Validity of three procedures for predicting reoperation in abdominal surgery: a cohort study
Keywords:
abdominal cavity, reoperation, prognosis, general surgery, emergency surgery.Abstract
Introduction: It is difficult to diagnose with certainty the need to reoperate a patient after major abdominal surgery.Objective: To assess the validity of three procedures for predicting reoperation in abdominal surgery.
Method: Explanatory, cohort, prospective study, from November 2016 to April 2017, 146 patients in postoperative period of major abdominal surgery, consecutively admitted to the intensive care unit of the Hospital "Carlos J Finlay". To decide on reoperation, patients were evaluated according to clinical, laboratory and imaging criteria. Independently, the probability of requiring a reoperation was estimated using the Acute Re-intervention Predictive Index, the Abdominal Surgery Reoperation Prognosis Aid System and intra-abdominal pressure. To analyse their usefulness, the Receiver Operating Characteristic curve was applied and the best cut-off point with its validity indicators was selected.
Results: 23 patients (15.8%) were reoperated. The area under the receiver operator curve (AUC) of the three scores was above 0.8, with an excellent ability to discriminate between patients who really required reoperation and those who did not, but with significant differences between them (p <0.001). The Abdominal Surgery Reoperation Prognosis Aid System had the best performance, with an AUC = 0.965 (CI 0.933-0.997), followed by the intra-abdominal pressure (AUC = 0.939, CI 0.892-0.987) and the Acute Re-intervention Predictive Index (AUC = 0.863, CI 0.789-0.938). CONCLUSIONS. The Abdominal Surgery Reoperation Prognosis Aid System shows an excellent performance and an efficiency superior to that demonstrated by the other two procedures, which makes it recommendable to predict the need to reoperate after major abdominal surgery.
Downloads
Download data is not yet available.
References
1. Avorn J. The Psychology of Clinical Decision Making - Implications for medication use. New Engl J Med . 2018 [acceso: 20/04/2019]; 378:689-91. Disponible en: https://listserv-archives.org/attachments/20180221/54da54c9/attachment.pdf
2. Saleh C, Kashal M, Sangwa C, Wakunga G, Tshilombo F, Odimba E . Etude des relaparotomies précoces aux Hôpitaux Universitaires de Lubumbashi: aspects épidémiologiques, cliniques et thérapeutiques. Pan African Medical Journal. 2018[acceso: 20/04/2019];30:127. [aprox. 10 p.] Disponible en: https://www.panafrican-med-journal.com/content/article/30/127/full/
3. Kamil RF, Lalisang TJ, Kekalih A. Merit of APACHE II, MPI and ARPI scores as determinants on demand relaparotomy. The New Ropanasuri Journal of Surgery. 2016 [acceso: 20/04/2019];1(1):16-8. Disponible en: https://doi.org/10.7454/nrjs.v1i1.5
4. Báez León AS, Juárez de la Torre JC, Navarro Tovar F, Heredia Montaño M, Quintero Cabrera JE. Reintervenciones quirúrgicas abdominales no planeadas en el Servicio de Cirugía General del Hospital Universitario de Puebla. Gac Med Mex. 2016[acceso: 20/04/2019]; 152(4): 508-15. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=67995
5. La Rosa Armero Y, Matos Tamayo ME, Rodríguez Fernández Z. Características de las reintervenciones en un servicio de cirugía general. MEDISAN. 2017 Feb [acceso: 20/04/2019]; 21(2):187-196. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192017000200009&lng=es
6. Rausei S, Pappalardo V, Ruspi L, Colella A, Giudici S, Ardita V, et al. Early versus delayed source control in open abdomen management for severe intra-abdominal infections: a retrospective analysis on 111 cases. World Journal of Surgery. 2017[acceso: 20/04/2019]; 42:707-12. DOI: 10.1007/s00268-017-4233-y
7. Amador FY, López ME, Concepción QL. Reintervenciones quirúrgicas abdominales. Medimay. 2013 [acceso: 20/04/2019];19(3):[aprox. 10 p.]. Disponible en: https://www.medigraphic.com/pdfs/revciemedhab/cmh-2013/cmh133f.pdf
8. Lombardo Vaillant TA, Soler Morejón C, Lombardo Vaillan J, Casamayor Laime Z. Aplicación del índice predictivo de reintervención abdominal en el diagnóstico de complicaciones infecciosas intraabdominales. Rev Cub Med Milit. 2009 Mar [acceso: 20/04/2019]; 38(1):[aprox. 15 p.]. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572009000100002&lng=es
9. Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol. 2017[acceso: 20/04/2019]; 21(9):709-14. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640761/pdf/10151_2017_Article_1689.pdf
10. Soler Morejón CD, Lombardo Vaillant TA, Tamargo Barbeito TO, Malbrain M. Modelo de pronóstico de reoperación en cirugía abdominal. ARS MEDICA Revista de Ciencias Médicas. 2016 [acceso: 20/04/2019]; 41(3):8-15. Disponible en: https://173.236.243.65/index.php/MED/article/view/56
11. Pusajo JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS, et al. Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index. Archives of Surgery (Chicago, I11: 1960). 1993 Feb [acceso: 20/04/2019];128(2):218-22. DOI: 10.1001/archsurg.1993.01420140095015
12. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis Related Organ Failure Assessment) score to describe organ disfunction failure. On behalf of the Working Group on Sepsis Related Problems of the European Society of Intensive Care Medicine. Int Care Med. 1996 [acceso: 20/04/2019]22:707-710. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/9824069
13. Pérez LJ, Barletta RC, Castro G, Barletta JB, Castillo F, Barletta JE. Mecanismos fisiopatológicos implicados en el síndrome compartimental abdominal. Revista Finlay. 2018[acceso: 20/04/2019];8(1):[aprox. 12p] Disponible en: https://www.revfinlay.sld.cu/index.php/finlay/article/view/587/1625
14. De Laet I, Malbrain MLNG, De Waele J. A Clinician's Guide to Management of Intraabdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Critical Care. 2020 [acceso: 20/04/2019]24(97):[aprox. 12 p.]. Disponible en: https://doi.org/10.1186/s13054-020-2782-1
15. Lombardo Vaillant TA, Soler Morejón CD, Tamargo Barbeito TO, Noriega Amado Y, inventors; Hospital Clínico Quirúrgico Hermanos Ameijeiras, assignee. SAPRCA. Sistema de ayuda para el pronóstico de reintervención en cirugía abdominal. Cuba patent 2719-09-2017. 2017.
16. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. Journal of the American College of Surgeons. 1998 May [acceso: 20/04/2019];186(5):594-5. Disponible en: https://doi.org/10.1016/S1072-7515(98)00122-7
17. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul [acceso: 20/04/2020];39(7):1190-206. Disponible en: https://doi.org/10.1007/s00134-013-2906
18. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subject. 64th WMA General Assembly, Seoul, October 2013. [acceso: 20/04/2020]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
19. World Medical Association Declaration of GINEBRA. Ethical Principles for Medical Research Involving Human Subject. 68th WMA General Assembly, Seoul, October 2017. [acceso: 20/04/2020]. Disponible en: https://www.wma.net/es/que-hacemos/etica-medica/declaracion-de-ginebra/
20. Rodríguez Fernández Z, La Rosa Armero Y, Matos Tamayo ME. Factores asociados a la mortalidad en las reintervenciones quirúrgicas. Rev Cubana Cir. 2017 Jun [acceso: 20/04/2020]; 56(2):12-21. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932017000200002&lng=es
21. Zegarra Cavani S, Huamán Egoavil E, Valderrama Barrientos R, Camacho Gutiérrez R. Relaparotomías en el Servicio de Cirugía de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen. Cirujano. 2018[acceso: 20/04/2020];15(1):28-35. Disponible en: https://www.scgp.org/revista-cirujano/pdf/2018-REVISTA-CIRUJANO.pdf#page=28
22. Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg. 2015[acceso:20/04/2020];10(61):[aprox. 18 p.]. Disponible en: https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0253-2
23. Van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Goulma DJ, Boermeester MA, et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surgery. 2011 Dec 23[acceso 28 Ene 2020];11(38): [aprox. 9 p.]. Disponible en: https://doi.org/10.1186/1471-2482-11-38
24. MINSAP. Anuario Estadístico de Salud. 2019. La Habana: Dirección de registros médicos y estadísticas de salud. [actualizado: 2019; acceso: 20/04/2020]. [aprox. 189 p.]. Disponible en: https://www.sld.cu/sitios/dne/
25. Soler Morejón C, Lombardo Vaillant TA, Tamargo Barbeito TO, de Almeida Francisco Borrego AS, Mezquia de Pedro N, Noriega Amado Y. Aplicación de un sistema pronóstico de reoperación en el posoperatorio de cirugía abdominal de urgencia. Rev Cub Med Int Emerg . 2019[acceso: 28/01/2020];18(4):e670. Disponible en: https://www.revmie.sld.cu/index.php/mie/article/view/670
26. Patel H, Patel P, Shah DK. Relaparotomy in general surgery department of tertiary care hospital of Western India. International Surgery Journal. 2016 Dec [acceso: 22/03/2020];4(Suppl. 1):344-7. Disponible en: https://dx.doi.org/10.18203/2349-2902.isj20164467
27. Van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Goulma DJ, Boermeester MA, et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surgery. 2011 Dec 23;11(38):[aprox 9 p]. DOI: 10.1186/1471-2482-11-38
28. Tolonen M, Coccolini F, Ansaloni L, Sartelli M, Roberts DJ, McKee JL, et al. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria. World Journal of Emergency Surgery. 2018[acceso: 20/04/2020];13(17):[aprox. 10 p.]. Disponible en: https://doi.org/10.1186/s13017-018-0177-2
29. Godinez Vidal AR, ChagaTorres JF, CruzRomero CI, VillanuevaHerrero JA, Jimenez Bobadilla B, Alarcón-Bernés L et al.Application of the predictive abdominal reoperation index for abdominal infection in patients with diagnosis of sepsis of the General Hospital of Mexico "Dr. Eduardo Liceaga" Rev Med Hosp Gen Mex. 2019 [acceso: 20/04/2020];82(1):11-14 Disponible en: https://doi/org/10.24875/HGMX.M19000007
30. Reintam A, Kitus R, Starkopf J, Kern H. Gastrointestinal Failure score in critically ill patients: a prospective observational study. Critical Care. 2008[acceso: 20/04/2020]12(4):R90. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646302(doi:10.1186/cc6958)
31. Soler Morejón CD, Lombardo Vaillant TA, Tamargo Barbeito TO, Wise R, Malbrain M. Re-operative abdominal predictive score: a prognostic model combining Acute Re-intervention Predictive Index and intra-abdominal pressure. Anaesthesiology Intensive Therapy. 2017[acceso: 20/04/2020];49(5):358-65. Disponible en: https://doi.org/10.5603/AIT.a2017.0069
2. Saleh C, Kashal M, Sangwa C, Wakunga G, Tshilombo F, Odimba E . Etude des relaparotomies précoces aux Hôpitaux Universitaires de Lubumbashi: aspects épidémiologiques, cliniques et thérapeutiques. Pan African Medical Journal. 2018[acceso: 20/04/2019];30:127. [aprox. 10 p.] Disponible en: https://www.panafrican-med-journal.com/content/article/30/127/full/
3. Kamil RF, Lalisang TJ, Kekalih A. Merit of APACHE II, MPI and ARPI scores as determinants on demand relaparotomy. The New Ropanasuri Journal of Surgery. 2016 [acceso: 20/04/2019];1(1):16-8. Disponible en: https://doi.org/10.7454/nrjs.v1i1.5
4. Báez León AS, Juárez de la Torre JC, Navarro Tovar F, Heredia Montaño M, Quintero Cabrera JE. Reintervenciones quirúrgicas abdominales no planeadas en el Servicio de Cirugía General del Hospital Universitario de Puebla. Gac Med Mex. 2016[acceso: 20/04/2019]; 152(4): 508-15. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=67995
5. La Rosa Armero Y, Matos Tamayo ME, Rodríguez Fernández Z. Características de las reintervenciones en un servicio de cirugía general. MEDISAN. 2017 Feb [acceso: 20/04/2019]; 21(2):187-196. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192017000200009&lng=es
6. Rausei S, Pappalardo V, Ruspi L, Colella A, Giudici S, Ardita V, et al. Early versus delayed source control in open abdomen management for severe intra-abdominal infections: a retrospective analysis on 111 cases. World Journal of Surgery. 2017[acceso: 20/04/2019]; 42:707-12. DOI: 10.1007/s00268-017-4233-y
7. Amador FY, López ME, Concepción QL. Reintervenciones quirúrgicas abdominales. Medimay. 2013 [acceso: 20/04/2019];19(3):[aprox. 10 p.]. Disponible en: https://www.medigraphic.com/pdfs/revciemedhab/cmh-2013/cmh133f.pdf
8. Lombardo Vaillant TA, Soler Morejón C, Lombardo Vaillan J, Casamayor Laime Z. Aplicación del índice predictivo de reintervención abdominal en el diagnóstico de complicaciones infecciosas intraabdominales. Rev Cub Med Milit. 2009 Mar [acceso: 20/04/2019]; 38(1):[aprox. 15 p.]. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572009000100002&lng=es
9. Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol. 2017[acceso: 20/04/2019]; 21(9):709-14. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640761/pdf/10151_2017_Article_1689.pdf
10. Soler Morejón CD, Lombardo Vaillant TA, Tamargo Barbeito TO, Malbrain M. Modelo de pronóstico de reoperación en cirugía abdominal. ARS MEDICA Revista de Ciencias Médicas. 2016 [acceso: 20/04/2019]; 41(3):8-15. Disponible en: https://173.236.243.65/index.php/MED/article/view/56
11. Pusajo JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS, et al. Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index. Archives of Surgery (Chicago, I11: 1960). 1993 Feb [acceso: 20/04/2019];128(2):218-22. DOI: 10.1001/archsurg.1993.01420140095015
12. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis Related Organ Failure Assessment) score to describe organ disfunction failure. On behalf of the Working Group on Sepsis Related Problems of the European Society of Intensive Care Medicine. Int Care Med. 1996 [acceso: 20/04/2019]22:707-710. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/9824069
13. Pérez LJ, Barletta RC, Castro G, Barletta JB, Castillo F, Barletta JE. Mecanismos fisiopatológicos implicados en el síndrome compartimental abdominal. Revista Finlay. 2018[acceso: 20/04/2019];8(1):[aprox. 12p] Disponible en: https://www.revfinlay.sld.cu/index.php/finlay/article/view/587/1625
14. De Laet I, Malbrain MLNG, De Waele J. A Clinician's Guide to Management of Intraabdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Critical Care. 2020 [acceso: 20/04/2019]24(97):[aprox. 12 p.]. Disponible en: https://doi.org/10.1186/s13054-020-2782-1
15. Lombardo Vaillant TA, Soler Morejón CD, Tamargo Barbeito TO, Noriega Amado Y, inventors; Hospital Clínico Quirúrgico Hermanos Ameijeiras, assignee. SAPRCA. Sistema de ayuda para el pronóstico de reintervención en cirugía abdominal. Cuba patent 2719-09-2017. 2017.
16. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. Journal of the American College of Surgeons. 1998 May [acceso: 20/04/2019];186(5):594-5. Disponible en: https://doi.org/10.1016/S1072-7515(98)00122-7
17. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul [acceso: 20/04/2020];39(7):1190-206. Disponible en: https://doi.org/10.1007/s00134-013-2906
18. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subject. 64th WMA General Assembly, Seoul, October 2013. [acceso: 20/04/2020]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
19. World Medical Association Declaration of GINEBRA. Ethical Principles for Medical Research Involving Human Subject. 68th WMA General Assembly, Seoul, October 2017. [acceso: 20/04/2020]. Disponible en: https://www.wma.net/es/que-hacemos/etica-medica/declaracion-de-ginebra/
20. Rodríguez Fernández Z, La Rosa Armero Y, Matos Tamayo ME. Factores asociados a la mortalidad en las reintervenciones quirúrgicas. Rev Cubana Cir. 2017 Jun [acceso: 20/04/2020]; 56(2):12-21. Disponible en: https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932017000200002&lng=es
21. Zegarra Cavani S, Huamán Egoavil E, Valderrama Barrientos R, Camacho Gutiérrez R. Relaparotomías en el Servicio de Cirugía de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen. Cirujano. 2018[acceso: 20/04/2020];15(1):28-35. Disponible en: https://www.scgp.org/revista-cirujano/pdf/2018-REVISTA-CIRUJANO.pdf#page=28
22. Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg. 2015[acceso:20/04/2020];10(61):[aprox. 18 p.]. Disponible en: https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0253-2
23. Van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Goulma DJ, Boermeester MA, et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surgery. 2011 Dec 23[acceso 28 Ene 2020];11(38): [aprox. 9 p.]. Disponible en: https://doi.org/10.1186/1471-2482-11-38
24. MINSAP. Anuario Estadístico de Salud. 2019. La Habana: Dirección de registros médicos y estadísticas de salud. [actualizado: 2019; acceso: 20/04/2020]. [aprox. 189 p.]. Disponible en: https://www.sld.cu/sitios/dne/
25. Soler Morejón C, Lombardo Vaillant TA, Tamargo Barbeito TO, de Almeida Francisco Borrego AS, Mezquia de Pedro N, Noriega Amado Y. Aplicación de un sistema pronóstico de reoperación en el posoperatorio de cirugía abdominal de urgencia. Rev Cub Med Int Emerg . 2019[acceso: 28/01/2020];18(4):e670. Disponible en: https://www.revmie.sld.cu/index.php/mie/article/view/670
26. Patel H, Patel P, Shah DK. Relaparotomy in general surgery department of tertiary care hospital of Western India. International Surgery Journal. 2016 Dec [acceso: 22/03/2020];4(Suppl. 1):344-7. Disponible en: https://dx.doi.org/10.18203/2349-2902.isj20164467
27. Van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Goulma DJ, Boermeester MA, et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surgery. 2011 Dec 23;11(38):[aprox 9 p]. DOI: 10.1186/1471-2482-11-38
28. Tolonen M, Coccolini F, Ansaloni L, Sartelli M, Roberts DJ, McKee JL, et al. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria. World Journal of Emergency Surgery. 2018[acceso: 20/04/2020];13(17):[aprox. 10 p.]. Disponible en: https://doi.org/10.1186/s13017-018-0177-2
29. Godinez Vidal AR, ChagaTorres JF, CruzRomero CI, VillanuevaHerrero JA, Jimenez Bobadilla B, Alarcón-Bernés L et al.Application of the predictive abdominal reoperation index for abdominal infection in patients with diagnosis of sepsis of the General Hospital of Mexico "Dr. Eduardo Liceaga" Rev Med Hosp Gen Mex. 2019 [acceso: 20/04/2020];82(1):11-14 Disponible en: https://doi/org/10.24875/HGMX.M19000007
30. Reintam A, Kitus R, Starkopf J, Kern H. Gastrointestinal Failure score in critically ill patients: a prospective observational study. Critical Care. 2008[acceso: 20/04/2020]12(4):R90. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646302(doi:10.1186/cc6958)
31. Soler Morejón CD, Lombardo Vaillant TA, Tamargo Barbeito TO, Wise R, Malbrain M. Re-operative abdominal predictive score: a prognostic model combining Acute Re-intervention Predictive Index and intra-abdominal pressure. Anaesthesiology Intensive Therapy. 2017[acceso: 20/04/2020];49(5):358-65. Disponible en: https://doi.org/10.5603/AIT.a2017.0069
Published
2020-10-06
How to Cite
1.
Soler Morejón C de D, Tamargo Barbeito TO, Pérez Mayo JC, Lombardo Vaillant TA, Illodo Hernández OL. Validity of three procedures for predicting reoperation in abdominal surgery: a cohort study. Rev Cubana Med Milit [Internet]. 2020 Oct. 6 [cited 2025 Apr. 4];49(4):e0200760. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/760
Issue
Section
Research Article
License
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
