- BACKGROUND: Gallbladder diseases (GBD) are one of the most common medical conditions requiring surgical intervention, both electively and urgently. It is widely accepted that sex and ethnic characteristics mighty influence both prevalence and outcomes. AIM: This study aimed to evaluate the differences on distributions of gender and ethnicity related to the epidemiology of GBD in the Brazilian public health system. METHODS: DATASUS was used to retrieve patients’ data recorded under the International Code of Diseases (ICD-10) - code K80 from January 2008 to December 2019. The number of admissions, modality of care, number of deaths, and in-hospital mortality rate were analyzed by gender and ethnic groups. RESULTS: Between 2008 and 2019, a total of 2,899,712 patients with cholelithiasis/cholecystitis (K80) were admitted to the hospitals of the Brazilian Unified Health System, of whom only 22.7% were males. Yet, the in-hospital mortality rate was significantly higher in males (15.9 per 1,000 male patients) than females (6.3 per 1,000 female patients) (p<0.05). Moreover, men presented a significantly higher risk of death (RR=2.5; p<0.05) and longer hospital stay (4.4 days vs. 3.3 days; p<0.05) than females. Compared to females, men presented a higher risk of death across all self-declared ethnic groups: whites (RR=2.4; p<0.05), blacks (RR=2.7; p<0.05), browns (RR=2.6; p<0.05), and Brazilian Indians (RR=2.13; p<0.05). CONCLUSION: In the years 2008-2019, women presented the highest prevalence of hospital admissions for GBD in Brazil, and men were associated with worse outcomes, including all ethnic groups.

Como preparar o centro cirúrgico para pacientes COVID-19

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico LEONARDO DE [1][2][3] . Fatigue and lack of supervision to attending physicians may contribute to increased complications and hospital mortality. Such situations, also added to the circadian rhythm and dynamics of abnormal operating changes can be crucial factors for the worst performance in these periods. The cumulative presence of a number of unfavorable conditions is remarkable and very common in these periods, situations that favor and increase vulnerability to error [1][2][3][4][5][6][7][8][9][10] . Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] . This highlights the need to analyze these situations trough of a model to interpret the error with a systemic view.Due to the lack of Brazilian studies, this study aimed to verify the impact of the shift of admission of patients who have suffered trauma, underwent surgery, in hospital mortality. According to these results, interpretation models and error correction are discussed. METHODS METHODS METHODS METHODS METHODSThis is a cohort study with retrospective collection of data, which were selected through electronic medical records, patients admitted from November 2011 to March 2012 in the emergency of Hospital do Subúrbio (HS) -a public hospital attending urgency and emergency and public-private administrative nature, in Subúrbio Ferroviá-rio, district of the city of Salvador, Bahia. The study included trauma patients admitted to the emergency HS who underwent surgery and were classified according to Internatio...