Apendicitis aguda en el paciente senil: Factores asociados a una mayor morbimortalidad post operatoria.

Abstract

Apendicitis aguda en el paciente senil: Factores asociados a una mayor morbimortalidad post operatoria. RESUMENObjetivo: Definir los factores asociados a una mayor morbilidad y mortalidad en pacientes seniles con apendicitis aguda. Material y métodos: Se realizó un estudio retrospectivo con 100 pacientes intervenidos en el Hospital Nacional Arzobispo Loayza, durante el período comprendido entre 1984 a 1994. Resultados: Se asociaron a una mayor frecuencia de complicaciones postoperatorias: edad mayor o igual a 70 años, tiempo de enfermedad mayor de 48 horas, presencia de apendicitis perforada con peritonitis localizada o generalizada (p<0.05). Además la presencia de apendicitis perforada se asoció significativamente a la presencia de absceso residual y/o fístula estercorácea (p=0.027) y la presencia de AA gangrenosa o perforada a mayor frecuencia de infección de herida operatoria (p<0.05). El antecedente de patología cardiovascular previa se asoció a mayor frecuencia de complicaciones cardiovasculares (p<0.05). Se asociaron a mayor mortalidad en AA, pacientes con intervención quirúrgica adicional a la apendicetomía (p=0.016) y presencia de AA perforada (p=0.027). Conclusiones: Los estadios avanzados de AA, así como la presencia de problema cardiovascular al momento del diagnóstico se asociaron con una mayor frecuencia de complicaciones post-operatorias. La presencia de peritonitis se asocia con la mortalidad. (Rev Med Hered 1996; 7: 62-67).PALABRAS CLAVE: Anciano, apendicitis aguda, complicaciones post-operatorias, mortalidad post-operatoria. SUMMARY Objective:To define the factor associated with higher post-surgical mortality and morbidity in acute appendicitis in elderly patients. Material and methods: We carried out a retrospective study which included 100 patients who were hospitalized between 1984 and 1994 at the Hospital Nacional Arzobispo Loayza, in Lima, Perú. Results: Age of 70 or more years, duration of disease longer than 48h and the presence of perforated acute appendicitis (AA) with whether localized or disseminated peritonitis were the factors associated with higher post-surgical complications (p<0.05). The presence of perforated AA was also related to residual intraabdominal abscess or entero-dermic fistulae (p=0.027) and gangrenous or perforated AA was associated with higher frequency of intected surgical wound (p<0.05). The prior history of cardiovascular problems was a related factor to the appearance of post-surgical complications in system (p<0.05). Perforated AA (p=0.027) and additional surgical procedure in the same time than appendicectomy (p=0.016) were associated with higher mortality rate. Conclusions: The advanced pathological stages of AA, as well as the presence of cardiovascular problems at the diagnostic time, is associated with a higher frequency of post-surgical complications. The concomitant presence of peritonitis associated with a higher frequency of post-surgical complications. The concomitant presence of peritonitis in associates with a fatal outcome. (Rev Med Hered 1996; 7...