4 research outputs found

    Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan SĂŁo Paulo, Brazil

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    O estudo objetivou avaliar associação entre via de parto e complicaçÔes maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital pĂșblico. As complicaçÔes avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesĂŁo de ĂłrgĂŁo contĂ­guo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, alĂ©m da regressĂŁo logĂ­stica. Estabeleceu-se o nĂ­vel de 0,05 como significante. Foram encontradas 15 complicaçÔes. Tomando-se o parto vaginal como referĂȘncia, encontrou-se associação entre cesĂĄrea e as complicaçÔes tomadas em conjunto. Analisando-se variĂĄveis confundidoras, encontrou-se associação das complicaçÔes com hipertensĂŁo, soropositividade para HIV, placenta prĂ©via e descolamento prematuro de placenta. ApĂłs controle para estas quatro variĂĄveis, manteve-se a associação entre cesĂĄrea e complicaçÔes (OR = 9,7; p = 0,04). Encontrou-se tambĂ©m associação entre complicaçÔes e cesĂĄrea eletiva comparada ao parto vaginal (OR = 4,7; p = 0,02), e maior proporção de complicaçÔes, no limite da significĂąncia estatĂ­stica, nas cesĂĄreas eletivas comparadas Ă  "tentativa de parto vaginal" (OR = 3; p = 0,058). Conclui-se que a cesĂĄrea associa-se a complicaçÔes maternas, mesmo apĂłs a realização de vĂĄrios ajustes.The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease
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