{"id":20338,"date":"2022-01-31T15:11:29","date_gmt":"2022-01-31T14:11:29","guid":{"rendered":"https:\/\/idibell.cat\/?p=20338"},"modified":"2022-01-31T15:15:04","modified_gmt":"2022-01-31T14:15:04","slug":"un-estudi-conclou-que-els-pacients-greus-operats-a-linici-de-la-pandemia-no-van-tenir-mes-complicacions-ni-mortalitat","status":"publish","type":"post","link":"https:\/\/idibell.cat\/2022\/01\/un-estudi-conclou-que-els-pacients-greus-operats-a-linici-de-la-pandemia-no-van-tenir-mes-complicacions-ni-mortalitat\/","title":{"rendered":"Un estudi conclou que els pacients greus operats a l&#8217;inici de la pand\u00e8mia no van tenir m\u00e9s complicacions ni mortalitat"},"content":{"rendered":"<p>Durant la pand\u00e8mia, es van impulsar diversos <strong>canvis organitzatius a l\u2019Hospital Universitari de Bellvitge<\/strong>: les unitats de cr\u00edtics de Medicina Intensiva i les unitats de cr\u00edtics d\u2019Anestesiologia\u2013Reanimaci\u00f3 d\u2019Urg\u00e8ncies (REA) i Reanimaci\u00f3 Quir\u00fargica (RPQ) es van traslladar a l\u2019\u00e0rea dels quir\u00f2fans de Cirurgia Major Ambulat\u00f2ria, i es van <strong>reduir els llits de cr\u00edtics disponibles<\/strong> per a pacients quir\u00fargics de manera significativa. Altres mesures van ser el <strong>cribratge preoperatori de SARS-CoV-2 <\/strong>i l\u2019habilitaci\u00f3 d\u2019espais de la zona de quir\u00f2fans clarament diferenciats: <strong>quir\u00f2fan Covid <\/strong>(es va utilitzar un quir\u00f2fan espec\u00edfic de Covid per als pacients de cirurgia d&#8217;emerg\u00e8ncia amb una RT-PCR positiva), quir\u00f2fan lliure de Covid, i \u00e0rea de cr\u00edtics lliure de Covid.<\/p>\n<p>Es van utilitzar <strong>diferents vies d&#8217;entrada i sortida<\/strong> per a l&#8217;\u00e0rea de quir\u00f2fan i per a l\u2019\u00e0rea de cr\u00edtics lliure de Covid, a fi de garantir que l\u2019\u00e0rea del quir\u00f2fan fos segura per a la cirurgia i la gesti\u00f3 postoperat\u00f2ria i cr\u00edtica. Tamb\u00e9 es va implantar un protocol de maneig de les vies respirat\u00f2ries i l\u2019\u00fas d&#8217;equips de protecci\u00f3 individual, obligatoris per a tot el personal implicat en quir\u00f2fans i en les unitats cr\u00edtiques situades a l\u2019\u00e0rea quir\u00fargica.<\/p>\n<p>Investigadors del grup de recerca en <a href=\"https:\/\/idibell.cat\/recerca\/area-de-neurociencies\/programa-de-neurociencies\/fisiopatologia-perioperatoria-i-dolor\/\">fisiopatologia perioperat\u00f2ria i dolor<\/a> de l\u2019IDIBELL i l\u2019HUB han portat a terme <strong>un estudi sobre l\u2019atenci\u00f3 assistencial a l\u2019\u00e0rea quir\u00fargica durant el primer pic de la pand\u00e8mia per SARS-CoV-2<\/strong>. Els resultats mostren que en el per\u00edode prepand\u00e8mic, del 13 de gener al 29 de febrer de 2020 es van operar 1.649 pacients amb ingr\u00e9s hospitalari. En el per\u00edode Covid-19, de l\u201911 de mar\u00e7 al 15 de maig de 2020 es van operar a l\u2019\u00e0rea quir\u00fargica 763 pacients amb ingr\u00e9s hospitalari.<\/p>\n<p>El percentatge de pacients amb complicacions de grau III a V segons la classificaci\u00f3 de Clavien-Dindo va ser la variable utilitzada a l\u2019estudi per determinar la no inferioritat del per\u00edode Covid respecte al per\u00edode prepand\u00e8mia. A partir de les mostres dels dos per\u00edodes, es va fer una selecci\u00f3 de pacients en base al risc preoperatori segons l\u2019ICD-10, considerant els graus 3-4 de severitat preoperat\u00f2ria, en funci\u00f3 dels antecedents dels pacients i de la complexitat de la cirurgia.<\/p>\n<p><strong>No hi va haver difer\u00e8ncies en la mortalitat ni en les complicacions<\/strong> de graus III-V Clavien-Dindo. L\u2019admissi\u00f3 a la Unitat de Cr\u00edtics d\u2019Anestesiologia va ser del 64% en el per\u00edode Pre-Covid-19 i del 44% en el per\u00edode Covid-19, un fet que representa una reducci\u00f3 significativa. Les readmissions a la Unitat de Cr\u00edtics en el curs del postoperatori no van presentar difer\u00e8ncies significatives: van ser del 5,1% en el per\u00edode Pre-Covid i del 4,4% en el per\u00edode Covid.<\/p>\n<p>La <strong>reducci\u00f3 de llits d\u2019atenci\u00f3 cr\u00edtica quir\u00fargica<\/strong> <strong>durant el per\u00edode de pand\u00e8mia<\/strong> va limitar clarament el nombre de procediments quir\u00fargics importants electius realitzats, mantenint el mateix nombre de procediments d\u2019emerg\u00e8ncia. No obstant aix\u00f2, l\u2019ingr\u00e9s tard\u00e0 a l\u2019UCI d\u2019Anestesiologia va ser similar en ambd\u00f3s per\u00edodes.<\/p>\n<p>Segons els investigadors, encara que es redu\u00eds el nombre de llits cr\u00edtics, la racionalitzaci\u00f3 de l\u2019\u00fas dels llits disponibles a les diverses UCIs <strong>hauria de minimitzar la necessitat de suspendre la cirurgia electiva i no hauria de ser una limitaci\u00f3 per programar m\u00e9s pacients quir\u00fargics<\/strong>.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em>L\u2019Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge (IDIBELL) \u00e9s un centre de recerca en biomedicina creat l\u2019any 2004. Est\u00e0 participat per l\u2019Hospital Universitari de Bellvitge i l\u2019Hospital de Viladecans de l\u2019Institut Catal\u00e0 de la Salut, l\u2019Institut Catal\u00e0 d\u2019Oncologia, la Universitat de Barcelona i l\u2019Ajuntament de l\u2019Hospitalet de Llobregat.<\/em><\/p>\n<p><em>L\u2019IDIBELL \u00e9s membre del Campus d\u2019Excel\u00b7l\u00e8ncia Internacional de la Universitat de Barcelona HUBc i forma part de la instituci\u00f3 CERCA de la Generalitat de Catalunya. L\u2019any 2009 es va convertir en un dels cinc primers centres d\u2019investigaci\u00f3 espanyols acreditats com a institut d\u2019investigaci\u00f3 sanit\u00e0ria per l\u2019Instituto de Salud Carlos III. A m\u00e9s, forma part del programa \u201cHR Excellence in Research\u201d de la Uni\u00f3 Europea i \u00e9s membre de EATRIS i REGIC. Des de l\u2019any 2018, l\u2019IDIBELL \u00e9s un Centro Acreditado de la Fundaci\u00f3n Cient\u00edfica AECC (FCAECC).<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Durant la pand\u00e8mia, es van impulsar diversos canvis organitzatius a l\u2019Hospital Universitari de Bellvitge: les unitats de cr\u00edtics de Medicina Intensiva i les unitats de cr\u00edtics d\u2019Anestesiologia\u2013Reanimaci\u00f3 d\u2019Urg\u00e8ncies (REA) i Reanimaci\u00f3 Quir\u00fargica (RPQ) es van traslladar a l\u2019\u00e0rea dels quir\u00f2fans de Cirurgia Major Ambulat\u00f2ria, i es van reduir els llits de cr\u00edtics disponibles per a [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":20339,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[459,340,457],"tags":[],"publishpress_future_action":{"enabled":false,"date":"2024-05-12 19:43:15","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"_links":{"self":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/20338"}],"collection":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/comments?post=20338"}],"version-history":[{"count":2,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/20338\/revisions"}],"predecessor-version":[{"id":20343,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/posts\/20338\/revisions\/20343"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media\/20339"}],"wp:attachment":[{"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/media?parent=20338"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/categories?post=20338"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/idibell.cat\/wp-json\/wp\/v2\/tags?post=20338"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}