Cirurgia em metástase vertebral : sobrevida e complicação pós-operatória: proposta de modelo preditivo

Registro completo de metadados
MetadadosDescriçãoIdioma
Autor(es): dc.contributorCunha, Luiz Antonio Munhoz da-
Autor(es): dc.contributorUniversidade Federal do Paraná. Setor de Ciências da Saúde. Programa de Pós-Graduação em Clínica Cirúrgica-
Autor(es): dc.creatorAnzuatégui, Pedro Reggiani-
Data de aceite: dc.date.accessioned2019-08-22T00:21:36Z-
Data de disponibilização: dc.date.available2019-08-22T00:21:36Z-
Data de envio: dc.date.issued2018-04-17-
Data de envio: dc.date.issued2018-04-17-
Data de envio: dc.date.issued2017-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/1884/54475-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/1884/54475-
Descrição: dc.descriptionOrientador: Prof. Dr. Luiz Antônio Munhoz da Cunha-
Descrição: dc.descriptionDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Clínica Cirúrgica. Defesa: Curitiba, 18/12/2017-
Descrição: dc.descriptionInclui referências: f. 48-55-
Descrição: dc.descriptionResumo: O presente trabalho tem o objetivo de avaliar os resultados cirúrgicos da metástase vertebral em relação à sobrevida e complicações, e também identificar fatores prognósticos com o intuito de desenvolver um modelo preditivo para resultados desfavoráveis. Este é um estudo retrospectivo, observacional, longitudinal, analítico e descritivo. Foram coletados dados clínicos de pacientes consecutivos submetidos à cirurgia aberta realizada no Hospital Erasto Gaertner. As variáveis analisadas foram sexo, idade, comorbidades, velocidade de progressão tumoral e contagem celular no sangue periférico. As comorbidades foram avaliadas segundo os índices de Charlson e Elixhauser. Utilizou-se o método de Rampersaud para caracterização das complicações. Mortalidade em 30 dias, em 90 dias e complicações foram os desfechos primários, enquanto que tempo médio de sobrevida, complicação específica, falha em resgatar e falha em resgatar por infecção foram os desfechos secundários. Os fatores prognósticos que se mostraram independentemente associados aos desfechos primários foram incluídos no modelo preditivo. Duzentos e cinco pacientes, com idade média de 59 anos, foram tratados cirurgicamente de metástases vertebrais entre 2002 a 2015. O tumor primário mais frequente foi de próstata (24%), seguido por mama (21%) e mieloma múltiplo (13%). O tempo médio de sobrevida foi de 502 dias. Em 30% dos casos ocorreu sobrevida acima de 12 meses. As cirurgias complicaram em 31% das vezes. A infecção de ferida operatória ocorreu em 10% dos pacientes, seguida por pneumonia (7%). As características clínicas independentemente associadas aos desfechos primários foram: ausência de tipo histológico de progressão lenta, presença de ao menos uma comorbidade e contagem total de linfócitos < 1000 células/?L. Os pacientes foram estratificados em quatro categorias de risco (baixo, médio, alto e extremo), com base na exposição a estes fatores prognósticos. Segundo a curva ROC, este modelo explicou 72% da mortalidade em 30 dias, 73% da mortalidade em 90 dias e 70% das complicações. Comparando-se as categorias do modelo, os desfechos primários e secundários ocorreram com aumento progressivo seguindo tendência linear. Conclui-se que a maioria dos pacientes não atingiu 12 meses de sobrevida e foi alta a incidência de complicações pós-operatórias. O modelo preditivo proposto se mostrou adequado estimador de resultados precoces desfavoráveis e, por possuir características inéditas, poderia ser mais uma ferramenta para auxiliar na tomada de decisão, frente ao paciente portador de metástase vertebral. Palavras-chave: Metástase vertebral, cirurgia, sobrevida, mortalidade, complicação, morbidade, falha em resgatar, linfócitos, comorbidades, modelo preditivo, classificação de risco.-
Descrição: dc.descriptionAbstract: The aim of this study was to evaluate the surgical results of vertebral metastasis regarding to survival and complications, as well as to identify prognostic factors focusing on the development of a predictor model of unfavorable results. This is a retrospective, observational, longitudinal, analytical and descriptive study. Data were collected from consecutive patients submitted to open surgery performed at the Erasto Gaertner Hospital. The variables analyzed were sex, age, comorbidities, primary tumor speed growth and peripheral blood cell counts. Comorbidities were assessed according to the Charlson and Elixhauser indexes. The Rampersaud method was used to characterize the complications. 30-day mortality, 90-day mortality and complications were the primary outcomes while mean survival time, specific complication, failure to rescue and failure to rescue by infectious disease were the secondary outcomes. The prognostic factors that were independently associated with the primary outcomes were included in the predictor model. Two hundred and five patients, mean age 59 years, were treated surgically for vertebral metastases between 2002 and 2015. The most frequent primary tumor was prostate (24%), followed by breast (21%) and multiple myeloma (13%). The mean survival time was 502 days. A minimum 12-month survival time occurred in 30% of the cases. Complications were observed in 31% of the procedures. Wound infection occurred in 10% of the patients, followed by pneumonia (7%). Clinical characteristics independently associated with the primary outcomes were: absence of slow growth primary tumor, presence of at least one comorbidity and total lymphocyte count <1000 cells/?L. Patients were stratified into four risk categories (low, medium, high and extreme), based on exposure to these prognostic factors. According to the ROC curve, this model explained 72% of the 30-day mortality, 73% of the 90-day mortality and 70% of the complications. Comparing model categories, the primary and secondary outcomes occurred with progressive increase following a linear trend. In conclusion, most patients did not reach 12-month survival and the incidence of postoperative complications was high. The proposed predictor model proved to be an adequate estimator of unfavorable early results and, by its novel characteristics, could be another tool to aid in decision making process regarding the patient with vertebral metastasis. Keywords: Vertebral metastasis, surgery, survival, mortality, complication, morbidity, failure to rescue, lymphocytes, comorbidities, predictor model, risk classification. The aim of this study was to evaluate the surgical results of vertebral metastasis regarding to survival and complications, as well as to identify prognostic factors focusing on the development of a predictor model of unfavorable results. This is a retrospective, observational, longitudinal, analytical and descriptive study. Data were collected from consecutive patients submitted to open surgery performed at the Erasto Gaertner Hospital. The variables analyzed were sex, age, comorbidities, primary tumor speed growth and peripheral blood cell counts. Comorbidities were assessed according to the Charlson and Elixhauser indexes. The Rampersaud method was used to characterize the complications. 30-day mortality, 90-day mortality and complications were the primary outcomes while mean survival time, specific complication, failure to rescue and failure to rescue by infectious disease were the secondary outcomes. The prognostic factors that were independently associated with the primary outcomes were included in the predictor model. Two hundred and five patients, mean age 59 years, were treated surgically for vertebral metastases between 2002 and 2015. The most frequent primary tumor was prostate (24%), followed by breast (21%) and multiple myeloma (13%). The mean survival time was 502 days. A minimum 12-month survival time occurred in 30% of the cases. Complications were observed in 31% of the procedures. Wound infection occurred in 10% of the patients, followed by pneumonia (7%). Clinical characteristics independently associated with the primary outcomes were: absence of slow growth primary tumor, presence of at least one comorbidity and total lymphocyte count <1000 cells/?L. Patients were stratified into four risk categories (low, medium, high and extreme), based on exposure to these prognostic factors. According to the ROC curve, this model explained 72% of the 30-day mortality, 73% of the 90-day mortality and 70% of the complications. Comparing model categories, the primary and secondary outcomes occurred with progressive increase following a linear trend. In conclusion, most patients did not reach 12-month survival and the incidence of postoperative complications was high. The proposed predictor model proved to be an adequate estimator of unfavorable early results and, by its novel characteristics, could be another tool to aid in decision making process regarding the patient with vertebral metastasis. Keywords: Vertebral metastasis, surgery, survival, mortality, complication, morbidity, failure to rescue, lymphocytes, comorbidities, predictor model, risk classification.-
Formato: dc.format61 f. : gráfs., tabs.-
Formato: dc.formatapplication/pdf-
Formato: dc.formatapplication/pdf-
Relação: dc.relationDisponível em formato digital-
Palavras-chave: dc.subjectCirurgia-
Palavras-chave: dc.subjectColuna vertebral - Cirurgia-
Palavras-chave: dc.subjectMetastase-
Palavras-chave: dc.subjectSobrevida-
Palavras-chave: dc.subjectComplicações pos-operatorias-
Palavras-chave: dc.subjectClassificação - Métodos-
Título: dc.titleCirurgia em metástase vertebral : sobrevida e complicação pós-operatória: proposta de modelo preditivo-
Tipo de arquivo: dc.typelivro digital-
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