Caracterização dos óbitos notificados decorrentes de complicações dos cuidados médicos e cirúrgicos

Objective: describing the cases of deaths reported due to complications of medical and surgical care in Brazil between 2015 to 2018. Method: a descriptive and retrospective conducted between June and July 2020 with the records of deaths extracted from the Health Mortality Information System. The data were grouped into two biennia, 2015-2016, and 2017-2018, and analyzed by descriptive statistics and percentage variations. Results: there were reported 6,587 deaths, especially the 2017-2018 biennium (n=3,425;52%). Deaths caused using medical equipment reduced in Brazil, with a negative percentage variation of 15.4% among the biennia. There was an increase in deaths from adverse effects of drugs/medications with a positive percentage variation of 12.2%. The number of deaths from accidents during hospital care remained stationary. Conclusion: changes were observed in the records of deaths notified in Brazil, and expanding preventive actions aimed at reducing deaths are necessary in all notification groups.Objetivo: describir los casos de muertes reportadas por complicaciones de la atención médica y quirúrgica en Brasil entre 2015 y 2018. Método: descriptivo y retrospectivo realizado entre junio y julio de 2020 con los registros de defunciones extraídos del Sistema de Información de Mortalidad en Salud. Los datos se agruparon en dos bienios 2015-2016 y 2017-2018 y se analizaron mediante estadísticas descriptivas y variaciones porcentuales. Resultados: se reportaron 6.587 muertes, especialmente em el bienio 2017-2018 (n=3.425;52%). Las muertes causadas por el uso de equipo médico se redujeron en Brasil, con una variación porcentual negativa del 15,4% entre los bienios. Hubo un aumento en las muertes por efectos adversos de medicamentos con una variación porcentual positiva de 12.2%. El número de muertes por accidentes durante la atención hospitalaria se mantuvo estacionario. Conclusión: se observaron cambios en los registros de muertes notificadas en Brasil, y es necesario ampliar las acciones preventivas dirigidas a reducir las muertes en todos los grupos de notificación.Objetivo: descrever os casos de óbitos notificados por complicações de assistência médica e cirúrgica no Brasil entre 2015 a 2018. Método: descritivo e retrospectivo conduzido entre junho e julho de 2020 com os registros de óbitos extraídos do Sistema de Informações sobre Mortalidade em Saúde. Os dados foram agrupados em dois biênios 2015-2016 e 2017-2018 e analisados por estatística descritiva e variações percentuais. Resultados: foram notificados 6.587 óbitos, com destaque para o biênio 2017-2018 (n=3.425;52%).  Os óbitos ocasionados pelo uso de equipamentos médicos reduziram no Brasil, com variação percentual negativa de 15,4% entre os biênios. Houve aumento das mortes por efeitos adversos de drogas/medicamentos com variação percentual positiva de 12,2%. O número de óbitos por acidentes durante a assistência hospitalar se manteve estacionário. Conclusão: observaram-se alterações nos registros de óbitos notificados no Brasil, e expandir ações preventivas que visem reduzir os óbitos são necessárias em todos os grupos de notificação

Using the Memorial Sloan Kettering Frailty Index to Identify Patients at High Risk for Postoperative Intensive Care Unit Admission, Specialized Advanced Care Unit Admission, and 30-day Readmission

Frailty is roughly defined as an accumulation of physiological, emotional, cognitive, and social deficits that impair a person’s response to stressful events. A frailty diagnosis has been associated with poor outcomes following surgical procedures. Cancer surgical patients aged 65 or older represent a vulnerable population susceptible to being frail and the potential associated complications that can accompany frailty. Measuring frailty is an objective risk assessment that identifies increased risk better than age or American Society of Anesthesiologists Physical Status (ASA-PS) score such that frailty can independently predict poor surgical outcomes. Frailty is not specifically a result of having cancer, disability, or advanced age. It represents a separate syndrome that diminishes a person’s response to stressful event. The assumption is there are certain domains that encompass a generally accepted definition of frailty that remains applicable to most frailty measures. These domains include comorbidities as well as functional, physiological, nutritional, and psychological statuses. Social activity and social support represent other important areas that the most comprehensive frailty indexes consider in their scoring. Frailty can be assessed using at frailty index where higher scores correlate with greater susceptibility to poor outcomes. The Memorial Sloan Kettering Frailty Index (MSK-FI) was the frailty measurement used for this dissertation. Using Rockwood’s Frailty Theory of Accumulated Deficits, a non-randomized, non-experimental, retrospective cohort study was conducted. The independent variable was frailty score. The dependent variables were Intensive Care Unit admission (ICU), Specialized Advanced Care Unit admission (SACU), and 30-day readmission. The sample population consisted of surgical patients, aged 65 or older, who had a surgical procedure at Memorial Sloan Kettering Cancer Center from January 1, 2015 to December 31, 2018. There were 4,417 subjects in this retrospective analysis. Multivariate logistic regression with fixed effect models were created to assess the relation between frailty and postsurgical admission to the ICU, SACU, and 30-day readmission. The researcher found evidence of an association between greater frailty and increased risk of admission to the ICU (OR 1.44; 95% CI 1.31, 1.59; p-value \u3c0.001), admission to the SACU (OR 1.46; 95% CI 1.33, 1.60; p-value \u3c0.001), and 30-day readmission (OR 1.09, 95% CI 1.02, 1.177; p-value = 0.012). This study demonstrated that a significant correlation between frailty status and postsurgical ICU admission, SACU admission, and 30-day readmission in geriatric cancer surgical patients exists. Using a frailty assessment in the preoperative assessment has the potential to identify high-risk geriatric patients who may have an elevated risk for poor outcomes following their surgical procedure. Once high-risk patients are identified, a multidisciplinary team can create a patient centered treatment plan and mobilization of appropriate resources to minimize poor outcomes