Desenvolvimento do website bariguide para facilitar o manejo clínico em situações de emergência pós-operatória de cirurgia baríatricade cirurgia bariátrica

Abstract

Introduction: Morbid obesity is a serious disease with an increasing incidence. Currently, bariatric surgery is the most recommended and effective long-term treatment. However, after the surgical procedure, some complications may occur, representing one of the current problems for the medical teams of bariatric societies, since the initial care of patients with acute abdomen in the postoperative period is provided by emergency physicians, not being specialists in this surgical area, which can often lead to diagnostic delay and dramatic worsening of the patient's prognosis. Objective: To evaluate the occurrence of complications in morbidly obese patients undergoing surgical treatment at the Hospital Regional do Noroeste do Paraná and to develop a website that enables the systematization of emergency care for patients with postoperative complications. Method: A retrospective study was carried out with postsurgical patients of Roux-en-Y Bypass reduction gastroplasty performed at a Regional Hospital in the Northwest of Paraná, from January 2019 to December 2020. The Information Technology Department of the mentioned hospital provided information on patients who required surgical reintervention or in-hospital clinical management due to complications after bariatric surgery. The ABLS algorithm proposed by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM) was used as an artificial intelligence mechanism for the BARIGUIDE website, which was voluntarily evaluated by 46 autonomous medical professionals (bariatric surgeons, general surgeons, emergency physicians and general practitioners) who introduced information of 4 clinical reports, simulating situations that occurred in patients with postoperative complications of bariatric surgery. After entering all the information, the BARIGUIDE website presented on the screen the probable diagnosis, as well as the indication of the first emergency measures to be adopted. A questionnaire was also applied to the volunteers, aiming to assess the degree of difficulty in using the website, the agility and consistency between the diagnostic hypothesis and the indication of the first emergency measures to be adopted. Results: During the period from January 2019 to December 2020, 601 bariatric surgeries were performed at the Hospital Regional do Noroeste do Paraná. However, 122 patients had post-surgical complications and required readmission, corresponding to 20.30%. However, there were 146 complications, because some patients developed more than one complication. In addition, 01 death occurred after the surgical/bariatric procedure, which corresponded to 0.16% of the patients. Cholecystectomy was the most frequent complication, corresponding to 42.47% of the cases of complications, being considered a late postoperative complication. The evaluation of the BARIGUIDE website was carried out by 46 medical professionals from the municipality of Paranavaí-PR, with specialists in bariatric surgery, general surgery, emergency physician and general practitioner. In addition, 100% of the volunteers considered accessing and entering information on the BARIGUIDE website as being quite simple. Regarding the time allocated for entering the information and obtaining the final diagnosis, 100% of the volunteers considered that the response provided by the website was quick, as 89.10% obtained the answer within five minutes, while 10.9% in up to 15 minutes. Regarding the consistency between the clinical suspicion and the diagnosis provided by the BARIGUIDE website, no volunteer evaluated the website as incoherent. Conclusion: Even though the evaluation of the BARIGUIDE website was not applied in real clinical situations, we believe that this product (BARIGUIDE) may contribute in post-operative bariatric emergencies, helping the emergency physician to diagnose, conduct and institute the first therapeutic measures as well as identify the conditions where the patient's referral to the bariatric team if necessary.