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Asociación de cirugía superpuesta con resultados perioperatorios
Eric Sun1,2, Michelle M Mello2,3, Chris A Rishel1
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
JAMA
|February 27, 2019
Resumen
La superposición de la cirugía no aumentó la mortalidad o las complicaciones en la mayoría de los pacientes, pero sí aumentó la duración de la cirugía. Los pacientes de alto riesgo experimentaron un aumento de la mortalidad y las complicaciones durante los procedimientos superpuestos.
Área de la Ciencia:
- Investigación de resultados quirúrgicos
- Seguridad del paciente
- Investigación en servicios de salud
Sus antecedentes:
- La superposición de cirugía, donde un cirujano maneja múltiples procedimientos simultáneamente, plantea preocupaciones con respecto a la seguridad del paciente y los posibles resultados adversos.
- Comprender el impacto de la cirugía superpuesta en la mortalidad, las complicaciones y la duración del procedimiento es crucial para la práctica quirúrgica y la atención al paciente.
Objetivo del estudio:
- Investigar la asociación entre la superposición de cirugías y la mortalidad hospitalaria, las complicaciones postoperatorias y la duración de la cirugía.
- Identificar si los subgrupos específicos de pacientes están en mayor riesgo durante los procedimientos quirúrgicos superpuestos.
Principales métodos:
- Un estudio de cohorte retrospectivo analizó 66.430 operaciones en varios tipos quirúrgicos (artroplastia total de rodilla / cadera, cirugía de columna vertebral, CABG, craneotomía) desde 2010 hasta 2018.
- La cirugía de superposición se definió como al menos una hora de superposición o toda la duración para casos de menos de una hora.
- Los resultados incluyeron mortalidad hospitalaria, complicaciones mayores/menores y duración de la cirugía, con seguimiento hasta el alta.
Principales resultados:
- La cirugía superpuesta (12% de los casos) no se asoció significativamente con un aumento de la mortalidad hospitalaria o las tasas generales de complicaciones en comparación con la cirugía no superpuesta.
- Se observó un aumento significativo en la duración de la cirugía para procedimientos superpuestos (30 minutos más largos).
- Los pacientes de alto riesgo sometidos a cirugía superpuesta mostraron tasas significativamente más altas de mortalidad y complicaciones en comparación con los pacientes de bajo riesgo.
Conclusiones:
- La superposición de cirugías en adultos sometidos a procedimientos comunes no está relacionada con un aumento de la mortalidad o las tasas de complicaciones, pero se asocia con una mayor duración de la cirugía.
- Los hallazgos sugieren que, si bien el riesgo general puede no aumentar, las poblaciones específicas de pacientes de alto riesgo pueden experimentar resultados adversos durante las cirugías superpuestas.
- Se justifica una investigación adicional para explorar las asociaciones matizadas de la cirugía superpuesta dentro de distintos subgrupos de pacientes.
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