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espanolIntroduccion: En hospitales que cuentan con programas de especializacion en cirugia general, un numero considerable de cierres de la pared abdominal se realizan por cirujanos en formacion. El objetivo de este trabajo consiste en determinar los factores de riesgo, la incidencia y la mortalidad derivada de la evisceracion (dehiscencia aguda de la pared abdominal) en los pacientes cuyo cierre laparotomico ha sido realizado por residentes de cirugia general. Metodo: Se llevo a cabo un estudio analitico, observacional y retrospectivo de casos y controles. Se analizaron los casos cuyo cierre de laparotomia habia sido realizado por residentes de cirugia general entre enero de 2016 y junio de 2018 en el Hospital General San Martin (La Plata, Argentina). En el grupo de casos se incluyeron los que desarrollaron evisceracion. En el grupo de controles se incluyeron los que no desarrollaron evisceracion. Se calculo la incidencia de esta complicacion y la mortalidad. Se consideraron como variables independientes la edad, el sexo, la cirugia de urgencia, el cancer digestivo, la infeccion del sitio operatorio, la relaparotomia y el cierre de la pared abdominal por cirujano novel. Se calculo el odds ratio. Se establecio el valor de p con la prueba de chi cuadrado (χ²) de Pearson. Se consideraron resultados estadisticamente signifi cativos con un valor de p Resultados: Durante el periodo de estudio se incluyeron 914 casos. La incidencia de evisceracion fue del 7.44 % (68 casos). La mortalidad en los pacientes eviscerados fue del 27.94 % (19 casos). Sin embargo, el cierre supervisado por un cirujano general con mas de 10 anos de entrenamiento quirurgico tuvo una incidencia signifi cativamente menor (3.77 %) (p = 0.000204). La edad avanzada, el cancer digestivo, la infeccion del sitio operatorio, la relaparotomia y el cierre de la pared abdominal por un cirujano novel resultaron factores de riesgo estadisticamente signifi cativos para evisceracion de la herida quirurgica (p Conclusiones: En los cierres de laparotomia realizados por residentes de cirugia general, la edad avanzada, el cancer digestivo, la infeccion del sitio operatorio, la relaparotomia y el cierre de la pared abdominal por un cirujano novel son factores de riesgo para la evisceracion de la herida quirurgica. La incidencia de evisceracion fue elevada en los casos en los que el cierre laparotomico fue realizado por un cirujano novel, y se redujo cuando se realizo bajo la supervision de un cirujano con mas de 10 anos de experiencia. EnglishIntroduction: In hospitals that have surgery specialization programs, a considerable number of abdominal wall closures are performed by surgeons in training. The objective of this study is to determine the risk factors, incidence and mortality of abdominal wound dehiscence in patients whose laparotomy closures has been performed by residents of general surgery. Method: An analytical, observational, case and control, retrospective study was carried out. The study considered the cases of Abdominal wall closure performed by residents of general surgery, between January 2016 and June 2018, in the Hospital General San Martin (La Plata, Argentina). In the case group, those who developed evisceration were included. In the control group, those who did not develop evisceration were included. The incidence of this complication and mortality was calculated. Independent variables were considered: age, sex, emergency surgery, digestive cancer, infection, relaparotomy, and closure of the abdominal wall by a novice surgeon. The Odds Ratio was calculated. The value of p was established with the chi-square test (χ²) of Pearson. Statistically significant results were considered with a value of p Results: During the study period, 914 cases were included. The incidence of abdominal wound dehiscence was 7.44 % (68 cases). Mortality in patients with acute wound failure was 27.94 % (19 cases). However, the closure supervised by a general surgeon with more than 10 years of surgical training had a significantly lower incidence (3.77 %) (p = 0.000204). Advanced age, digestive cancer, infection, relaparotomy, and closure of the abdominal wall by a novice surgeon were statistically significant risk factors for abdominal wound dehiscence (p Conclusions: In laparotomy closures performed by residents of general surgery, advanced age, digestive cancer, operative site infection, relaparotomy and closure of the abdominal wall by a novice surgeon are risk factors for evisceration of the surgical wound. The incidence of evisceration was high when the laparotomic closure has been performed by a novel surgeon. Nevertheless, the closure supervised by a surgeon with more than 10 years of surgical training had a significantly lower incidence. |
