Riesgo asociado a la cirugía cardíaca mayor en pacientes octogenarios : una revisión sistemática de la literatura.


Autoria(s): Pomares Estrada, Jose Carlos; Montes, Félix Ramón; Morón Duarte, Lina Sofía
Contribuinte(s)

Montes, Félix Ramón

Data(s)

15/06/2012

Resumo

Introducción: La enfermedad cardiovascular es la principal causa de muerte a nivel mundial, afectando principalmente la salud pública de países pobres con economías emergentes. La transición epidemiológica en Colombia ha incrementado la proporción de pacientes ancianos con enfermedad cardiovascular y que requieren cirugía cardíaca. Sin embargo, no existe consenso sobre la conducta para la selección de pacientes añosos para este tipo de intervenciones. El objetivo de este estudio fue definir el riesgo mortalidad asociado a cirugía cardíaca en este grupo de pacientes, basados en una revisión sistemática de la literatura. Materiales y Métodos: Se diseñó una revisión sistemática empleando las plataformas PubMed (Medline), EBSCO Discovery Service, Ovid SP-EBMR, Sciverse y MDConsult. Los términos de búsqueda fueron “Aged”, “Cardiac surgery” and “Mortality”, conjugados de acuerdo con el lenguaje de cada buscador. Las publicaciones fueron seleccionadas por consenso. Los resultados se analizaron en un modelo de Mantel-Haenszel. Resultados: La búsqueda arrojó un total de 8.565 publicaciones. Los datos analizados en el modelo incluyeron 81.547 pacientes (7.855 octogenarios y 73.692 más jóvenes). El riesgo de mortalidad asociado a cirugía cardíaca en octogenarios fue de 125% (OR=2,35, IC 95% [2,15 - 2,57]). Discusión: El sometimiento de pacientes octogenarios a cirugías cardíacas mayores es una decisión que requiere un juicio clínico minucioso en el que es importante destacar que la probabilidad de un resultado francamente desfavorable es alta. Se necesitan más estudios diseñados que permitan aumentar la solidez de la evidencia actual en cuanto al riesgo aquí encontrado.

Introduction: Cardiovascular diseases are the most common cause of death in the elderly. Documented reduced efficacy of medical therapy in these patients has led to an increase in the number of heart operations in elderly patients. The aim of this study was to conduct a systematic review to determine the true safety of performing cardiac surgery in these patients. Methods: Systematic review of the literature of articles obtained from primary databases, systematic reviews and meta search engines that provided evidence of safety and effectiveness of cardiac surgery in octogenarians. Methodological quality was assessed by recording characteristics and results of the studies obtained. Results: Six studies were found comparable, published by Alexander et al. (2000), Bakaeen et al.(2010), Rahmanian et al. (2010), Afilalo et al. (2012), Sahaian et al. (2012) and Speziale et al (2011). The correlation model results were significant and applicable only for comparison in the first three listed here. The group of octogenarian patients exhibited an increased risk of mortality compared with younger groups, when they undergo major heart surgeries such as CABG, AVR and MVR. Discussion: The clinical inference dictates that older patients have a significantly higher risk of dying as a result of surgical stress and complications associated with surgery, is supported by medical evidence in accordance with the revised in all cases, shows a increased mortality risk. Conclusions: The submission of octogenarian patients with major cardiac surgery is a decision that requires careful clinical judgment in which it is important to note that the probability of an outcome unfavorable to high. Designed studies are needed that increase the strength of the current evidence regarding the risk found here.

Formato

application/pdf

Identificador

http://repository.urosario.edu.co/handle/10336/3592

Idioma(s)

spa

Publicador

Facultad de Medicina

Direitos

info:eu-repo/semantics/openAccess

Fonte

instname:Universidad del Rosario

reponame:Repositorio Institucional EdocUR

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Shahian DM, O'Brien SM, Sheng S, Grover FL, Mayer JE, Jacobs JP, et al. Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study). Circulation 2012 Mar 27;125(12):1491-500.

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TEME 0053 2012

Palavras-Chave #CORAZON - CIRUGIA #ANESTESIA EN CARDIOLOGIA #SALUD PUBLICA - INVESTIGACIONES #Octogenarians #Cardiac surgery #Mortality #Safety #Systematic review
Tipo

info:eu-repo/semantics/bachelorThesis

info:eu-repo/semantics/acceptedVersion