Avaliação da associação entre performance física e desfechos no pós-operatório imediato de apcientes submetidos à cirurgia cardíaca eletiva
Avaliação da associação entre performance física e desfechos no pós-operatório imediato de apcientes submetidos à cirurgia cardíaca eletiva
Data
2022
Autores
Santana, Abisai dos Santos
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
introdução: Avaliação da performance física representa no pré-operatório uma ferramenta que pode auxiliar na determinação do risco cirúrgico e melhor momento para a intervenção. Existem testes não invasivos e de fácil realização, desenvolvidos para avaliação da performance física. Objetivo: Avaliar a performance física no pré-operatório de cirurgia cardíaca eletiva, estabelecendo associações com as complicações pós-operatórias imediatas até o momento da alta hospitalar, tempo de ventilação mecânica, tempo para caminhar, tempo para alta hospitalar e óbito. Métodos: Estudo prospectivo, longitudinal observacional, recrutamos pacientes candidatos à cirurgia eletiva de revascularização do miocárdio, troca valvar e combinada, no Instituto Nacional de Cardiologia - Rio de Janeiro. A performance física foi avaliada pelos testes de força de preensão palmar (FPP) pela dinamometria, sentar-levantar em 30 segundos (TSL-30s) e timed up and go (TUG). Os dados demográficos, socioeconômicos e clínicos foram obtidos analisando os prontuários. Os pacientes foram estratificados em dois grupos: idade igual ou maior a 60 anos (grupo 1) e idade menor que 60 anos (grupo 2). Resultados: Foram avaliados 166 pacientes no pré-operatório, sendo a maioria do gênero masculino (65%). A idade foi de 58±11 anos. Houve predomínio de pacientes no grupo 1 (53,6%). Foram submetidos a cirurgia de revascularização do miocárdio 82 pacientes (49,4%), 67 submetidos a cirurgia valvar (40,3%) e 17 procedimentos combinada (10,2%). Houve associação entre a FPP e óbito intra-hospitalar (P=0,008) e no modelo ajustado pelo European System for Cardiac Operative Risk Evaluation (EUROSCORE II) (P=0,036). A area under the ROC curve (AUC) respectivamente foi de 0,80 para a FPP e de 0,77 para o EUROSCORE II. A AUC da FPP associada com o EUROSCORE II de 0,83. Conclusões: Os resultados evidenciam a importância de realizarmos testes não invasivos, de fácil execução, no pré-operatório, podendo identificar possíveis fragilidades nesses pacientes podendo estar associadas com óbito pós-operatório.
Palavras-chave: Procedimento, Cirurgia Cardíaca / Desempenho Físico Funcional / Fragilidade / mortalidade
Introduction: Assessment of physical performance represents in the preoperative period a tool that can help to determine the surgical risk and the best time for the intervention. There are non-invasive and easy-to-perform tests designed to assess physical performance. Objective: To evaluate physical performance in the preoperative period of elective cardiac surgery, establishing associations with immediate postoperative complications up to the time of hospital discharge, time on mechanical ventilation, time to walk, time to hospital discharge and death. Methods: Prospective, longitudinal observational study, we recruited patients who were candidates for elective coronary artery bypass graft, valve replacement and combined surgery at the Instituto Nacional de Cardiologia - Rio de Janeiro. Physical performance was evaluated by tests of handgrip strength (HS) by dynamometry, sit-stand in 30 seconds (SS-30s) and timed up and go (TUG). Demographic, socioeconomic and clinical data were obtained by analyzing medical records. They were stratified into two groups: aged at and over 60 years (group 1) and under 60 years (group 2). Results: A total of 166 patients were evaluated preoperatively, most of them male (65%). The age was 58±11 years. There were more patients in group 1 (53.61%). A total of 82 patients (49.39%) underwent coronary artery bypass graft surgery, 67 underwent valve surgery (40.36%) and 17 (10.24%) were combined. There was an association between HS and in-hospital death (P=0.008) and adjusted by European System for Cardiac Operative Risk Evaluation (EUROSCORE II) (P=0.036). The area under the ROC curve (AUC) respectively was 0.80 for HS and was 0.77 for EUROSCORE II. HS associated with EUROSCORE II had AUC of 0.83. Conclusions: The results show the importance of performing untested, non-invasive, preoperative tests, which can identify possible patient scenarios that may be associated with postoperative death. Keywords: Procedure, Cardiac Surgical / Physical Functional Performance / Frailty / Mortality
Introduction: Assessment of physical performance represents in the preoperative period a tool that can help to determine the surgical risk and the best time for the intervention. There are non-invasive and easy-to-perform tests designed to assess physical performance. Objective: To evaluate physical performance in the preoperative period of elective cardiac surgery, establishing associations with immediate postoperative complications up to the time of hospital discharge, time on mechanical ventilation, time to walk, time to hospital discharge and death. Methods: Prospective, longitudinal observational study, we recruited patients who were candidates for elective coronary artery bypass graft, valve replacement and combined surgery at the Instituto Nacional de Cardiologia - Rio de Janeiro. Physical performance was evaluated by tests of handgrip strength (HS) by dynamometry, sit-stand in 30 seconds (SS-30s) and timed up and go (TUG). Demographic, socioeconomic and clinical data were obtained by analyzing medical records. They were stratified into two groups: aged at and over 60 years (group 1) and under 60 years (group 2). Results: A total of 166 patients were evaluated preoperatively, most of them male (65%). The age was 58±11 years. There were more patients in group 1 (53.61%). A total of 82 patients (49.39%) underwent coronary artery bypass graft surgery, 67 underwent valve surgery (40.36%) and 17 (10.24%) were combined. There was an association between HS and in-hospital death (P=0.008) and adjusted by European System for Cardiac Operative Risk Evaluation (EUROSCORE II) (P=0.036). The area under the ROC curve (AUC) respectively was 0.80 for HS and was 0.77 for EUROSCORE II. HS associated with EUROSCORE II had AUC of 0.83. Conclusions: The results show the importance of performing untested, non-invasive, preoperative tests, which can identify possible patient scenarios that may be associated with postoperative death. Keywords: Procedure, Cardiac Surgical / Physical Functional Performance / Frailty / Mortality
Description
Palavras-chave
Procedimento, Cirurgia Cardíaca, Desempenho Físico Funcional, Fragilidade, Mortalidade, Procedure, Cardiac Surgical, Physical Functional Performance, Frailty, Mortality
Citação
Santana AS. Avaliação da associação entre performance física e desfechos no pós-operatório imediato de apcientes submetidos à cirurgia cardíaca eletiva. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2022.