Correlação entre os resultados pré-operatórios de testes cardiopulmonares e a evolução pós-operatória em cirurgia bariátrica
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Data
2016-03-01
Autores
Hasimoto, Claudia Nishida [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A obesidade é o acúmulo de gordura anormal ou excessiva que representa um risco potencial à saúde. A cirurgia bariátrica consiste em uma alternativa de tratamento cirúrgico da obesidade mórbida, permitindo uma perda de peso expressiva e duradoura com consequente melhoria das comorbidades associadas. A obesidade está associada a alterações da mecânica ventilatória e constitui um fator de risco para o desenvolvimento de complicações pulmonares no pós-operatório de cirurgias abdominais. Objetivo: Verificar se os testes de função respiratória, de força muscular respiratória e de exercícios são capazes de predizer complicações no pós-operatório em pacientes submetidos à cirurgia bariátrica. Método: Foram avaliados 174 pacientes (81% mulheres) submetidos à cirurgia bariátrica, no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Todos os pacientes foram submetidos à medidas antropométricas, testes de espirometria, medida de pico de fluxo expiratório, manovacuometria, teste de caminhada de seis minutos e teste de escada. Os dados foram colhidos no período pré-operatório e correlacionados com as complicações pós-operatórias, incluindo as complicações cardiopulmonares e cirúrgicas. Resultados: A média de idade foi de 41,59 ± 10,70 anos. O índice de massa corpórea variou de 35,44 a 62,79 Kg/m2, com média de 46,74 ± 6,35 Kg/m2. As comorbidades mais prevalentes foram: hipertensão arterial sistêmica, diabetes mellitus, dislipidemia e hipotireoidismo. A taxa de complicação pós-operatória foi de 5,75% (10/174), a taxa de complicação cardiopulmonar de 2,3% (4/174) e a taxa de complicação cirúrgica de 3,45% (6/174). Pela correlação linear de Pearson a variável tempo de internação apresentou correlação com a variável complicação cardiopulmonar (CCP) (r=0,73, p<0,001) e o tempo de internação em Unidade de Terapia Intensiva (t UTI) se correlacionou com a saturação de oxigênio antes do início do teste de caminhada (r= -0,16, p=0,05) e com a pressão expiratória máxima, medido em porcentagem do predito (r= -0,16, p=0,04). Na regressão linear simples, a variável t UTI apresentou correlação com a variação da saturação de oxigênio no teste de caminhada (p=0,03). Enquanto que a variável tempo de internação hospitalar (t internação) apresentou correlação com CCP (p<0,0001). Na regressão logística a variável t UTI apresentou correlação com a saturação de oxigênio depois do término do teste de caminhada (OR: 0,69; IC: 0,52-0,93) Conclusão: Os testes cardiopulmonares não foram capazes de estratificar os pacientes que apresentaram complicações no pós-operatório de cirurgia bariátrica. O único parâmetro avaliado que apresentou relação com os desfechos pós-operatórios foi a saturação de oxigênio após o teste de caminhada, com t UTI (quanto menor a saturação em 1 ponto percentual aumenta em 7 vezes o tempo de internação em UTI). As complicações cardiopulmonares pós-operatórias e o tempo de internação não apresentaram correlação com nenhuma variável nos modelos estudados.
Introduction: Obesity is the accumulation of abnormal or excessive fat which represents a potential health risk. The bariatric surgery consists of an alternative for surgical treatment of morbid obesity, thus allowing significant and lasting weight loss with consequent improvement of the related comorbidities. Obesity is associated with the changes in the ventilatory mechanics and poses a risk factor for the development of pulmonary complications in the post-operative period of abdominal surgeries. Objective: Check whether the respiratory function tests, the respiratory muscle strength and the exercises are able to foresee post-operative complications in patients undergoing bariatric surgery. Methodo: 174 patients (81% women) undergoing bariatric surgery were evaluated at the Clinical Hospital of the Botucatu School of Medicine. All the patients were submitted to anthropometric measures, spyrometry tests, the measurement of peak expiratory flow, manovacuometry, a 6-minute walking test and stair-climbing test. The data were collected in the pre-operative and correlated with the post-operative complications, including both the cardiopulmonary and surgical complications. Results: The average age was 41,59 ± 10,70 years. The BMI (Body Mass Index) varied from 35,44 to 62,79 kg/m2 with an average of 46,74 ± 6,35 kg/m2. The most prevalent comorbidities were: systemic arterial hypertension, diabetes mellitus, dyslipidemia and hypothyroidism. The post-operative complication rate was at 5,75% (10/174), the cardiopulmonary complication rate at 2,3% (4/174) and the surgical complication rate at 3,45% (6/174). Through the Pearson correlation with the cardiopulmonary complication rate (CCR) (r=0,73, p<0,001) and the length of stay at the Intensive Care Unit (t ICU) correlated with the oxygen saturation before the beginning of the walking test (r=-0,16, p=0,05) as well as with the maximum expiratory pressure measured in predicted percentage (r=0,16, p=0,04). As far as the linear regression is concerned, the variable of t ICU presented a correlation with the variation of the oxygen saturation in walking test (p=0,03) whereas the variable hospital length of stay (t admission) presented correlation with CCR (p<0,0001). As to the logistic regression the variable t ICU presented correlation with the oxygen saturation after the end of the walking test (OR: 0,69, IC: 0,52-0,93). Conclusion: The cardiopulmonary exercise tests were not able to stratify the patients who experienced complications in the post-operative of the bariatric surgery. The only parameter which was related to the post-operative outcomes was the saturation of oxygen after the walking test with t ICU (one percentual point smaller of saturation increases seven times the ICU time). Post-operative cardiopulmonary complications and the admission time did not show correlation with any variable of the previous studied models.
Introduction: Obesity is the accumulation of abnormal or excessive fat which represents a potential health risk. The bariatric surgery consists of an alternative for surgical treatment of morbid obesity, thus allowing significant and lasting weight loss with consequent improvement of the related comorbidities. Obesity is associated with the changes in the ventilatory mechanics and poses a risk factor for the development of pulmonary complications in the post-operative period of abdominal surgeries. Objective: Check whether the respiratory function tests, the respiratory muscle strength and the exercises are able to foresee post-operative complications in patients undergoing bariatric surgery. Methodo: 174 patients (81% women) undergoing bariatric surgery were evaluated at the Clinical Hospital of the Botucatu School of Medicine. All the patients were submitted to anthropometric measures, spyrometry tests, the measurement of peak expiratory flow, manovacuometry, a 6-minute walking test and stair-climbing test. The data were collected in the pre-operative and correlated with the post-operative complications, including both the cardiopulmonary and surgical complications. Results: The average age was 41,59 ± 10,70 years. The BMI (Body Mass Index) varied from 35,44 to 62,79 kg/m2 with an average of 46,74 ± 6,35 kg/m2. The most prevalent comorbidities were: systemic arterial hypertension, diabetes mellitus, dyslipidemia and hypothyroidism. The post-operative complication rate was at 5,75% (10/174), the cardiopulmonary complication rate at 2,3% (4/174) and the surgical complication rate at 3,45% (6/174). Through the Pearson correlation with the cardiopulmonary complication rate (CCR) (r=0,73, p<0,001) and the length of stay at the Intensive Care Unit (t ICU) correlated with the oxygen saturation before the beginning of the walking test (r=-0,16, p=0,05) as well as with the maximum expiratory pressure measured in predicted percentage (r=0,16, p=0,04). As far as the linear regression is concerned, the variable of t ICU presented a correlation with the variation of the oxygen saturation in walking test (p=0,03) whereas the variable hospital length of stay (t admission) presented correlation with CCR (p<0,0001). As to the logistic regression the variable t ICU presented correlation with the oxygen saturation after the end of the walking test (OR: 0,69, IC: 0,52-0,93). Conclusion: The cardiopulmonary exercise tests were not able to stratify the patients who experienced complications in the post-operative of the bariatric surgery. The only parameter which was related to the post-operative outcomes was the saturation of oxygen after the walking test with t ICU (one percentual point smaller of saturation increases seven times the ICU time). Post-operative cardiopulmonary complications and the admission time did not show correlation with any variable of the previous studied models.
Descrição
Palavras-chave
Cirurgia bariátrica, Complicações pós-operatórias, Complicações cardiopulmonares, Gastroplastia, Obesidade mórbida, Risco cirúrgico, Testes pré-operatórios, Bariatric surgery, Post-operative complication, Gastroplasty, Morbid obesity, Surgical risk, Pre-operative tests