were applied to calculate direct and fixed postoperative costs.

Results: Each additional hour of cold ischemia time increased the risk of infection by 2.6 times (95% CI: 1.28-7.51; p=0.025). Patients with more than 8 hours of cold ischemia had longer hospital stays (average of 36 days) and higher costs (average of R$98,190.42) compared to those with less than 8 hours (20 days and R$49,519.05). Patients who developed an infection remained hospitalized 2.16 times longer and had higher average total costs (R$148,400.00) compared to those without infection (R$58,200.00). Higher expenditures on materials, medications, nursing care, and prolonged stays in the Intensive Care Unit (ICU) were associated with lower survival.

Conclusion: Cold ischemia time directly influenced the increase in costs and higher rates of posttransplant infection. Higher expenditures on materials, medications, nursing care, and prolonged ICU stays were associated with lower survival rates.

Introduction: Sentinel lymph node biopsy is fundamental for staging and prognostication of cutaneous melanoma when indicated. However, it still yields a high rate of negative results. To reduce the rate of true negatives, oncology centers have developed nomograms to better stratify patients for whom the procedure is recommended.

Objective: To study the accuracy of two nomograms developed by the Memorial Sloan-Kettering Cancer Center (MSKCC) and the Melanoma Institute Australia (MIA) for calculating the probability of sentinel lymph node positivity in a population of patients from southern Brazil.

Methods: An accuracy study was conducted, including data from 320 patients diagnosed with melanoma at a referral oncology institution in Santa Catarina, Brazil. The risk of sentinel lymph node positivity was calculated for each patient using the studied nomograms and compared to the results of histopathological examination. Discrimination was assessed by calculating the area under the Receiver Operating Characteristic (ROC) curve, thereby determining the accuracy of each nomogram.

Results: The MSKCC nomogram demonstrated an overall accuracy of 69.05%, while the MIA nomogram showed an accuracy of 68.38%.

Conclusion: The nomograms did not exhibit acceptable levels of accuracy for application in the studied population.