Información del artículo
Abstract
Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics.
Keywords:
Perioperative care
Prevention and control
Practice guidelines
Antibiotic prophylaxis
Venous thrombosis
Pain
Postoperative nausea and vomiting
Resumen
A pesar de los avances en las técnicas quirúrgicas y en la anestesia, todavía se produce un número significativo de complicaciones en el postoperatorio de la cirugía mayor. Las más frecuentes son las infecciones de la herida quirúrgica, la sepsis, las complicaciones cardiovasculares y respiratorias y los fenómenos tromboembólicos. La aparición de estas complicaciones aumenta la estancia hospitalaria, los costes sanitarios y la mortalidad. Para reducir su incidencia, se han introducido diferentes estrategias farmacológicas perioperatorias que, sin embargo, han estado sometidas a una gran variabilidad de unos hospitales a otros e incluso entre los profesionales de un mismo centro. En el presente artículo se revisan las recomendaciones de las guías de práctica clínica más establecidas sobre la medicación habitualmente empleada en esta situación, como los antibióticos, antitrombóticos, analgésicos y antieméticos.
Palabras clave:
Cuidados perioperatorios
Profilaxis
Guías de práctica clínica
Profilaxis antibiótica
Trombosis venosa
Dolor
Náuseas y vómitos postoperatorios
El Texto completo está disponible en PDF
References
[1.]
S.F. Khuri, W.G. Henderson, R.G. DePalma, C. Mosca, N.A. Healey, D.J. Kumbhani.
Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.
Ann Surg, 242 (2005), pp. 326-341
[2.]
J.B. Dimick, P.J. Pronovost, J.A. Cowan Jr, P.A. Lipsett, J.C. Stanley, G.R. Upchurch Jr.
Variation in postoperative complication rates after highrisk surgery in the United States.
Surgery, 134 (2003), pp. 534-540
[3.]
J.B. Dimick, S.L. Chen, P.A. Taheri, W.G. Henderson, S.F. Khuri, D.A. Campbell Jr.
Hospital costs associated with surgical complications: A report from the private-sector National Surgical Quality Improvement Program.
J Am Coll Surg, 199 (2004), pp. 531-537
[4.]
N.A. Khan, H. Quan, J.M. Bugar, J.B. Lemaire, R. Brant, W.A. Ghali.
Association of postoperative complications with hospital costs and length of stay in a tertiary care center.
J Gen Intern Med, 21 (2006), pp. 177-180
[5.]
P. Gorecki, M. Schein, J.C. Rucinski, L. Wise.
Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: The chaos continues.
World J Surg, 23 (1999), pp. 429-432
[6.]
M. Delgado, G. Martínez, A. Gómez, M. Medina.
Quimioprofilaxis en cirugía: problemas y soluciones en su cumplimiento.
Cir Esp, 71 (2002), pp. 96-101
[7.]
J.P. Burke.
Infection control-a problem for patient safety.
N Engl J Med, 348 (2003), pp. 651-656
[8.]
National Nosocomial Infections Surveillance, System..
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October, 2004.
Am J Infect Control., 32 (2004), pp. 470-485
[9.]
E.N. Perencevich, K.E. Sands, S.E. Cosgrove, E. Guadagnoli, E. Meara, R. Platt.
Health and economic impact of surgical site infections diagnosed after hospital discharge.
Emerg Infect Dis, 9 (2003), pp. 196-203
[10.]
Auerbach AD. Prevention of surgical site infections. En: Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ, editores. Making health care safer: A critical analysis of patient safety practices. Evidence report/technology assessment no. 43. Rockville, MD: Agency for Healthcare Research and Quality; 2001. p. 221–44. [cited, Dic 8, 2003]. Available from: URL: http://www.ahrq.gov/clinic/ptsafety/pdf/ptsafety.pdf.
[11.]
D.W. Bratzler, P.M. Houck, Surgical Infection Prevention Guideline. Writers Workgroup.
Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project.
Am J Surg, 189 (2005), pp. 395-404
[12.]
Antibiotic prophylaxis in surgery.
Treatment guidelines.
The Medical Letter, 2 (2004), pp. 27-32
[13.]
Scottish Intercollegiate Guidelines Network (SIGN). Antibiotic prophylaxis in surgery. A national clinical guideline. En: Brown K, De Beaux A, Qureshi S, Twaddle S, editors. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2008 Jul. 71 p. (SIGN publication; no. 104) [cited, Apr 2009]. Available from: URL: www.sign.ac.uk.
[14.]
X. Guirao Garriga, J.M. Badia Pérez.
Profilaxis antibiótica en cirugía.
Guía Clínica de Infecciones Quirúrgicas. Sección de infección quirúrgica. Asociación española de Cirujanos,
[15.]
J.M. Badia Pérez, M. Girvent Montllor, A. Sitges Serra.
Anti-bioticoterapia profiláctica y terapéutica en la cirugía general.
Cirugía AEC. Manual de la Asociación Española de Cirujanos, pp. 96-108
[16.]
F.A. Anderson, F.A. Spencer.
Risk factors for venous thromboembolism.
Circulation, 107 (2003), pp. I9-I16
[17.]
W.H. Geerts, D. Bergqvist, G.F. Pineo, J.A. Heit, C.M. Samama, M.R. Lassen, et al.
Prevention of venous thromboembolism. American College of Chest Physicians. Evidenced-based clinical practice guidelines (8th Edition).
Chest, 133 (2008), pp. 381S-453S
[18.]
F.A. Anderson, H.B. Wheeler, R.J. Goldberg, D.W. Hosmer, N.A. Patword- han, B. Jovanovic, et al.
A population-based perspective of the hospital incidence and casefatality rates of deep vein thrombosis and pulmonary embolism: The Worcester DVT Study.
Arch Intern Med, 151 (1991), pp. 933-938
[19.]
S.D. Sullivan, S.R. Kahn, B.L. Davidson, L. Borris, P. Bossuyt, G. Raskob, et al.
Measuring the outcomes and pharmacoeconomic consequences of venous thromboembolism prophylaxis in major orthopaedic surgery.
Pharmacoeconomics, 21 (2003), pp. 477-496
[20.]
International Multicentre Trial.
Prevention of fatal pulmonary embolism by low doses of heparin.
Lancet, 2 (1975), pp. 45-51
[21.]
H. Halkin, J. Goldberg, M. Modan, M. Baruch.
Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis.
Ann Intern Med, 96 (1982), pp. 561-565
[22.]
D. Bergqvist, B. Lindgren, T. Matzsch.
Cost-effectiveness of preventing postoperative deep vein thrombosis.
Disorders of thrombosis, pp. 228-233
[23.]
G.P. Clagett, J.S. Reisch.
Prevention of venous thromboembolism in general surgical patients: Results of meta-analysis.
Ann Surg, 208 (1988), pp. 227-240
[24.]
L.N. Jorgensen, P. Wille-Jorgensen, O. Hauch.
Prophylaxis of postoperative thromboembolism with low molecular weight heparins.
Br J Surg, 80 (1993), pp. 689-704
[25.]
M.M. Samama.
Applying risk assessment models in general surgery: effective risk stratification.
Blood Coagul Fibrinolysis, 10 (1999), pp. S79-S84
[26.]
A. Cohen, R. Alikhan, J. Arcelus, J. Bergmann, S. Haas, G. Merli, et al.
A risk assessment model for identifying medical patients who should receive thromboprophylaxis [resumen].
J Thromb Haemost, 1 (2003), pp. OC437
[27.]
W.H. Geerts, D. Bergqvist, G.F. Pineo, J.A. Heit, C.M. Samama, M.R. Lassen, et al.
Prevention of venous thromboembolism; American College of Chest Physicians evidence-based guidelines (8th edition) Antithrombotic and Thrombolytic Therapy.
Chest, 133 (2008), pp. 381S-453S
[28.]
J.L. Apfelbaum, C. Chen, S.S. Mehta, T.J. Gan.
Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged.
Anesth Analg, 97 (2003), pp. 534-540
[29.]
F.M. Perkins, H. Kehlet.
Chronic pain as an outcome of surgery. A review of predictive factors.
Anesthesiology, 93 (2000), pp. 1123-1133
[30.]
Dolor postoperatorio en España.
Primer documento consenso. AEC, GEDOS, SEDAR y SED.
Ed Imago Conceps and Image Development, (2005),
[31.]
R.W. Rosenquist, J. Rosenberg.
United States Veterans Administration Postoperative pain guidelines.
Reg Anesth Pain Med, 28 (2003), pp. 279-288
[32.]
American Society of Anesthesiologists Task Force on Acute Pain Management.
Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management.
Anesthesiology, 100 (2004), pp. 1573-1581
[33.]
R. Allvin, L. Brasseur, B. Crul, J. Dhal, K. Lehmann, F. Nicosia, et al.
European minimum standards for the management of post- operative pain. EuroPain Task Force.
Pegasus Healthcare Intl, (1998),
[34.]
M.R. Tramer.
A rational approach to the control of post- operative nausea and vomiting: Evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues.
Acta Anaesthesiol Scand, 45 (2001), pp. 4-13
[35.]
C.C. Apfel, A. Bacher, A. Biedler, K. Danner, O. Danzeisen, L.H. Eberhart, et al.
A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. Duke 4.
Anaesthesist, 54 (2005), pp. 201-209
[36.]
M. Koivuranta, E. Läärä, L. Snare, S. Alahuhta.
A survey of postoperative nausea and vomiting.
Anaesthesia, 52 (1997), pp. 443-449
[37.]
S. Pierre, H. Benais, J. Pouymayou.
Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting.
Can J Anaesth, 49 (2002), pp. 237-242
[38.]
T.J. Gan, T.A. Meyer, C.C. Apfel, F. Chung, P.J. Davis, A.S. Habib, Society for Ambulatory Anesthesia, et al.
Society for Ambu- latory Anesthesia guidelines for the management of post- operative nausea and vomiting.
Anesth Analg, 105 (2007), pp. 1615-1628
Copyright © 2009. Asociación Española de Cirujanos
