Article

Nutrición y metabolismo en Cirugía

Conferencia Rafael Casas Morales, 2009; Profesor titular de Cirugía, director del Departamento de Cirugía; Pontificia Universidad Javeriana, Hospital Universitario de San Ignacio; presidente, Asociación Colombiana de Cirugía, Bogotá, D.C, Colombia
Rev Colomb Cir 01/2009; 24:223-8.

ABSTRACT Introducción El trauma y la cirugía, que constituyen el diario quehacer del cirujano, son el origen de cambios inflamatorios y metabólicos profundos que tienen como objetivo primordial garantizar la adecuada defensa del organismo y priorizar las vías metabólicas hacia productos de utilidad en la fase aguda de la enfermedad. Sin embargo, una respuesta exagerada por parte del paciente, se asocia a disfunción y daño de órganos y sistemas y, por lo tanto, la comprensión del estado metabólico de un paciente es un punto fundamental para lograr terapias adecuadas y los mejores resultados de las intervenciones. No es raro, entonces, que hayan sido cirujanos los inventores de los diferentes tipos de terapia nutricional y los estudiosos del metabolismo del paciente quirúrgico; nombres como Stanley Dudrick (1) , Douglas Wilmore y Jonathan Roads estarán siempre grabados en la memoria de los cirujanos modernos, como los precursores del amplio conocimiento que hoy existe de la respuesta inflamatoria, la respuesta metabólica, sus consecuencias y su modulación por medio de innovadoras formas de terapia entérica y parenteral.

0 0
 · 
0 Bookmarks
 · 
55 Views
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986-1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients. Prospective data (NSQIP) were collected on 5031 noncardiac surgical patients at the Veteran's Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of surgical site infection. The mean age of the study cohort was 61 plus minus 13. SSI occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin- and non-insulin-dependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI. This study confirms that diabetes and malnutrition (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study has documented that tobacco use, steroid use, and COPD are not independent predictors of SSI. Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition.
    Journal of Surgical Research 04/2002; 103(1):89-95. · 2.02 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Although several studies have established a link between obesity and colon cancer risk, little is known about the effect of obesity on outcomes after diagnosis. We investigated the association of body mass index (BMI) with outcomes after colon cancer in patients from cooperative group clinical trials. The study cohort consisted of 4288 patients with Dukes B and C colon cancer who were accrued from July 1989 to February 1994 to National Surgical Adjuvant Breast and Bowel Project randomized trials. Risk of recurrence, second primary cancer, and mortality (overall and by likely cause) were evaluated in relation to BMI at diagnosis using statistical modeling. Median follow-up time was 11.2 years. All statistical tests were two-sided. Very obese patients (BMI > or = 35 kg/m2) had greater risk of a colon cancer event (recurrence or secondary primary tumor; hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 1.10 to 1.73) than normal weight patients (BMI = 18.5-24.9 kg/m2). Mortality was greater for very obese (HR = 1.28, 95% CI = 1.04 to 1.57) and underweight (BMI < 18.5 kg/m2) (HR = 1.49, 95% CI = 1.17 to 1.91) than for normal weight patients. The increased risk of mortality for underweight patients was dominated by non-colon cancer deaths (HR of such deaths compared with normal weight patients = 2.23, 95% CI = 1.50 to 3.31), whereas for the very obese, deaths likely due to colon cancer were increased (HR = 1.36, 95% CI = 1.06 to 1.73). Among colon cancer patients, a BMI greater than 35.0 kg/m2 at diagnosis was associated with an increased risk for recurrence of and death from colon cancer. Further studies are needed to determine pathways between obesity and recurrence risk and whether weight reduction or related interventions would improve prognosis.
    CancerSpectrum Knowledge Environment 11/2006; 98(22):1647-54. · 14.07 Impact Factor
  • Source
    Journal of Parenteral and Enteral Nutrition 34(4):452; author reply 453-4. · 2.49 Impact Factor

Full-text

View
0 Downloads
Available from