Fatores de risco em cirurgias de cabeça e pescoço

Risk factors on head and neck surgery

ARTIGOS ORIGINAIS

Fatores de risco em cirurgias de cabeça e pescoço

Risk factors on head and neck surgery

Benedito Valdecir de Oliveira^I; Gyl Henrique Albrecht Ramos, TCBC-PR^II; Andrea Hilgenberg^III; Flávio Daniel Saavedra Tomasich, ACBC-SP^III; Paola Andrea Galbiatti Pedruzzi^IV; Clarice Nana Yamanouchi^IV

^IMédico Chefe do Serviço de Cabeça e Pescoço do Hospital Erasto Gaertner

^IIMédico do Serviço de Cabeça e Pescoço do Hospital Erasto Gaertner

^IIIMédico Oncologista, ex-Residente do Hospital Erasto Gaertner

^IVResidente do Hospital Erasto Gaertne

^{Endereço para correspondência}

RESUMO

Os estudos publicados quanto aos exames pré-operatórios mostram-se controversos e poucos abordam os riscos especificamente em cirurgias de cabeça e pescoço. O objetivo deste estudo foi identificar fatores de risco em cirurgia de cabeça e pescoço para, a partir destes, estabelecer uma rotina pré-operatória racionalizada que permita identificar o grupo de pacientes mais afetados e diminuir as taxas de complicação e mortalidade. Foram avaliados em 17 meses, 382 pacientes submetidos a cirurgia de cabeça e pescoço por neoplasias benignas ou malignas. Os fatores avaliados no estudo foram: a idade, tratamento prévio à cirurgia, o estado geral, os riscos anestésico, cardíaco e pulmonar, o potencial de contaminação, o porte e o caráter da cirurgia em relação às taxas de complicação e mortalidade. Após a análise estatística foi realizada regressão logística até se obter uma fórmula numérica, na qual se incluíram os fatores mais significativos. Encontramos em nosso serviço uma taxa de morbidade de 27,2% e uma mortalidade de 3,9%. As principais complicações foram infecção pulmonar e infecção da ferida operatória. Através dos resultados observamos que os fatores estado geral, porte e caráter da cirurgia foram significativos quanto à morbidade. Quanto à mortalidade foram significativos a idade, o estado geral e o porte cirúrgico. Isto nos permite uma abordagem pré-operatória, atuando especificamente sobre estes fatores ou suas implicações com a intenção de diminuir as taxas de morbidade e mortalidade.

Unitermos: Fatores de risco; Cirurgia de cabeça e pescoço; Neoplasia; Complicações.

ABSTRACT

The published studies about the pre-surgery examinations show themselves in controversy, and only a few of the studies mention the risks of head and neck surgery. The objective of this report was to identify the risk factors on head and neck surgeries, and after that establish a rationalized pre-operative routine that allows us to identify the most and the least affect group ofpatients. In the period of17 months, 382 patients were submitted to head and neck surgery because ofmalign and benign neoplasms. The evaluatedfactors were: the age, the previous treatment to surgery, the general aspect, the cardiac, the pulmonary and anaesthetic risk, the potential of contamination, the port and the character of the surgery related to the complication and mortality rufes. After the statistical analysis a logistical regression was realized to obtain the numeric formula, in which was included the most significantfasctors. We havefounded in our service, a morbidity rale of27,2% and a mortality rufe of 3,9%. The Mo main complications were: pulmonary infection and infection ofthe operative wound. We could observe through the results that the general aspect, the surgical port and character were significant in relation to the morbidity. In relation to the mortality the age, the general aspect and the surgical port were significant. This conclusion allows us to obtain a pro-surgical approach. that will act specifically on the factors or implications, with the intention of decreasing the mortality and morbidity rates.

Key words: Riskfactors; Complications; Head and neck surgery; Neoplasms.

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Full text available only in PDF format.

Recebido em 2/10/97

Aceito para publicação em 16/7/98

Trabalho realizado no Hospital Erasto Gaertner, Curitiba – PR.

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Endereço para correspondência:

Dr. Benedito Valdecir de Oliveira

Liga Paranaense Combate ao Câncer

Rua Dr. Ovande do Amaral, 201

81520-060 - Curitiba - PR

Datas de Publicação

• Publicação nesta coleção
  17 Maio 2010
• Data do Fascículo
  Out 1998

Histórico

• Recebido
  02 Out 1997
• Aceito
  16 Jul 1998