RESUMO
INTRODUCTION: Vitamin D plays a crucial role in various biological processes, including the well-known regulation of the immune system and calcium metabolism. While its involvement in the surgical outcomes of various medical specialties is recognized, there is a lack of consistent data regarding plastic surgery. This study aimed to assess preoperative serum levels of 25-hydroxyvitamin D and its relationship with complications in patients undergoing reconstructive and aesthetic plastic surgeries. METHODS: prospective and observational cohort study, conducted from October 2021 to August 2023 at the Hospital das Clínicas, Universidade Federal de Pernambuco, involving 83 patients. RESULTS: vitamin D levels were deemed deficient in 7 (8,4%) patients, insufficient in 36 (43,4%), and sufficient in 40 (48,2%). No direct association was demonstrated between deficient or insufficient serum levels of 25-hydroxyvitamin D and the incidence of complications in plastic surgery, even when considering comorbidities. CONCLUSION: preoperative hypovitaminosis D was not associated with complications in plastic surgery.
Assuntos
Complicações Pós-Operatórias , Deficiência de Vitamina D , Vitamina D , Humanos , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/sangue , Projetos Piloto , Estudos Prospectivos , Feminino , Masculino , Vitamina D/sangue , Vitamina D/análogos & derivados , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Pessoa de Meia-Idade , Adulto , Procedimentos de Cirurgia Plástica/efeitos adversos , Adulto Jovem , Período Pré-Operatório , Idoso , AdolescenteRESUMO
BACKGROUND: Bile duct injury (BDI) repair surgery is usually associated with morbidity/mortality. The neutrophil-to-lymphocyte ratio (NLR) easily assesses a patient's inflammatory status. The study aims to determine the possible relationship between preoperative NLR (pNLR) with postoperative outcomes in BDI repair surgery. METHODS: Approved Ethics/Research Committee retrospective study, in patients who had a Bismuth-Strasberg type E BDI repair (2008-2023). Data registered was: morbidity, mortality, and long-term outcomes (primary patency and loss of primary patency) (Kaplan-Meier). Group comparison (U Mann-Whitney), receiver operator characteristic (ROC): area under curve [AUC]; cut-off value, and Youden index [J], and logistic regression analysis were used for pNLR evaluation. RESULTS: Seventy-three patients were studied. Mean age was 44.4 years. E2 was the commonest BDI (38.4%). Perioperative morbidity/mortality was 31.5% and 1.4%. Primary patency was 95.9%. 8.2% have lost primary patency (3-year actuarial patency: 85.3%). Median pNLR was higher in patients who had any complication (4.84 vs. 2.89 p = 0.015), biliary complications (5.29 vs. 2.86 p = 0.01), and patients with loss of primary patency (5.22 vs. 3.1 p = 0.08). AUC's, cut-off values and (J) were: any complication (0.678, pNLR = 4.3, J = 0.38, p = 0.007), serious complication (0.667, pNLR = 4.3, J = 0.34, p = 0.04), biliary complications (0.712, pNLR = 3.64, J = 0.46, p = 0.001), and loss of primary patency (0.716, pNLR = 3.24, J = 0.52, p = 0.008). Logistic regression was significant in any complication (Exp [B]: 0.1, p = 0.002), serious complications (Exp [B]: 0.2, p = 0.03), and biliary complications (Exp [B]: 8.1, p = 0.003). CONCLUSIONS: pNLR is associated with complications in BDI repair with moderate to acceptable predictive capacity. pNLR could potentially predict patency of a BDI repair.
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Ductos Biliares , Linfócitos , Neutrófilos , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , IdosoRESUMO
OBJECTIVE: We would like to investigate the prognostic utility of the previously described factors and offer a new parameter called neutrophil-to-C-reactive protein ratio (NCR) as a predictor of post-operative complications of pancreas cancer. METHODS: 92 patients underwent pancreaticoduodenectomy for the pancreatic head tumor were enrolled in this study. Receiver operating curve analysis was performed to detect the cutoff values, and logistic regression analyses were performed to identify the independent risk factors of complications. RESULTS: In univariate analysis, complications were observed in lymphocyte-to-C-reactive protein ratio levels below 0.06 (Odds Ratio [OR]: 3.92, 95% confidence interval [CI] = 1.08-14.21, p = 0.037). In multivariate analysis, albumin < 3.6 (OR: 3.25, 95% CI: 1.16-9.06, p = 0.024) and NCR < 0.28 (OR: 2.81, 95 % CI: 1.07-7.63, p = 0.042) were the independent and significant predictors of the overall survival. DISCUSSION: Quantification of preoperative NCR and albumin may help surgeons to settle an effective perioperative management, take extra caution, and be aware of post-operative complications of pancreatic cancer patients.
OBJETIVO: Se investigó la proporción de neutrófilos a proteína C reactiva (NCR) como predictor de complicaciones posoperatorias del cáncer de páncreas. MATERIAL Y MÉTODOS: 92 pacientes fueron sometidos a pancreaticoduodenectomía (PD) por el tumor de la cabeza del páncreas incluidos en este estudio. Se realizaron análisis de curva operativa del receptor (ROC) y análisis de regresión logística para detectar los valores de corte y los factores de riesgo independientes de complicaciones. RESULTADOS: En análisis univariado; se observaron complicaciones en niveles de LCR por debajo de 0,06 (OR: 3.92, IC 95%: 1.08-14.21, p = 0.037). En análisis multivariado; albúmina < 3.6 (OR: 3.25, IC 95 %: 1.16-9.06, p = 0.024), NCR < 0.28 (OR: 2.81, IC 95 %: 1.07-7.63, p = 0.042) fueron los predictores independientes y significativos de la supervivencia. CONCLUSIÓN: La cuantificación de la NCR y la albúmina preoperatorias puede ayudar a los cirujanos a establecer un manejo perioperatorio efectivo, tomar precauciones adicionales y estar atentos a las complicaciones posoperatorias.
Assuntos
Proteína C-Reativa , Neutrófilos , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Humanos , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/sangue , Masculino , Feminino , Proteína C-Reativa/análise , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Idoso , Pancreaticoduodenectomia/efeitos adversos , Prognóstico , Estudos Retrospectivos , Contagem de Leucócitos , Albumina Sérica/análise , Adulto , Idoso de 80 Anos ou mais , Fatores de Risco , Curva ROCRESUMO
PURPOSE: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years). MATERIALS AND METHODS: A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants. RESULTS: The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients. CONCLUSION: After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later.
Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Redução de Peso , Humanos , Derivação Gástrica/efeitos adversos , Feminino , Masculino , Redução de Peso/fisiologia , Adulto , Estudos Prospectivos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Seguimentos , Resultado do Tratamento , Pessoa de Meia-Idade , Aumento de Peso , Glicemia/metabolismo , Fatores de Tempo , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/sangue , Lipídeos/sangueRESUMO
OBJECTIVE: With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. MATERIALS AND METHODS: Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. RESULTS: Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). CONCLUSION: Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.
Assuntos
Nomogramas , Hiperplasia Prostática , Serotonina , Ressecção Transuretral da Próstata , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/sangue , Idoso , Ressecção Transuretral da Próstata/efeitos adversos , Fatores de Risco , Serotonina/sangue , Pessoa de Meia-Idade , Biomarcadores/sangue , Espasmo/etiologia , Espasmo/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Curva ROC , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/sangue , Valores de ReferênciaRESUMO
BACKGROUND: Risk stratification is an important step in perioperative evaluation. However, the main risk scores do not incorporate biomarkers in their set of variables. OBJECTIVE: Evaluate the incremental power of troponin to the usual risk stratification. METHODS: A total of 2,230 patients admitted to the intensive care unit after non-cardiac surgery were classified according to three types of risk: cardiovascular risk (CVR), Revised Cardiac Risk Index (RCRI); and inherent risk of surgery (IRS). The main outcome was all-cause mortality. Cox regression was used as well as c-statistics before and after addition of high-sensitivity troponin (at least one measurement up to three days after surgery). Finally, net reclassification index and integrated discrimination improvement were used to assess the incremental power of troponin for risk stratification. Significance level was set at 0.05. RESULTS: Mean age of patients was 63.8 years and 55.6% were women. The prevalence of myocardial injury after non-cardiac surgery (MINS) was 9.4%. High CVR-patients had a higher occurrence of MINS (40.1 x 24.8%, p<0.001), as well as high IRS-patients (21.3 x 13.9%, p=0.004) and those with a RCRI≥3 (3.0 x 0.7%, p=0.009). Patients without MINS, regardless of the assessed risk, had similar mortality rate. The addition of troponin to the risk assessment improved the predictive ability of death at 30 days and at 1 year in all risk assessments. CONCLUSION: The prevalence of MINS is higher in the high-risk population. However, its prevalence in lower-risk population is not negligible and causes a higher risk of death. The addition of high-sensitivity troponin increased the predictive ability of risk assessment in all groups.
FUNDAMENTO: A estratificação ode risco é uma importante etapa na avaliação perioperatória. No entanto, os principais escores de risco não incorporam biomarcadores em seus conjuntos de variáveis. OBJETIVO: Avaliar o poder incremental da troponina à estratificação de risco tradicional. MÉTODOS: Um total de 2230 pacientes admitidos na unidade de terapia intensiva após cirurgia não cardíaca foram classificados de acordo com três tipos de risco: Risco Cardiovascular (RCV), Índice de Risco Cardíaco Revisado (IRCR), e Risco Inerente da Cirurgia (RIC). O principal desfecho foi mortalidade por todas as causas. A regressão de Cox foi usada, assim como a estatística C antes e após a adição de troponina ultrassensível (pelo menos uma medida até três dias após a cirurgia). Finalmente, o índice de reclassificação líquida e a melhoria de discriminação integrada foram usadas para avaliar o poder incremental da troponina para a estratificação de risco. O nível de significância usado foi de 0,05. RESULTADOS: A idade média dos pacientes foi 63,8 anos e 55,6% eram do sexo feminino. A prevalência de lesão miocárdica após cirurgia não cardíaca (MINS) foi 9,4%. Pacientes com um RCV elevado apresentaram uma maior ocorrência de MINS (40,1% x 24,8%, p<0,001), bem como pacientes com alto RIC (21,3 x 13,9%, p=0,004) e aqueles com IRCR≥3 (3,0 x 0,7%, p=0,009). Pacientes sem MINS, independentemente do risco avaliado, apresentaram taxa de mortalidade similar. A adição de troponina à avaliação de risco melhorou a capacidade preditiva de mortalidade em 30 dias e de mortalidade em um ano em todas as avaliações de risco. CONCLUSÃO: A prevalência de MINS é mais alta na população de alto risco. No entanto, sua prevalência na população de risco mais baixo não é desprezível e causa um maior risco de morte. A adição da troponina ultrassensível melhorou a capacidade preditiva da avaliação de risco em todos os grupos.
Assuntos
Biomarcadores , Troponina , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Biomarcadores/sangue , Idoso , Troponina/sangue , Fatores de Risco , Período Perioperatório , Valor Preditivo dos Testes , Procedimentos Cirúrgicos Operatórios/mortalidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores de Tempo , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/sangue , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/sangueRESUMO
INTRODUCTION: PTH measurement has been proposed to predict transient and permanent postoperative hypocalcemia. There is no standard cut-off point or time for sampling. AIM: To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia. METHODS: In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured. RESULTS: Transient (< 12 months) and permanent (> 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period. CONCLUSIONS: Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.
Assuntos
Cálcio , Hipocalcemia , Hormônio Paratireóideo , Tireoidectomia , Humanos , Hipocalcemia/etiologia , Hipocalcemia/epidemiologia , Hipocalcemia/sangue , Tireoidectomia/efeitos adversos , Hormônio Paratireóideo/sangue , Feminino , Masculino , Cálcio/sangue , Pessoa de Meia-Idade , Incidência , Adulto , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Magnésio/sangue , Valor Preditivo dos TestesRESUMO
To verify the viability and functionality of cryopreserved thyroid autotransplantation in rats who underwent total thyroidectomy in the treatment of postoperative hypothyroidism. Thirty-two Wistar rats were randomly assigned into groups (G) with eight animals each: control (CG); simulation (SG); hypothyroidism (HTG) and transplanted (TG). At the beginning and in the 13th week of the experiment, serum levels of total T3, free T4, TSH and calcium were determined. In both the first and 14th weeks, scintigraphic examinations, 99m-Tc pertechnetate radioisotope biodistribution and histopathology were performed. In the 14th week, the expression of proliferating cell nuclear antigen (PCNA) and cellular apoptosis (caspase-3) were also evaluated. In the 13th week, the transplanted animals had normal serum levels of total T3 and free T4. TSH levels showed a tendency towards normality. In the 14th week, scintigraphic exams displayed graft isotopic uptake in all animals in the TG group. Histological examinations 13 weeks after transplantation showed the viability and functionality of thyroid follicles. PCNA revealed significant immunoreactivity of the graft (p < 0.001) when the TG was compared to the CG. There was no difference between CG and TG considering the expression of activated caspase-3. The experimental study confirmed the viability and functionality of thyroid autotransplantation implanted in skeletal muscle with evidence of cell proliferation without cellular apoptosis. This surgical strategy was effective in the treatment of postoperative hypothyroidism.
Assuntos
Hipotireoidismo/cirurgia , Complicações Pós-Operatórias/cirurgia , Glândula Tireoide/transplante , Tireoidectomia/efeitos adversos , Animais , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Ratos , Ratos Wistar , Tiroxina/sangue , Transplante Autólogo , Tri-Iodotironina/sangueRESUMO
Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).
Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)