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      Correlação entre o momento da cirurgia e a ocorrência de complicações per-operatórias no tratamento das fraturas trocanterianas do fêmur Translated title: Correlation between timing of surgery and the occurrence of perioperative complications in the treatment of trocantheric femoral fractures


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          OBJETIVO: Estabelecer se há correlação entre o momento da cirurgia e a ocorrência de complicações intra e pós- operatórias no tratamento das fraturas trocanterianas do fêmur no idoso. MÉTODO: Estudo retrospectivo avaliando o histórico de 281 pacientes operados entre 2000 e 2009 no Hospital das Clinicas da FMRP-USP. As variáveis avaliadas foram: sexo, idade, data, mecanismo do trauma, momento da admissão, tipo da fratura, complicações pré e pós- operatórias, tempo entre o trauma e a cirurgia, horário e duração da cirurgia, implante utilizado, Tip Apex Distance (TAD), tempo de hospitalização, re-operações. De acordo com o horário da cirurgia os casos foram divididos em dois grupos: Horário Comercial (7:00 - 17:00) x Horário Plantão (17:01 - 6:59). RESULTADOS: Houve um predomínio de cirurgias no horário comercial, na proporção aproximada de 5:1. O intervalo de tempo médio entre a data do trauma e a cirurgia foi de três dias. Não houve diferença estatística entre os grupos (hora comercial x plantão) relacionada ao TAD médio, tipo da fratura, implante, complicações sistêmicas e mortalidade em um ano. O tempo médio entre o trauma e a cirurgia foi três dias. CONCLUSÕES: Para pacientes que são admitidos ou operados com mais de 24 horas decorridas do trauma, o horário da cirurgia não se mostrou uma variável relevante, no que diz respeito à ocorrência de complicações per operatórias. Em nossa realidade, é preferível realizar a fixação destas fraturas em horário comercial, dispondo de completa infra-estrutura de recursos humanos e técnicos.

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          OBJECTIVE: This study aimed to verify if there is any relationship between the time of surgery and per operative complications in the treatment of intertrochanteric femoral fractures. METHOD: The records of 281 patients operated between the years of 2000 and 2009 were evaluated retrospectively. The variables taken into account were sex, age, date and mechanism of injury, time of admission, type of fracture (AO classification), pre and post-operative complica- tions, delay between trauma and surgery time, time and duration of surgery, implant used, Tip Apex Distance (TAD), and hospital stay. The cases were divided according with the start time of surgery into two groups: usual working hours (7:00 - 17:00) x non-usual working hours (17:01 - 6:59). RESULTS: Most of the surgeries were performed during working hours, at an approximate ratio of 5:1. The average time between trauma and surgery was three days. There was no statistical difference between groups (working vs. non-working hours) in relation to the average TAD, type of fracture, implant, clinical complications and mortality in one year. CONCLUSIONS: Our study demonstrates that for patients that are not admitted or operated within the first 24 hours from trauma, the time of surgery is not a relevant variable, regarding to per-operative complications. In our reality, there is no reason for operating such patients out of working hours, when all necessary resources are available.

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          R: A language and environment for statistical computing

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            Time of day is associated with postoperative morbidity: an analysis of the national surgical quality improvement program data.

            To examine the association between surgical start time and morbidity and mortality for nonemergent procedures. Patients require medical services 24 hours a day. Several studies have demonstrated a difference in outcomes over the course of the day for anesthetic adverse events, death in the ICU, and dialysis care. The relationship between operation start time and patient outcomes is yet undefined. We performed a retrospective cohort study of 144,740 nonemergent general and vascular surgical procedures performed within the VA Medical System 2000-2004 and entered into the National Surgical Quality Improvement Program Database. Operation start time was the independent variable of interest. Logistic regression was used to adjust for patient and procedural characteristics and to determine the association between start time and, in 2 independent models, mortality and morbidity. Unadjusted later start time was significantly associated with higher surgical morbidity and mortality. After adjustment for patient and procedure characteristics, mortality was not significantly associated with start time. However, after appropriate adjustment, operations starting between 4 pm and 6 pm were associated with an elevated risk of morbidity (OR = 1.25, P < or = 0.005) over those starting between 7 am and 4 pm as were operations starting between 6 pm and 11 pm (OR = 1.60, P < or = 0.005). When considering a nonemergent procedure, surgeons must bear in mind that cases that start after routine "business" hours within the VA System may face an elevated risk of complications that warrants further evaluation.
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              Quality effects of operative delay on mortality in hip fracture treatment.

              A Liski, R Sund (2005)
              Most hip fracture patients undergo surgery, but there is conflicting evidence on the relation between the timing of surgery and the outcome of treatment. There is considerable variation in the length of surgical delays between hospitals, possibly reflecting the quality of care. To examine the associations between in-hospital surgical delay and the mortality of hip fracture patients from a practical quality assessment perspective. The effects of operative delay on mortality were estimated using various statistical methods applied to observational data from 16 881 first time hip fracture patients aged 65 or older from 47 hospitals (providers) in Finland in 1998-2001. A prolonged in-hospital operative delay was associated with a higher mortality of hip fracture patients in individual level analyses, but the instrumental variable approach indicated that the individual level effect was not caused by the operative delay but by inappropriate methodological assumptions. There was extensive variation between providers in the proportion of late surgery patients. Provider level analyses showed that the effects of the provider of operative delay on mortality are quite small, but there is a clear association between the proportion of late surgery patients and non-optimal treatment. If provider level heterogeneity is not explicitly taken into account, studies of the effects of surgical delay on outcomes are prone to serious bias. The proportion of patients with prolonged waiting time for surgery at the provider level seems to work as an effective evidence-based quality indicator. Providers should reduce unnecessary delays to surgery and identify more carefully patients not suitable for early surgery.

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                Revista Brasileira de Ortopedia
                Rev. bras. ortop.
                Sociedade Brasileira de Ortopedia e Traumatologia (São Paulo )
                : 46
                : suppl 1
                : 44-47
                [1 ] Universidade de São Paulo Brazil



                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0102-3616&lng=en

                Trocantheric Hip Fracture,Surgical Treatment,Timing of Surgery,Outcomes,Fratura Trocanteriana do Femur,Tratamento Cirurgico,Momento da Cirurgia,Resultados


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