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Doctoral Thesis
DOI
10.11606/T.5.2012.tde-16012013-173003
Document
Author
Full name
Beatriz Calil Padis Campos Costenaro
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2012
Supervisor
Committee
Barros Filho, Tarcisio Eloy Pessoa de (President)
Caromano, Fátima Aparecida
Cristante, Alexandre Fogaça
Picado, Celso Herminio Ferraz
Reis, Fernando Baldy dos
Title in Portuguese
Estudos das fraturas do anel pélvico utilizando-se bases de dados públicas
Keywords in Portuguese
Avaliação dos resultados
Base de dados
Índice de gravidade do trauma
Pelve/cirurgia
Abstract in Portuguese
Introdução: As fraturas do anel pélvico são raras e graves, sua incidência é de aproximadamente 3% de todas as fraturas e a mortalidade varia de 6 a 50%. Objetivo: Avaliar os desfechos hospitalares de pacientes submetidos à cirurgia de reparo de fratura do anel pélvico, admitidos em hospitais com diferentes volumes de atendimentos. Método: Coletou-se nas bases de dados públicas DATASUS (1993-2010) e Nationwide Inpatient Sample (1993-2009), brasileira e norte-americana, respectivamente, informações que permitissem estudar a associação entre os desfechos hospitalares (mortalidade, tempo de internação, complicações e alta hospitalar) e o volume de atendimento hospitalar. Resultados: A população do estudo incluiu 26.581 e 4.580 pacientes, predomínio de homens (76,9% e 62,6%) com média de idade de 35,8 (dp = 15,9) e 38,5 (dp = 17,3) anos, no Brasil e Estados Unidos, respectivamente. A maioria dos pacientes foi operada em hospital universitário no Brasil (49,3%) e hospital escola-urbano nos Estados Unidos (77,9%). A mortalidade foi observada em 1,5% na população brasileira e 7,1% na norte-americana. Em ambos os países, a mortalidade foi superior em hospitais de baixo volume de atendimento (OR =1,89; IC 95%, 1,42-2,51 e OR =1,62; IC 95%, 1,21-2,18; p<0,001) e mais frequente na primeira semana de internação (p<0,001). O tempo médio de internação foi de 11 dias no Brasil e de 18,7 dias nos Estados Unidos. Foram frequentes as complicações hospitalares em 43,3% da população norte-americana. Hospitais norte-americanos com baixo volume de atendimento encaminharam mais pacientes para centros de reabilitação (p<0,001). Conclusão: Pacientes operados em hospitais de alto volume de atendimento apresentaram menor taxa de mortalidade e a frequência de encaminhamento a hospitais de reabilitação foi menor. A associação entre complicações e volume hospitalar não atingiu significância.
Title in English
Study of pelvic ring fractures using public databases
Keywords in English
Database
Outcome assessment
Pelvis/surgery
Trauma severity indices
Abstract in English
Introduction: Pelvic ring fractures are rare and severe, its occurrence is about 3% approximately from all fractures and mortality rate varies from 6 to 50%. Purpose: To assess hospitals outcomes among patients undergoing pelvic fracture surgery who were admitted on different providers volumes. Method: Data were extracted from DATASUS (1993-2010) and Nationwide Inpatient Sample (1993-2009) public brazilian and north-american databases, respectively, in order to study the associations between hospitals outcomes (mortality rate, hospital stay, complications and discharge disposition) and hospital volume. Results: The study population included 26.581 and 4.580 patients who were predominantly men (76,9% and 62,6%) with a mean age of 35,8 (dp = 15,9) and 38,5 (dp = 17,3) years, at Brazil and United States, respectively. Most patients were treated at teaching hospitals (49,3%) in Brazil and in the United States at urban teaching hospitals (77,9%). Mortality had been observed in 1,5% and 7,1% in brazilian and north-american population. In both countries, mortality was higher at low hospital volumes (OR =1,89; IC, 95% 1,42- 2,51 e OR =1,62; IC, 95% 1,21-2,18; p<0,001) and at first week of hospitalization (p<0,001). The average length of stay was 11 days in Brazil and 18,7 in the United States. Hospital complications affected 43,3% of the north-american patients. Nonroutine discharge disposition was more frequent in american hospitals with low volume. Conclusion: Brazilian and North-american patients' demographic characteristics are similar once is considered gender and age. Patients treated by providers with lower caseloads volumes had higher rates of mortality and nonroutine disposition. The association between hospital volume and complications did not achieve significance.
 
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Publishing Date
2013-01-17
 
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