Tiempo de espera quirúrgico en apendicitis aguda y complicaciones postoperatorias en un hospital nivel 3 de Lima-Perú, entre los años 2019-2021

Abstract

Objetivo: Identificar la asociación entre el tiempo de espera quirúrgico mayor de 36 horas y las complicaciones postoperatorias antes y durante la pandemia, en pacientes post apendicectomizados de un hospital nivel 3 en Lima-Perú.

Métodos: Se realizó un estudio observacional analítico transversal con un muestreo censal, en dos periodos diferente de tiempo, desde Julio del 2019 hasta Septiembre del 2021, delimitados por el 16 de Marzo del 2020. Además, se estimó la razón de prevalencia e intervalos de confianza al 95% (IC95%) mediante modelos lineales generalizados de la familia Poisson.

Resultados: Se incluyeron 202 pacientes pre-pandemia y 294 durante la pandemia. En total, 41,58% tuvieron un tiempo de espera quirúrgico mayor de 36 horas pre-pandemia, y 42,52% durante la pandemia. De estos, 21,29% desarrollaron complicaciones postoperatorias pre-pandemia, y 20,75% durante la pandemia. Para un tiempo de espera quirúrgico mayor de 36 horas, la frecuencia de complicaciones postoperatorias fue de 65,12% pre-pandemia, y de 65,57% durante la pandemia. Pre-pandemia evidenciamos una asociación en modelo crudo [RP: 2,62 (IC95%: 1,49 - 4,60 p<0,001)], modelo ajustado epidemiológico [RPa1: 2,43 (IC95%: 1,38 - 4,30 p<0,05)] y modelo ajustado estadístico [RPa2: 2,20 (IC95%: 1,23 - 3,91 p<0,05)]. Lo mismo ocurrió durante la pandemia, [RP: 2,57 (IC95%: 1,60 - 4,14 p<0,001)], [RPa1: 2,04 (IC95%: 1,25 - 3,32 p<0,05)] y [RPa2: 2,00 (IC95%: 1,22 - 3,27 p<0,05)], respectivamente.

Conclusión: El tiempo de espera mayor a 36 horas está asociado con la presentación de complicaciones postoperatorias en pacientes post apendicectomizados, antes y durante la pandemia por COVID-19.

Objective: To identify the association between over 36-hour surgical wait time and postoperative complications before and during the pandemic in post-appendectomy patients in a level 3 hospital in Lima-Peru.

Methods: A cross-sectional analytical observational study was conducted using a census sampling method during two different time periods, from July 2019 to September 2021, both with the cut-off date of March 16, 2020. Moreover, a 95% confidence interval (95%CI) was estimated, as well as the prevalence ratio (PR), using the Poisson generalized linear models.

Results: The study included 202 patients before the pandemic and 294 during the pandemic. In total, before the pandemic, 41.58% of patients had a surgical wait time of over 36 hours, and during the pandemic, the total was 42.52%. Among these patients, 21.29% developed postoperative complications pre-pandemic, and 20.75% during the pandemic. The frequency of postoperative complications was 65.12% pre-pandemic and 65.57% during the pandemic for a surgical wait time of over 36 hours. Pre-pandemic, we evidenced an association in the crude model [PR: 2.62 (95%CI: 1.49 - 4.60 p<0.001)], in the epidemiological adjusted model [PRa1: 2.43 (95%CI: 1.38 - 4.30 p<0.05)] and in the statistical adjusted model [PRa2: 2.20 (95%CI: 1.23 - 3.91 p<0.05)]. The same occurred during the pandemic, [RP: 2.57 (95%CI: 1.60 - 4.14 p<0.001)], [RPa1: 2.04 (95%CI: 1.25 - 3.32 p<0.05)] and [RPa2: 2.00 (95%CI: 1.22 - 3.27 p<0.05)], respectively.

Conclusion: A wait time of over 36 hours is associated with the occurrence of postoperative complications in post-appendectomy patients before and during the COVID-19 pandemic.