Mortalidad postoperatoria / Postoperative mortality

Enero 4, 2017. No. 2560

Nuevo sistema de puntuación quirúrgica para predecir la mortalidad postoperatoria. New surgical scoring system to predict postoperative mortality. Kinoshita M1, Morioka N2, Yabuuchi M1, Ozaki M1. J Anesth. 2016 Dec 19. [Epub ahead of print] Abstract PURPOSE: There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality. METHODS: The study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality. RESULTS: Increased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001). CONCLUSIONS: The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems. KEYWORDS: American Society of Anesthesiologists physical status classification (ASA-PS); Patient safety; Postoperative mortality; Surgical Apgar score (sAs) PDF El puntaje de apgar quirúrgico predice la complicación temprana en amputados transfemorales: Estudio retrospectivo de 170 amputaciones mayores. Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations. Wied C1, Foss NB1, Kristensen MT1, Holm G1, Kallemose T1, Troelsen A1. World J Orthop. 2016 Dec 18;7(12):832-838. doi: 10.5312/wjo.v7.i12.832. eCollection 2016. Abstract AIM: To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS: This was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery. RESULTS: A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0.004] and for the TFA sub-group [OR = 3.82 (1.5-9.42), P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648 (0.562-0.733), P = 0.001], for TFA patients = [0.710 (0.606-0.813), P < 0.001] and for TTA patients = [0.472 (0.383-0.672), P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients. CONCLUSION: SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups. KEYWORDS: Lower extremity amputation; Mortality; Post-operative complication; Surgical apgar score; Transfemoral amputation PDF Estudio observacional para valorar y predecir serios eventos adversos después de cirugía mayor Observational Study to Assess and Predict Serious Adverse Events after Major Surgery. Shiozaki K1, Morimatsu H, Matsusaki T, Iwasaki T. Acta Med Okayama. 2016 Dec;70(6):461-467. Abstract Many patients suffer from postoperative serious adverse events (SAEs). Here we sought to determine the incidence of SAEs, assess the accuracy of currently used scoring systems in predicting postoperative SAEs, and determine whether a combination of scoring systems would better predict postoperative SAEs. We prospectively evaluated patients who underwent major surgery. We calculated 4 scores: American Society of Anesthesiologists physical status (ASA-PS) score, the Charlson Score, the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score, and the Surgical Apgar Score (SAS). We assessed the occurrence of SAEs. We assessed the association between each score and SAEs. We combined these scoring systems to find the best combination to predict the occurrence of SAEs. Among 284 patients, 43 suffered SAEs. All scoring systems could predict SAEs. However, their predictive power was not high (the area under the receiver operating characteristic curves [AUROC] 0.6-0.7). A combination of the ASA-PS score and the SAS was the most predictive of postoperative SAEs (AUROC 0.714). The incidence of postoperative SAEs was 15.1 . The combination of the ASA-PS score and the SAS may be a useful tool for predicting postoperative serious adverse events after major surgery. PDF  5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

El impacto del pamidronato y la quimioterapia en los tiempos de supervivencia en perros con tumores óseos primarios apendiculares tratados con radioterapia paliativa



http://www.canceroseo.com.mx/academia/el-impacto-del-pamidronato-y-la-quimioterapia-en-los-tiempos-de-supervivencia-en-perros-con-tumores-oseos-primarios-apendiculares-tratados-con-radioterapia-paliativa/

El impacto del pamidronato y la quimioterapia en los tiempos de supervivencia en perros con tumores óseos primarios apendiculares tratados con radioterapia paliativa

The impact of pamidronate and chemotherapy on survival times in dogs with appendicular primary bone tumors treated with palliative radiation therapy

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/23253085

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.2012.00968.x/abstract;jsessionid=FE8F299ADD0472C0C8F66B1F8BA1ED1D.f04t04



De:

Oblak ML¹, Boston SE, Higginson G, Patten SG, Monteith GJ, Woods JP.

Vet Surg. 2012 Apr;41(3):430-5. doi: 10.1111/j.1532-950X.2012.00968.x.



Todos los derechos reservados para:

© Copyright 2012 by The American College of Veterinary Surgeons.

Abstract

OBJECTIVE:

To assess survival times in dogs that received palliative radiation therapy (RT) alone, and in combination with chemotherapy, pamidronate, or both for primary appendicular bone tumors and determine whether the addition of these adjunctive therapies affects survival.

STUDY DESIGN:

Retrospective case series.

ANIMALS:

Dogs (n = 50) with primary appendicular bone tumors.

CONCLUSIONS:

Chemotherapy should be recommended in addition to a palliative RT protocol to improve survival of dogs with primary appendicular bone tumors. When combined with RT ± chemotherapy, pamidronate decreased MST and should not be included in a standard protocol.

Resumen
OBJETIVO:
Evaluar los tiempos de supervivencia en perros que recibieron radioterapia paliativa sola y en combinación con quimioterapia, pamidronato o ambos para tumores óseos apendiculares primarios y determinar si la adición de estas terapias complementarias afecta la supervivencia.


DISEÑO DEL ESTUDIO:
Serie de casos retrospectivos.


ANIMALES:
Perros (n = 50) con tumores óseos apendiculares primarios.


CONCLUSIONES:
La quimioterapia debe recomendarse además de un protocolo de RT paliativo para mejorar la supervivencia de los perros con tumores óseos apendiculares primarios.

© Copyright 2012 by The American College of Veterinary Surgeons.

PMID: 23253085  DOI:  10.1111/j.1532-950X.2012.00968.x

[PubMed – indexed for MEDLINE]

Errores médicos / Medical errors

Enero 6, 2017. No. 2561

Definiendo la excelencia: los próximos pasos para los clínicos que tratan de prevenir el error de diagnóstico. Defining excellence: next steps for practicing clinicians seeking to prevent diagnostic error. Foster PN1, Klein JR2. J Community Hosp Intern Med Perspect. 2016 Sep 7;6(4):31994. doi: 10.3402/jchimp.v6.31994. eCollection 2016. Abstract The Institute of Medicine (IOM) released its report on diagnostic errors in September, 2015. The report highlights the urgency of reducing errors and calls for system-level intervention and changes in our basic clinical interactions. Using the report's controversial definition of diagnostic error as a starting point, we introduce the issues and the potential impact on practicing physicians. We report a case used to illustrate this in an academic conference. Finally, we turn to the challenge of integrating these ideas into the traditional peer-review process. We argue that the medical community must evolve from understanding diagnostic failures to redesigning the diagnostic process. We should see errors as steps toward diagnostic excellence and reliable processes that minimize the risk of mislabeling and harm. KEYWORDS: Institute of Medicine; diagnostic error; graduate medical education; patient safety; peer review PDF Efecto adverso y error de eventos inesperados que amenazan la vida dentro de las 24 horas del ingreso al servicio de urgencias. Adverse event and error of unexpected life-threatening events within 24h of emergency department admission. Zhang E1, Hung SC1, Wu CH1, Chen LL2, Tsai MT1, Lee WH3. Am J Emerg Med. 2016 Nov 30. pii: S0735-6757(16)30897-X. doi: 10.1016/j.ajem.2016.11.062. Abstract OBJECTIVES: Errors and adverse events associated with unexpected life-threatening events including unplanned transfer to the intensive care unit (ICU) and unexpected death after emergency department (ED) hospitalization are not well characterized. We performed this study to investigate the role of unexpected life-threatening events as a trigger to capture errors and adverse events for ED patient safety. METHODS: This prospective observational study enrolled adult non-trauma patients with unexpected life-threatening events within 24h of general ward admission from the ED of a medical center in Taiwan. The period of study was one year (in 2013); the medical records of enrolled patients were reviewed to identify adverse events and errors. We measured the incidence rate of adverse events or errors. Preventability, type, and physical injury severity of adverse events were investigated. RESULTS: Of 33,224 adult non-trauma ward admissions from the ED, 100 admissions (0.3%) met the study criteria. Incidence rate was 2% and 15% for errors and adverse events, respectively. In admissions involving error, all were preventable and the error type was overlooked of severity. In admissions that involved adverse events, 93.3% were preventable. There were 20% of admissions that resulted in death and 60% developed with severe physical injury. The adverse event types were diagnosis issues (53.3%), management issues (40%), and medication adverse events (6.7%). CONCLUSIONS: Unexpected life-threatening events within 24h of admission from the ED could be a useful trigger tool to identify preventable adverse events with serious physical injury in ED. PDF Análisis descriptivo de once años de veredictos de corte cerrado sobre errores médicos en España y Massachusetts. Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts. Giraldo P1, Sato L2, Martínez-Sánchez JM3, Comas M4, Dwyer K5, Sala M6, Castells X6. BMJ Open. 2016 Aug 30;6(8):e011644. doi: 10.1136/bmjopen-2016-011644. Abstract OBJECTIVES:To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. DESIGN, SETTING AND PARTICIPANTS: We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. RESULTS: Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. CONCLUSIONS: This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution. KEYWORDS: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; FORENSIC MEDICIN PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Mexicali, México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015