https://www.complicaciones-ortopedicas.mx/academia/caracteristicas-de-los-pacientes-duracion-de-la-estadia-costo-de-la-atencion-y-complicaciones-en-pacientes-super-obesos-que-se-sometieron-a-una-artroplastia-total-de-cadera-un-estudio-de-base-de-da/

Características de los pacientes, duración de la estadía, costo de la atención y complicaciones en pacientes súper obesos que se sometieron a una artroplastia total de cadera: un estudio de base de datos nacional

junio 20, 2023 por admin

El propósito de este estudio fue comparar las tasas de complicaciones postoperatorias en pacientes súper obesos (SO) con un índice de masa corporal (IMC) ≥ 50 kg/m2 sometidos a artroplastia total de cadera (ATC) versus pacientes no súper obesos (NSO) sometidos a THA.
Las tasas de complicaciones postoperatorias en pacientes SO fueron más altas que las del grupo NSO. La duración de la estancia y el costo de la atención fueron mayores, mientras que la edad media fue menor para el grupo SO. Por lo tanto, la ATC en pacientes con OS debe realizarse solo después de una consideración cuidadosa y preferiblemente en un centro terciario capaz de manejar todas las complicaciones médicas y quirúrgicas intrahospitalarias.

El objetivo del estudio fue comparar las tasas de complicaciones postoperatorias en pacientes superobesos (SO) con un índice de masa corporal (IMC) ≥ 50 kg/m2 que se sometieron a una artroplastia total de cadera (THA) con las de pacientes no superobesos (NSO) que se sometieron a la misma cirugía. Los autores utilizaron la base de datos National Inpatient Sample (NIS) para revisar 1.646 casos de THA en pacientes SO entre 2016 y 2019. Utilizaron los códigos de la Clasificación Internacional de Enfermedades (CIE)-10 para evaluar las variables postoperatorias, como la duración de la estancia, el coste de la atención (coste de la hospitalización intrahospitalaria) y las complicaciones médicas y quirúrgicas entre los pacientes SO y NSO antes del alta.

Los resultados mostraron que los pacientes SO tenían una mayor duración de la estancia (3,43 días frente a 2,32 días), un mayor coste de la atención (79.784,64 dólares frente a 66.821,75 dólares) y unas mayores probabilidades de desarrollar complicaciones médicas como anemia, insuficiencia renal aguda, neumonía y necesidad de transfusión sanguínea. Los pacientes SO también presentaron un mayor riesgo de complicaciones quirúrgicas como fracturas periprotésicas, infección y dehiscencia de la herida.
Los autores concluyeron que las tasas de complicaciones postoperatorias en los pacientes SO eran más altas que en el grupo NSO. La edad media era más baja para el grupo SO. Por lo tanto, la THA en pacientes SO debe realizarse sólo después de una cuidadosa consideración y preferiblemente en un centro terciario capaz de manejar todas las complicaciones médicas y quirúrgicas intrahospitalarias.

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study – PubMed (nih.gov)

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study – PMC (nih.gov)

CIOS :: Clinics in Orthopedic Surgery (ecios.org)

Copyright © 2023 by The Korean Orthopaedic Association

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Cuidado respiratorio perioperatorio del obeso / Perioperative respiratory care of obesity

Diciembre 18, 2017. No. 2936

Manejo respiratorio perioperatorio de los pacientes obesos Respiratory Management of Perioperative Obese Patients. Imber DA1,2, Pirrone M1,3, Zhang C1,4, Fisher DF5, Kacmarek RM6, Berra L7,8. Author information Respir Care. 2016 Dec;61(12):1681-1692. Epub 2016 Sep 13. Abstract With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. KEYWORDS: PEEP; atelectasis; mechanical ventilation; noninvasive ventilation; obesity; recruitment maneuver PDF International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Vía aérea en el obeso / Airway in the obese

Junio 27, 2017. No. 2732

El desempeño de la Escala de Dificultad de la Intubación en parturientas obesas sometidas a Cesárea The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section. Eiamcharoenwit J1, Itthisompaiboon N2, Limpawattana P3, Siriussawakul A4. Biomed Res Int. 2017;2017:3075756. doi: 10.1155/2017/3075756. Epub 2017 Jan 26. Abstract Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively. PDF El grado de dificultad de intubación y la frecuencia de complicaciones en pacientes obesos en el Servicio de Urgencias del Hospital y la Unidad de Cuidados Intensivos: Estudio de casos y controles. The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study. Cierniak M1, Sobczak R, Timler D, Wieczorek A, Borkowski B, Gaszyński T. Medicine (Baltimore). 2016 Dec;95(52):e5777. doi: 10.1097/MD.0000000000005777. Abstract The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score. Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to explain those correlations would be needed. PDF Manejo de la vía aérea perioperatoria y periprocedimientos y seguridad respiratoria para el paciente obeso: Consenso SIAARTI 2016. Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus. Petrini F1, Di Giacinto I2, Cataldo R3, Esposito C4, Pavoni V5, Donato P6, Trolio A7, Merli G8, Sorbello M9, Pelosi P10; Obesity Task Force for the SIAARTI Airway Management Study Group. Collaborators (34) Minerva Anestesiol. 2016 Dec;82(12):1314-1335. Epub 2016 Oct 19. Abstract Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as "globesity". Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org