Validez de tres procedimientos para la predicción de reoperación en cirugía abdominal: estudio de cohorte.

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    • Alternate Title:
      Validity of three procedures for predicting reoperation in abdominal surgery: a cohort study.
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    • 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. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Introducción: Resulta difícil diagnosticar con certeza la necesidad de reoperar a un paciente después de cirugía abdominal mayor. Objetivo: Evaluar la validez de tres procedimientos para la predicción de la reoperación en cirugía abdominal. Métodos: Estudio explicativo, de cohorte, prospectivo, realizado de noviembre de 2016 a abril de 2017; 146 pacientes en posoperatorio de cirugía abdominal mayor, ingresados consecutivamente en la unidad de cuidados intensivos del Hospital Militar Central "Dr. Carlos J. Finlay". Para ser reoperados, los pacientes fueron evaluados según criterios clínicos, de laboratorio e imágenes. De forma independiente, se estimó la probabilidad de requerir una reoperación mediante el Acute Re-intervention Predictive Index, el Sistema de Ayuda al Pronóstico de Reoperación en Cirugía Abdominal (SAPRCA) y la presión intraabdominal. Se aplicó la curva característica operativa del receptor y se seleccionó el mejor punto de corte con sus indicadores de validez. Resultados: Fueron reoperados 23 pacientes (15,8 %). El área bajo la curva característica operativa del receptor (ABC) de los tres puntajes fue > 0,8, con excelente capacidad de discriminación, pero con diferencias significativas entre ellas (p < 0,001). El SAPRCA tuvo mejor desempeño (ABC = 0,965; CI 0,933 - 0,997), seguido de la presión intraabdominal (ABC = 0,939; CI 0,892 - 0,987) y el Acute Reintervention Predictive Index (ABC = 0,863, CI 0,789 - 0,938). Conclusiones: El SAPRCA mostró un excelente desempeño y una eficacia superior a la demostrada por los otros dos procedimientos, que lo hace recomendable para pronosticar la necesidad de reoperar después de cirugía abdominal mayor. [ABSTRACT FROM AUTHOR]
    • Abstract:
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