Predictor's factors of infectious surgical complications in older adults after emergency abdominal surgery
Keywords:
older adult, surgery, urgency, complications, predictor's factors.Abstract
Introduction: The increase in life expectancy of the population determines the increase in the number of elderly patients undergoing emergency surgery, and its complications.Objective: To identify the predictor's factors of infectious surgical complications in elderly patients after emergency abdominal conventional surgery.
Methods: A study of cases and controls was carried out in elderly patients who presented surgical complications after emergency abdominal conventional surgery. Controls were uncomplicated patients. The analysis was carried out using tetrachoric tables; the presence of risk and its statistical significance were computed by analyzing the Odds Ratio (OR), their confidence intervals and the chi-square test with a level of significance a= 0.05.
Results: The variables, preoperative physical examination according to the classification of the American Society of Anesthesiologists ASA III and IV (OR= 10.33), contaminated and dirty operations (OR= 28.00), surgical time of 2 hours or more (OR= 49.33) and alterations in nutritional status (OR= 10.33) on adults elderly who underwent emergency abdominal conventional surgery, were more likely to develop an infectious post-surgical complication.
Conclusions: The predictor's factors are ASA III and IV preoperative physical status, contaminated and dirty operations, surgical time of 2 hours and more, and nutritional alterations due to excess (obesity) or deficiency (malnutrition).
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References
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3. Arango-Díaz A, López-Berrío S, Vera-Núñez D, Castellanos-Sánchez E, Rodríguez-Sanabria P, Rodríguez-Feitó M. Epidemiología de las infecciones asociadas a la asistencia sanitaria. Acta Médica del Centro. 2018 [acceso: 28/02/2022]; 12(3):[aprox. 10 p.]. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/923
4. Wolfe JD, Wolfe NK, Rich MW. Perioperative care of the geriatric patient for noncardiac surgery. Clin Cardiol. 2020; 43(2):127-136. DOI: 10.1002/clc.23302
5. Barrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery. 2017; 152(8):784-791. DOI: 10.1001/jamasurg.2017.0904
6. Sánchez-Brizuela J. Morbimortalidad por infecciones posoperatorias en un servicio de Cirugía General. Archivo Médico Camagüey. 2019 [acceso: 28/03/2022]; 23(3):361-73. Disponible en: http://revistaamc.sld.cu/index.php/amc/article/view/6180
7. Chong JX, McIlveen E, Quasim, Moug SJ. Decision making in emergency laparotomy: the role of predicted life expectancy. BJS Open. 2021; 5(5):zrab090. DOI: 10.1093/bjsopen/zrab090
8. Cheng H, Po-Han Chen B, Soleas IM, Ferko CN, Cameron GCh, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017 [acceso: 08/03/2022]; 18(6):722-35. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28832271/
9. Sasaki M, Miyoshi N, Fujino S, Ogino T, Takahashi H, Uemura M, et al. The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Scientific reports. 2020; 10(1):10744. DOI: 10.1038/s41598-020-67285-y
10. AMM. Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos. Asociación Médica Mundial; 2017. [acceso: 08/02/2022]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
11. Aceto P, Incalzi A, Bettelli G, Carron M, Chiumiento F, Corcione A, et al. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res. 2020; 32:1647-73. DOI: 10.1007/s40520-020-01624-x
12. Eguaras Córdoba I. Análisis de la mortalidad y de la evolución del estado funcional en pacientes ancianos operados por patología abdominal urgente, utilizando el CriSTAL (Criteria for Screening and Triaging to Appropiate alterantive Care) score modificado [Tesis Doctoral]. España: Universidad Pública de Navarra; 2020. [acceso: 28/01/2022]. Disponible en: https://academica-e.unavarra.es/xmlui/handle/2454/38885
13. del-Rio-Pérez G, Torres-Toledo D, Duménigo-Rodríguez R, Zurbano-Fernández J, Linares-Rodríguez A. Abdomen agudo quirúrgico en el adulto mayor. Acta Médica del Centro. 2020 [acceso 28/03/2022]; 14(2):217-21. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/115012
14. Céspedes-Rodríguez H, Bello-Carr A, Fernández-Pérez R. Abdomen agudo quirúrgico en el paciente geriátrico. Revista Cubana de Cirugía. 2020 [acceso 28/03/2022]; 59(4):e_923. Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/923/543
15. Argomedo C, Stefany K. Factores asociados a complicaciones post operatorias de abdomen agudo quirúrgico en pacientes adultos mayores en el Hospital Nacional "Hipólito Unanue" 2018-2019 [Tesis en opción al título de médico cirujano]. Lima: Universidad "Federico Villarreal"; 2020. [acceso: 08/03/2022]. Disponible en: http://repositorio.unfv.edu.pe/bitstream/handle/UNFV/4277/CAQUE%20ARG-OMEDO%20KEYSI%20STEFANY%20-%20T%C3%8DTULO%20PROFESIONAL.pdf?
Published
2022-10-17
How to Cite
1.
Calás Balbuena RM, Falcón Vilariño GC, Rodríguez Fernández Z, Romero García LI, Piña Prieto LR. Predictor’s factors of infectious surgical complications in older adults after emergency abdominal surgery. Rev Cubana Med Milit [Internet]. 2022 Oct. 17 [cited 2025 Jan. 31];51(4):e02202047. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2047
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