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Cambio en la clasificación macroscópica de la apendicitis. ¿Tiene algún impacto? Estudio retrospectivo en un Hospital Universitario Pediátrico
Change in the macroscopic classification of appendicitis. Does it have any impact? Retrospective study in a Pediatric teaching hospital
Palabras clave:
Antibióticos, Apendicitis, Sépsis abdominal, Complicaciones Posoperatorias, Antibiótico post-operatorio (es)Anti-Bacterial Agents, Appendicitis, Sepsis, Postoperative care, Postoperative antibiotic (en)
Antecedentes. La definición actual de apendicitis diferencia la aguda en apéndices no perforados y perforados. Esta clasificación describe los apéndices perforados como aquellos con la presencia de un orificio visible en el apéndice o la presencia de un fecalito libre en la cavidad y ha cambiado el manejo postoperatorio actual.
Objetivo. Determinar si el cambio en la definición macroscópica de la apendicitis aguda tiene alguna influencia en la duración de la estancia hospitalaria y la tasa de complicaciones dado el cambio en el manejo antibiótico postoperatorio.
Materiales y métodos. Se llevó a cabo un rastreo de aquellos pacientes llevados a cirugía con diagnóstico de apendicitis aguda durante el primer semestre del año 2009 y el segundo semestre del año 2011 en la Fundación HOMI. Se excluyeron los pacientes llevados a laparoscopia diagnóstica por estudio del dolor abdominal, apendicectomias incidentales y los pacientes manejados en el protocolo de apendicectomía de Intervalo.
Resultados. Se observó una disminución en el número de días de hospitalización/año y en el número de dosis de antibiótico/año y reducción en el número de complicaciones, lo cual demuestra que la clasificación y el protocolo de manejo actual no se correlacionan con un aumento en el número de complicaciones y se asocia con menores costos.
Conclusión. El cambio en la clasificación macroscópica y el aportar la nueva definición sobre apendicitis perforada ha logrado disminuir la estancia hospitalaria y la cantidad de antibióticos utilizados sin una repercusión significativa en la tasa de complicaciones.
Background. The current definition differences the acute appendix in nonperforated and perforated. This classification describes the perforated appendicitis as those with the presence of a visible hole in the appendix or the presence of a free fecalito in the cavity and changed the postoperative current management.
Objective. Determine whether the change in the macroscopic definition of acute appendicitis have any influence on the length of hospital stay and complication rates given the change in the post-operative antibiotic treatment.
Materials and Methods. Patients undergoing surgery with a diagnosis of acute appendicitis in the first half of 2009 and the second half of 2011. Patients excluded were those taken to surgery for diagnostic laparoscopy by study of abdominal pain, also incidental appendectomy and patients managed in the protocol of appendectomy interval.
Results. A decrease in the number of hospital days /year and the number of doses of antibiotic/ year and decrease in the number of complications was observed which demonstrates that the classification and current management protocol are not correlated with an increase in number of complications and is associated with lower costs.
Conclusions. The change in the macroscopic classification and provide the new definition of perforated appendicitis has reduced hospital stay and the amount of antibiotics used without a significant impact on the rate of complications.
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Derechos de autor 2015 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
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