RESUMO
BACKGROUND: In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM). METHODS: Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. RESULTS: PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. CONCLUSIONS: This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.
RESUMO
More than 80% of patients with metastatic melanoma initially show only one distant organ site involvement, most commonly the lungs. Several studies on patients with pulmonary metastatic diseases have determined prognostic factors for survival; however, these studies included patients with a variety of primary tumor types and failed to discriminate melanoma-specific prognostic factors. Surgical therapy has been shown in several studies to be associated with a 5-year survival rate as high as 39%. We retrospectively analyzed 48 patients with previously treated melanoma who developed pulmonary metastases and were admitted between 1990 and 2006. The overall survival was estimated using Kaplan-Meier analysis. Log-rank and Breslow's tests were used to compare survival differences for each variable. Multivariate analyses to determine the independent prognostic factors for overall survival were performed using the Cox proportional hazard model, as identified by the univariate analyses. The median overall survival for all patients was 32 months, with an estimated 5-year survival rate of 36%. Multivariate analyses identified the type of resection and the number of malignant nodules resected as independent prognostic factors for overall survival. We observed a significant survival benefit from pulmonary metastasectomy for a subset of patients with metastatic pulmonary melanoma.