Apendicitis aguda perforada en adultos; aproximación a las inequidades sociales en salud, Bogotá 2012

Autoria(s): Linares Ramírez, Juan David; Ricaurte Aragón, Alberto Enrique
Contribuinte(s)

Alvarado, Ricardo

Dávila, Fabián
Data(s)

21/08/2013
Resumo

La perforación del apéndice es una complicación temprana de la apendicitis aguda, demoras en el diagnóstico o tratamiento incrementan la tasa de perforación. Se desconoce si la perforación dl apéndice es un reflejo de inequidades sociales. Se pretendió determinar la asociación de la apendicitis aguda perforada en adultos y la equidad en acceso a salud. Estudio tipo cohorte retrospectivo documental, de historias clínicas de pacientes con apendicitis aguda; el análisis se realizó con Stata 11.1 y Epi-info. Los resultados se presentaron en tablas y figuras. Se incluyeron 540 casos (292 hombre y 248 mujeres), el grupo de edad que aporto más datos fue el de 18 a 49 años (391 pacientes); el tiempo medio de síntomas a consulta fue de 37,45 horas, y de 5,3 horas para el paso a cirugía desde el ingreso, fueron solicitadas 76 ecografías y 53 tomografías, 50 interconsultas a urología y 10 a ginecología hasta el diagnostico. El grupo de mayores de 49 años, el estrato socioeconómico tres y la tomografía fueron factores de riesgo independientes para perforación del apéndice. El análisis multivariado mostró asociación lineal entre el estrato socioeconómico y tiempo de síntomas al ingreso, tiempo para paso a cirugía, solicitud de ayudas diagnósticas e interconsultas, con buena significación estadística. La apendicitis aguda perforada en adultos, podría ser un indicador de inequidad en salud. Se requiere de estudios multi-céntricos, con mayor tiempo de evaluación y muestra para demostrar si el apéndice perforado es un trazador de inequidades en salud en Colombia.

Perforation of the appendix is an early complication of acute appendicitis; delays in diagnosis or treatment increase the perforation rate. It is unknown whether appendiceal perforation is a reflection of social inequities. It was intended to determine the association of perforated acute appendicitis in adults and equity in access to health care. Documentary retrospective cohort study type of clinical records of patients with acute appendicitis was done; the analysis was performed using Stata 11.1 and Epi-info. The results are presented in tables and figures. 540 patients (292 men and 248 women)were included, the age group that most provided was that of 18-49 years (391 patients), the median time to consultation was 37.45 hours, and 5, 3 hours for passage surgery from admission; 76 echography’s, 53 CT scans, 50 interconsultations to urology and 10 to gynecology were done for diagnosis. The 18-49 age groups and the CT request were independent risk factors for perforation of the appendix. Multivariate analysis showed linear association between time of admission symptoms, socioeconomic status, time to surgery and diagnostic aid request and consultations, with good statistical significance. The perforated acute appendicitis in adults may be an indicator of health inequity. It requires multi-center studies, with longer assessment and sample size to show whether perforated appendix is a tracer of health inequalities in Colombia.
Formato

application/pdf
Identificador

http://repository.urosario.edu.co/handle/10336/4688
Idioma(s)

spa
Publicador

Facultad de Medicina
Direitos

info:eu-repo/semantics/openAccess
Fonte

instname:Universidad del Rosario

reponame:Repositorio Institucional EdocUR

1. Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Quintero-Gutierrez FJ, Sevilla-Vicente J, Martinez-Vigo M, et al. Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations. European archives of psychiatry and clinical neuroscience [Internet]. 2008 Mar [cited 2013 May 20];258(2):117–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17990050

2. Anotaciones sobre la Equidad en los Resultados en Salud. 2008;(1):97–108.

3. Romero RV, Ramirez NA, Mendez PAM, Velez OR. Atención primaria integral de salud: estrategia para la transformación del sistema de salud y el logro de la equidad en salud [Internet]. Alcaldía Mayor de Bogotá, Secretaría Distrital de Salud; 2009 [cited 2013 Jun 4]. p. 313. Available from: http://books.google.com/books?id=3Wadg3EYI_0C&pgis=1

4. GEGA (Global Equity Gauge Alliance-Alianza Global para el Monitoreo de la Equidad). Monitoreo de la Equidad, conceptos, principios y pautas. [Internet]. Durban, Sudáfrica; 2003; 2003 p. 1–34. Available from: http://medcontent.metapress.com/index/A65RM03P4874243N.pdf

5. Kerguelén C. Calidad en salud en Colombia. Los principios. Bogotá [Internet]. 2008 [cited 2013 Jul 29]; Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Calidad+en+salud+en+Colombia#7

6. Bratu I, Martens PJ, Leslie WD, Dik N, Chateau D, Katz A. Pediatric appendicitis rupture rate: disparities despite universal health care. Journal of pediatric surgery [Internet]. 2008 Nov [cited 2013 Jul 29];43(11):1964–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18970925

7. Jablonski KA, Guagliardo MF. Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access. Population health metrics [Internet]. 2005 May 4 [cited 2013 Aug 18];3(1):4. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1156944&tool=pmcentrez&rendertype=abstract

8. Lee SL, Shekherdimian S, Chiu VY. Effect of race and socioeconomic status in the treatment of appendicitis in patients with equal health care access. Archives of surgery (Chicago, Ill. : 1960) [Internet]. 2011 Feb [cited 2013 Aug 18];146(2):156–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21339425

9. Cura J Del, Oleaga L, Grande D, Vela A, Ibáñez A. Indicación de las técnicas de diagnóstico por la imagen en la sospecha de apendicitis aguda: propuesta de protocolo diagnóstico. Radiología [Internet]. 2001 [cited 2013 Aug 18];43(10):478–89. Available from: http://www.elsevier.es/es/revistas/radiologia-119/indicacion-las-tecnicas-diagnostico-imagen-sospecha-apendicitis-13023588-originales-2001

10. Pieper R, Kager L, Näsman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chirurgica Scandinavica [Internet]. 1981 [cited 2013 Aug 18];148(1):51–62. Available from: http://europepmc.org/abstract/MED/7136412

11. Hale D, Molloy M, Pearl R. Appendectomy: a contemporary appraisal. Annals of … [Internet]. 1997 [cited 2013 Aug 18];225(3):252–61. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1190674/

12. Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U. In-hospital delay increases the risk of perforation in adults with appendicitis. World journal of surgery [Internet]. 2011 Jul [cited 2013 Jul 29];35(7):1626–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21562871

13. Stănescu D, Mihalache D. Treatment of acute peritonitis. Results in County Hospital Suceava with 317 cases]. … a Societă̆ţ̜ii de … [Internet]. 2010 [cited 2013 Aug 18];114(2):372–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20700970

14. Busch M, Gutzwiller F, Aellig S. In-hospital delay increases the risk of perforation in adults with appendicitis. World journal of … [Internet]. 2011 Jul [cited 2013 Aug 18];35(7):1626–33. Available from: http://link.springer.com/article/10.1007/s00268-011-1101-z

15. CONPES D. 3386-Consejo Nacional de Política Económica y Social. República de Colombia Departamento Nacional de … [Internet]. 2005 [cited 2013 Aug 15];(PLAN DE ACCIÓN PARA LA FOCALIZACIÓN DE LOS SUBSIDIOS PARA SERVICIOS PÚBLICOS DOMICILIARIOS):1–30. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Consejo+Nacional+de+Pol�tica+Econ�mica+y+Social#0

16. Graat L, Bosma E. Appendectomy by residents is safe and not associated with a higher incidence of complications: a retrospective cohort study. Annals of surgery [Internet]. 2012 Apr [cited 2013 Aug 18];255(4):715–9. Available from: http://journals.lww.com/annalsofsurgery/Abstract/2012/04000/Appendectomy_by_Residents_Is_Safe_and_Not.16.aspx

17. Bratu I, Martens P, Leslie W, Dik N. Pediatric appendicitis rupture rate: disparities despite universal health care. Journal of pediatric … [Internet]. Elsevier Inc.; 2008 Nov [cited 2013 Aug 18];43(11):1964–9. Available from: http://www.sciencedirect.com/science/article/pii/S002234680800434X

18. Jablonski K, Guagliardo M. Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access. Popul Health Metr [Internet]. 2005 May [cited 2013 Aug 18];3(1):4. Available from: http://www.biomedcentral.com/content/pdf/1478-7954-3-4.pdf

19. Paulson EK, Kalady MF, Pappas TN. Clinical practice. Suspected appendicitis. The New England journal of medicine [Internet]. 2003 Jan 16 [cited 2013 Aug 8];348(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12529465

20. Lee S, Shekherdimian S. Perforated appendicitis in children: equal access to care eliminates racial and socioeconomic disparities. Journal of pediatric … [Internet]. Elsevier Inc.; 2010 [cited 2013 Aug 18];45(6):1203–7. Available from: http://www.sciencedirect.com/science/article/pii/S0022346810002083

21. Chichom M, Tchounzou R. Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. Journal de … [Internet]. 2009 Aug [cited 2013 Aug 18];146(4):387–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19765706

22. Calderón CAA, Botero JC, Bolaños JO, Martínez RR. Sistema de salud en Colombia: 20 años de logros y problemas. Ciência & Saúde Coletiva [Internet]. ABRASCO - Associação Brasileira de Saúde Coletiva; 2011 Jun [cited 2013 Jul 29];16(6):2817–28. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232011000600020&lng=en&nrm=iso&tlng=es

23. Rubio-Mendoza ML. Equidad en el Acceso a los Servicios de Salud y Equidad en la Financiación de la Atención en Bogotá. Revista de Salud Pública [Internet]. Instituto de Salud Publica, Faculdad de Medicina - Universidad Nacional de Colombia; 2008 Dec [cited 2013 Jul 29];10:29–43. Available from: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0124-00642008000600004&lng=en&nrm=iso&tlng=es

24. Restrepo H, Málaga H. La promoción de la salud: cómo construir vida saludable [Internet]. 2001st ed. Bogotá, Colombia: Editorial Médica Panamericana; 2001 [cited 2013 Aug 18]. p. 120–37. Available from: http://books.google.com/books?hl=en&lr=&id=g4gU_P7vAEMC&oi=fnd&pg=PA9&dq=Promoción+de+la+salud:+Cómo+construir+vida+saludable&ots=MoCf4pCdJt&sig=hnST1cHPpjwsgu9YMzvqRIewQqE

25. Kong V, Aldous C, Handley J, Clarke D. The cost effectiveness of early management of acute appendicitis underlies the importance of curative surgical services to a primary healthcare programme. Annals of the Royal College of Surgeons of England [Internet]. 2013 May [cited 2013 Jul 31];95(4):280–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23676814

26. Potyk D, Graham J. Basic health care is not a “market good”. Archives of internal medicine [Internet]. 2012 Oct 22 [cited 2013 Jul 31];172(19):1525–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23090202

27. Martenyi F, Zavadenko NN, Jarkova NB, Yarosh AA, Soldatenkova VO, Bardenstein LM, et al. Atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: a 6-week, randomized, placebo-controlled, double-blind trial in Russia. European child & adolescent psychiatry [Internet]. 2010 Jan [cited 2013 Jul 25];19(1):57–66. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19568826

28. Gonda T, MacEntee MI, Kiyak HA, Persson GR, Persson RE, Wyatt C. Predictors of multiple tooth loss among socioculturally diverse elderly subjects. The International journal of prosthodontics [Internet]. [cited 2013 Aug 18];26(2):127–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23476905

29. Borgonovi F. The relationship between education and levels of trust and tolerance in Europe. The British journal of sociology [Internet]. 2012 Mar [cited 2013 Aug 10];63(1):146–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22404393

30. Omer T. Research utilization in a multicultural nursing setting in Saudi Arabia: barriers and facilitators. The journal of nursing research : JNR [Internet]. 2012 Mar [cited 2013 Aug 6];20(1):66–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22333967

31. Pesut B, Reimer-Kirkham S, Sawatzky R, Woodland G, Peverall P. Hospitable hospitals in a diverse society: from chaplains to spiritual care providers. Journal of religion and health [Internet]. 2012 Sep [cited 2013 Aug 18];51(3):825–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20838896

32. Schurman J V, Cushing CC, Garey CL, Laituri CA, St Peter SD. Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial. Journal of pediatric surgery [Internet]. 2011 Jun [cited 2013 Aug 18];46(6):1121–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21683209

33. Yaghoubian A, de Virgilio C, Lee SL. Appendicitis outcomes are better at resident teaching institutions: a multi-institutional analysis. American journal of surgery [Internet]. 2010 Dec [cited 2013 Aug 18];200(6):810–3; discussion 813. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21146025

34. Yilmaz HG, Akgun Y, Bac B, Celik Y. Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study. International journal of surgery (London, England) [Internet]. 2007 Jul [cited 2013 Jul 31];5(3):192–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17509502

35. Maa J. Appendicitis: the great masquerader. Archives of internal medicine [Internet]. 2012 Oct 22 [cited 2013 Jul 31];172(19):1525. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23090201

36. Weeks WB. Of appendectomies, markets, and fictional charges. Archives of internal medicine [Internet]. 2012 Oct 22 [cited 2013 Jul 31];172(19):1524–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23090200

37. Epelboym I, Flory J. Charge variability for acute appendicitis: is the problem overstated? Archives of internal medicine [Internet]. 2012 Oct 22 [cited 2013 Jul 31];172(19):1524. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23090199

38. La Estratificación Socioeconómica para el Cobro de los Servicios Públicos Domiciliarios en Colombia: ¿Solidaridad o Focalización? (Google eBook) [Internet]. United Nations Publications; 2006 [cited 2013 Aug 3]. p. 102. Available from: http://books.google.com/books?id=c8q6jf0DSUYC&pgis=1

39. Bautista GO, Gómez FR, Lara JLA. Impacto del aseguramiento sobre uso y gasto en salud en Colombia [Internet]. Pontificia Universidad Javeriana; 2003 [cited 2013 Aug 3]. p. 337. Available from: http://books.google.com/books?id=9tlHjgBH_UsC&pgis=1

40. Fenyö G. [Appendectomy in Sweden. A survey and proposal for quality indicators]. Nordisk medicin [Internet]. 1995 Jan [cited 2013 Jul 31];110(4):111–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7724353
Palavras-Chave #APENDICITIS - COMPLICACIONES #APENDICITIS - DIAGNOSTICO #APENDICITIS - TRATAMIENTO #DESIGUALDADES EN LA SALUD - BOGOTÁ (COLOMBIA) #INEQUIDAD SOCIAL - BOGOTÁ (COLOMBIA) #"Appendicitis/complications" #"Appendicitis/economics" #"Appendicitis/organization and administration"
Tipo

info:eu-repo/semantics/bachelorThesis

info:eu-repo/semantics/acceptedVersion
Acesso ao item digital