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Efecto del volumen quirúrgico hospitalario en la mortalidad perioperatoria de los pacientes con cáncer gástrico en un país de medianos ingresos: estudio poblacional en Bogotá, Colombia
dc.rights.license | Atribución-NoComercial-SinDerivadas 4.0 Internacional |
dc.contributor.advisor | Guevara Cruz, Oscar Alexander |
dc.contributor.advisor | Buitrago Gutiérrez, Giancarlo |
dc.contributor.author | Cuesta Nova, Antonio José |
dc.date.accessioned | 2021-02-03T21:42:39Z |
dc.date.available | 2021-02-03T21:42:39Z |
dc.date.issued | 2021-02-03 |
dc.identifier.citation | Cuesta Nova, A. J. (2021). Efecto del volumen quirúrgico hospitalario en la mortalidad perioperatoria de los pacientes con cáncer gástrico en un país de medianos ingresos: estudio poblacional en Bogotá, Colombia [Tesis de especialidad, Universidad Nacional de Colombia]. Repositorio Institucional. |
dc.identifier.uri | https://repositorio.unal.edu.co/handle/unal/79064 |
dc.description.abstract | Introducción: El objetivo del estudio fue evaluar la asociación entre el volumen quirúrgico hospitalario con la mortalidad perioperatoria de los pacientes con cáncer gástrico. Métodos: Se realizó un estudio retrospectivo de cohorte a partir de una base administrativa, que incluyó pacientes llevados a resección quirúrgica por cáncer gástrico entre 2014 y 2016 en la ciudad de Bogotá, Colombia. Se estimó la edad al momento del diagnóstico, sexo, tipo de régimen al que pertenece el paciente y mortalidad a 30 y 90 días postoperatoria. Se llevó a cabo una comparación de la mortalidad entre los hospitales de bajo volumen de gastrectomías vs. alto volumen (<25 vs ≥25 al año) usando la prueba de Chi cuadrado (𝟀²p) de Pearson y realizando análisis bivariado y multivariado mediante regresión logística de Poisson. Resultados: Se incluyeron 743 pacientes en el estudio. La edad media fue de 61 ± 13 años. El 61,5% de los pacientes fueron hombres. El 30,4% de los pacientes fueron operados en el régimen subsidiado y el 69,6% restante en el contributivo. La mortalidad comparada entre los hospitales de mayor y menor volumen fue menor a los 30 y los 90 días, en el modelo bivariado (30 días: 2,25% vs. 5,95% 𝟀² p 0,032) (90 días: 6,76% vs. 12,28% 𝟀² p 0,025). En el análisis multivariado esta diferencia siguió siendo estadísticamente significativa, con una menor mortalidad a 30 y 90 días (OR 30 días 0,36 [CI 95% 0,14 - 0,96] p 0,040 y OR 90 días 0,50 CI 95% [0,28 - 0,90] p 0,020) Conclusiones: Los pacientes operados por cáncer gástrico en hospitales con un alto volumen quirúrgico en la ciudad de Bogotá, Colombia, tienen una mortalidad perioperatoria menor comparada con los centros de bajo volumen. |
dc.description.abstract | Introduction: The objective of the study was to evaluate the association between hospital surgical volume and perioperative mortality in patients with gastric cancer. Methods: A retrospective cohort study was carried out from an administrative database, which included patients undergoing surgical resection for gastric cancer between 2014 and 2016 in the city of Bogotá, Colombia. Age at diagnosis, sex, type of healthcare insurance to which the patient belongs and mortality at 30 and 90 days postoperative were estimated. A comparison of mortality between low-volume gastrectomy hospitals vs. high-volume (<25 vs ≥25 per year) using Pearson's Chi square test (𝟀²p) and through bivariate and multivariate analysis ussing Poisson regression . Results: 743 patients were included in the study. The mean age was 61 ± 13 years. 61.5% of the patients were men. 30.4% of the patients were operated on in the subsidized regime and the remaining 69.6% in the contributory. The mortality between the hospitals with the largest and the smallest volume was lower at 30 and 90 days, in the bivariate model (30 days: 2.25% vs. 5.95% 𝟀² p 0.032) (90 days: 6.76 % vs. 12.28% 𝟀² p 0.025).In the multivariate analysis, this difference remained statistically significant, with lower mortality at 30 and 90 days (OR 30 days 0.36 [CI 95% 0.14 - 0.96] p 0.040 and OR 90 days 0.50 CI 95 % [0.28 - 0.90] p 0.020) Conclusions: Patients operated for gastric cancer in hospitals with a high surgical volume in the city of Bogotá, Colombia, have a lower perioperative mortality compared to low volume centers. |
dc.format.extent | 47 |
dc.format.mimetype | application/pdf |
dc.language.iso | spa |
dc.rights | Derechos reservados - Universidad Nacional de Colombia |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
dc.subject.ddc | 617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología |
dc.title | Efecto del volumen quirúrgico hospitalario en la mortalidad perioperatoria de los pacientes con cáncer gástrico en un país de medianos ingresos: estudio poblacional en Bogotá, Colombia |
dc.type | Otro |
dc.rights.spa | Acceso abierto |
dc.type.driver | info:eu-repo/semantics/other |
dc.type.version | info:eu-repo/semantics/acceptedVersion |
dc.publisher.program | Bogotá - Medicina - Especialidad en Cirugía General |
dc.description.degreelevel | Especialidades Médicas |
dc.publisher.branch | Universidad Nacional de Colombia - Sede Bogotá |
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dc.relation.references | Mamidanna R, Ni Z, Anderson O, et al. Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England. Ann Surg. 2016;263(4):727‐732. |
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dc.relation.references | Varagunam M, Hardwick R, Riley S, Chadwick G, Cromwell DA, Groene O. Changes in volume, clinical practice and outcome after reorganisation of oesophago-gastric cancer care in England: A longitudinal observational study. Eur J Surg Oncol. 2018;44(4):524‐531. |
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dc.relation.references | Makris EA, et al. Surgical Considerations in the Management of Gastric Adenocarcinoma. Surg Clin N Am. 2017;97:295–316 |
dc.relation.references | Mamidanna R, Ni Z, Anderson O, et al. Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England. Ann Surg. 2016;263(4):727‐732. |
dc.relation.references | Van Putten M, Nelen SD, Lemmens VEPP, et al. Overall survival before and after centralization of gastric cancer surgery in the Netherlands. Br J Surg. 2018;105(13):1807‐1815. |
dc.relation.references | Varagunam M, Hardwick R, Riley S, Chadwick G, Cromwell DA, Groene O. Changes in volume, clinical practice and outcome after reorganisation of oesophago-gastric cancer care in England: A longitudinal observational study. Eur J Surg Oncol. 2018;44(4):524‐531 |
dc.relation.references | Claassen YHM, van Amelsfoort RM, Hartgrink HH, et al. Effect of Hospital Volume With Respect to Performing Gastric Cancer Resection on Recurrence and Survival: Results From the CRITICS Trial. Ann Surg. 2019;270(6):1096‐1102. |
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dc.relation.references | Iwatsuki M, Yamamoto H, Miyata H, et al. Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer. 2019;22(1):190‐201. |
dc.relation.references | Mahar AL, McLeod RS, Kiss A, et al. A systematic review of the effect of institution and surgeon factors on surgical outcomes for gastric cancer. J Am Coll Surg 214:860–868. |
dc.rights.accessrights | info:eu-repo/semantics/openAccess |
dc.subject.proposal | Cáncer gástrico |
dc.subject.proposal | Gastrectomy |
dc.subject.proposal | Mortality |
dc.subject.proposal | Gastrectomía |
dc.subject.proposal | Gastric cancer |
dc.subject.proposal | Volumen hospitalario |
dc.subject.proposal | Mortalidad |
dc.subject.proposal | Hospital volume |
dc.type.coar | http://purl.org/coar/resource_type/c_1843 |
dc.type.coarversion | http://purl.org/coar/version/c_ab4af688f83e57aa |
dc.type.content | Text |
oaire.accessrights | http://purl.org/coar/access_right/c_abf2 |
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