Registro de intervenciones en pacientes con cardiopatía congénita de la Sociedad Española de Cirugía Cardiovascular y Endovascular: 2021 y retrospectiva de la última década

Resumen La Sociedad Española de Cirugía Cardiovascular y Endovascular, de manera conjunta al registro general de actividad 2021, muestra sus datos de actividad en pacientes con cardiopatía congénita del período temporal 2012-2021, basado en un registro voluntario y anónimo de los centros participantes. En 2021, aún marcado por las secuelas de la pandemia COVID-19, persiste el descenso de actividad quirúrgica en cardiopatías congénitas (CC) del 2020 respecto a los años previos. Presentamos agrupados los datos de actividad de la última década, para reflejar mejor nuestros resultados con estas patologías relativamente infrecuentes. En este tiempo se realizaron en España 20.139 cirugías de CC, que suponen el 9,5% de la cirugía cardiovascular mayor realizada en nuestro país durante ese tiempo. El 81,5% de las cirugías congénitas se hicieron con circulación extracorpórea y el 18,5% restante sin ella. Destacamos las intervenciones neonatales y en adultos, que asocian elevada complejidad y suponen, respectivamente, el 18% y el 21% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,07% (Aristóteles: 6,29), y en cirugías sin circulación extracorpórea, del 2,25% (Aristóteles: 4,82). Nuestro registro nacional de actividad quirúrgica en CC muestra buenos resultados, permite establecer comparaciones a nivel nacional e internacional, para diseñar estrategias de mejora, fijar objetivos y aumentar la calidad de nuestras actuaciones. The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2021 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2021 cardiovascular surgery annual report, and they are published together. In 2021, still marked by the aftermath of the COVID-19 pandemic, the decline in our 2020 congenital activity persists, compared with previous years. We included data from the previous 10years, in order to obtain real information related to our activity with these relatively scarce pathologies. In the last decade, a total of 20,139 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital +acquired) performed in Spain during that period. Of these surgeries, 81.5% of them required extracorporeal circulation and 18.5% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 21% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.07% (Aristotle: 6.29), and without cardiopulmonary bypass 2.25% (Aristotle: 4.82). Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Anesthetic considerations for the management of the surgical patient with COVID-19 / Consideraciones anestésicas para el abordaje del paciente quirúrgico con COVID-19

Resumen Introducción: La situación actual causada por el COVID-19 demanda la implementación de nuevas técnicas en el manejo anestésico y los riesgos preexistentes en los servicios quirúrgicos. Objetivo: Identificar las consideraciones anestésicas para pacientes con COVID-19 con el fin de sugerir intervenciones en el área quirúrgica. Metodología: Revisión integrativa de alcance descriptivo en conjunto con el cumplimiento de los pasos metodológicos de Whittemore-Knafl y los parámetros PRISMA. Se realizó la búsqueda en las bases de datos: PubMed, BVS, Coronavirus Research Database, SCOPUS, Elsevier y SAGE. Se obtuvieron 953 artículos que, junto a un análisis crítico por CASPe, cumplieron los criterios establecidos de inclusión y exclusión. Resultados: Se seleccionaron 27 artículos clasificados en: criterios de selección de técnica anestésica; anestesia general y el uso de medicamentos específicos para el manejo anestésico que disminuyan la tos y prevengan la liberación de aerosoles; manejo de la vía aérea encaminada a evitar intubaciones fallidas; anestesia regional y consideraciones de enfermería sobre la preparación de elementos y dispositivos de manera previa al ingreso del paciente al quirófano; identificación y monitorización de pacientes sintomáticos y asintomáticos durante el proceso perioperatorio. Conclusión: Con respecto a la técnica anestésica, es importante priorizar el uso, en cuanto sea posible, de la anestesia regional guiada con ultrasonido. En caso de requerirse la anestesia general, es recomendable mantener las precauciones para prevenir el contagio con el virus. Para enfermería, es destacable el rol en la preparación de un entorno quirúrgico seguro, del conocimiento sobre la técnica anestésica empleada y los cuidados individualizados según las necesidades requeridas.

Abstract Introduction: The current situation caused by COVID-19 demands the implementation of new techniques in anesthetic management and pre-existing risks in surgical services. Objective: to identify the anesthetic considerations for patients with COVID-19 to suggest interventions in the surgical area. Methodology: Integrative review of descriptive scope in conjunction with compliance with the methodological steps of Whittemore-Knafl and the PRISMA parameters. The search was performed in the following databases: PubMed, VHL, Coronavirus Research Database, SCOPUS, Elsevier, and SAGE. A total of 953 articles were obtained, which together with a critical analysis by CASPe, met the established inclusion and exclusion criteria. Results: Twenty-seven articles classified as: selection criteria for anesthetic techniques; general anesthesia and the use of specific medications for anesthetic management that reduce cough and prevent the release of aerosols; airway management to avoid failed intubations; regional anesthesia and nursing considerations in the preparation of elements and devices prior to the patient's admission to the operating room; identification and follow-up of symptomatic and asymptomatic patients during the perioperative process. Conclusion: Regarding the anesthetic technique, it is important to prioritize the use, as far as possible, of ultrasound-guided regional anesthesia. If general anesthesia is required, it is advisable to maintain precautions to prevent infection with the virus. For nursing, the role in preparing a safe surgical environment, knowledge of the anesthetic technique used and individualized care according to the required needs stand out.

Cirugía cardiovascular en España en el año 2021. Registro de intervenciones de la Sociedad Española de Cirugía Cardiovascular y Endovascular

Resumen El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2021. Se trata de un registro anónimo y voluntario de datos agregados en el que han participado hospitales del territorio nacional, transfiriendo sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Se comunican, por trigésimo tercer año consecutivo los datos de la actividad nacional. El registro de 2021 puede tener valor para analizar la posible recuperación de la actividad después de la pandemia de SARS-CoV2 sobre la actividad en cirugía cardiaca en nuestro país. En el año 2021 comunicaron su actividad 58 hospitales frente a los 60 que compartieron datos en 2020. En total, se realizaron 29.319 intervenciones, con 19.229 procedimientos de cirugía cardiaca mayor. De estos, 16.863 procedimientos fueron realizados con circulación extracorpórea, 17.616 fueron de enfermedad adquirida y 1.613 de enfermedad congénita. Además, se registraron 2.637 intervenciones de cirugía vascular periférica.Como en años previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro. Dentro de los diferentes apartados de cirugía cardiaca mayor se realizaron: 7.673 procedimientos de cirugía valvular aislada, 1.523 de cirugía valvular combinada, 4.287 procedimientos de revascularización, 2159 de cirugía de aorta y 654 procedimientos de válvulas transcatéter. En comparación con 2020, observamos un aumento generalizado de la actividad, que fue de 7,9% con respecto de dicho año previo, pero con una reducción de más del 12% con respecto de la media de los 9 años anteriores (2012-2020). This report provides the data corresponding to the cardiovascular surgery activity performed in Spain during 2021. The Spanish Registry is an anonymous and voluntary registry of aggregated data in which hospitals in the national territory have taken part, transferring their data to the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE). For the thirty-third consecutive year, the national activity data is reported. The 2021 registry may be of some value for analyzing the possible recovery of the cardiac surgery activity after the SARS-CoV2 pandemic in our country.In 2021, 58 hospitals reported their activity compared to the 60 that shared their data in 2020. In total, 29,319 interventions were performed, with 19,229 major cardiac surgical procedures. Of these, 16,863 procedures were performed with cardiopulmonary bypass, 17,616 were indicated because of acquired disease and 1,613 for congenital disease. In addition, 2,637 peripheral vascular surgical interventions were registered.As in previous years, both congenital heart surgery and heart transplantation activity and outcomes will be reported in separate registries. Within the different types of major cardiac surgical procedures, the following were performed: 7,673 isolated valve procedures, 1,523 combined valve and coronary surgeries, 4,287 coronary revascularization procedures, 2,159 aortic surgeries, and 654 transcatheter valve implantations. Compared to 2020, we observed a general increase in activity, which was 7.9% compared to the previous year, but with a reduction of more than 12% compared to the mean of the previous 9 years (2012-2020).

Evolución de la cirugía urgente en un servicio de cirugía general durante la pandemia de COVID-19 y comparación con una cohorte histórica.

BACKGROUND: Acute care surgery decreased during the first wave of the COVID-19 pandemic. OBJECTIVE: To study the evolution of acute care surgery and its relationship with the pandemic severity. METHOD: Retrospective cohort study which compared patients who underwent acute care surgery during the pandemic to a control group. RESULTS: A total of 660 patients were included (253 in the control group, 67 in the first-wave, 193 in the valley, and 147 in the second wave). The median daily number of acute care surgery procedures was 2 during the control period. This activity decreased during the first wave (1/day), increased during the valley (2/day), and didn't change in the second wave (2/day). Serious complications were more common during the first wave (22.4%). A negative linear correlation was found between the daily number of acute care surgery procedures, number of patients being admitted to the hospital each day and daily number of patients dying because of COVID-19. CONCLUSIONS: Acute care surgery was reduced during the first wave of the COVID-19 pandemic, increased during the valley, and returned to the pre-pandemic level during the second wave. Thus, acute care surgery was related to pandemic severity, with fewer surgeries being performed when the pandemic was more severe.

ANTECEDENTES: La cirugía urgente disminuyó durante la primera ola de la pandemia de COVID-19. OBJETIVO: Estudiar la evolución de la cirugía urgente y su relación con la gravedad de la pandemia. MÉTODO: Estudio de cohortes retrospectivo que compara los pacientes intervenidos de forma urgente durante la pandemia con un grupo control. RESULTADOS: Se incluyeron 660 pacientes (253 en el grupo control, 67 en primera ola de la pandemia, 193 en el periodo valle y 147 en la segunda ola). La mediana del número de cirugías urgentes fue de 2 (intervalo intercuartílico: 1-3) durante el periodo control, disminuyó durante la primera ola (1/día), aumentó durante el valle (2/día) y no se modificó en la segunda ola (2/día). Las complicaciones mayores fueron más comunes durante la primera ola (22.4%). Se encontró una correlación lineal negativa entre el número de procedimientos quirúrgicos urgentes diarios y el número de ingresos hospitalarios y fallecimientos diarios por COVID-19. CONCLUSIONES: La cirugía urgente se redujo durante la primera ola, aumentó durante el periodo valle y volvió a niveles prepandémicos durante la segunda ola. Además, la cirugía urgente se relaciona con la gravedad de la pandemia, ya que se realizaron menos cirugías urgentes durante el periodo de mayor gravedad de la pandemia.

Virtual meetings on morbidity and mortality in Colombia: An exploratory study / Reuniones virtuales de morbilidad y mortalidad en Colombia: un estudio exploratorio

Resumen Introducción: la pandemia por la Covid-19 modificó la educación médica con estrategias apoyadas en plataformas virtuales y en escenarios no convencionales. Un ejemplo de ello son las reuniones de morbilidad y mortalidad (M y M). El objetivo de este estudio es describir las características de las M y M virtuales en las instituciones de práctica de los residentes de cirugía general en Colombia; así como la percepción de los participantes sobre su funcionamiento, comparado con las M y M presenciales o tradicionales. Método: estudio observacional y descriptivo realizado en 21 instituciones hospitalarias de práctica, de 17 programas de cirugía general de Colombia en donde operan M y M virtuales. Se obtuvo información sobre sus objetivos, características operativas y alcances. Con encuestas autodiligenciadas se investigó, además, la percepción de los participantes acerca de su utilidad y funcionamiento, producto del cambio a la virtualidad. Participaron 82 residentes y 65 docentes de diferentes programas de posgrado de cirugía general del país. Resultados: las M y M virtuales se ejecutan en el 53 % de los sitios de práctica de los residentes de Colombia, con el predominio en las instituciones privadas. Si bien hay diferencias en su organización, persiste el modelo tradicional de M y M: objetivos, estructura y alcances. Hay una duración mayor de las reuniones, se realizan en horarios no convencionales, con una percepción de un menor nivel académico. Se respira un menor ambiente de hostilidad con el uso de la virtualidad. Conclusión: las reuniones de morbilidad y mortalidad se realizan en un escenario de virtualidad. Su funcionamiento es similar a las reuniones presenciales y su ejecución ofrece oportunidades de mejora en términos de forma y fondo.

Summary Introduction: The Covid-19 pandemic changed medical education, with strategies supported by virtual platforms and non-conventional scenarios. An example of this is the morbidity and mortality meetings (M&M). The objective of this study is to find the characteristics of virtual M&M meetings in different institutions focused on general surgery resident´s students in Colombia, and how medical residents and professors feel about them compared to the traditional face-to-face meetings. Methodology: This is an observational, and descriptive study in 21 hospital practice institutions of 17 General Surgery programs in Colombia, where virtual M&M operate. Information was obtained on their objectives, operational characteristics and scope. Additionally, in self-completion surveys, the participants' perception about the usefulness and operation was investigated, this, because of the shift to virtuality. There was participation of 82 residents and 65 professors from different postgraduate programs in General Surgery in the country. Results: Virtual M&Ms continue in 53 % of the practice sites, with a predominance in private institutions. There are differences in their organization, although the traditional M&M model persists: objectives, structure, and scope. There is a longer duration of meetings, unconventional schedules and the perception of a reduced academic level. There is an improvement in the hostile environment, within the virtuality. Conclusion: M&Ms have a place in a virtual scenario. Its operation is like face-to-face meetings, and its execution offers opportunities for improvement in terms of form and content.

Retrospective analysis of the one-year surgical deferral of the COVID-19 pandemic.

Introduction: surgical deferral since the beginning of the COVID-19 pandemic represents a risk to the health of patients and a challenge for health institutions. The metric of productivity indicators in the operating room, such as the surgical deferral rate, will provide us with information to plan strategies based on scientific evidence that allow us to improve the quality of care. Objective: to determine the surgical deferral rate during the COVID-19 pandemic. Material and methods: a retrospective, descriptive and cross-sectional study was carried out in which 297 patients whose surgeries were deferred during the period from March 11, 2020 to March 10, 2021 were analyzed. Descriptive statistics were employed, using measures of central tendency and dispersion, simple frequencies and proportions. Additionally, a Pareto diagram was made. The information was processed with SPSS v-25.0. Results: the deferral rate was 7.34%. 20.92% of the causes were attributed to the patient, 31.65% to medical causes and 47.49% logistic-administrative. Conclusion: the established causes of surgical deferral are avoidable and reveal failures in the logistical-administrative processes that require continuous improvement plans. (English) [ FROM AUTHOR] Introducción: el diferimiento quirúrgico desde el inicio de la pandemia COVID-19 representa un riesgo para la salud de los pacientes y un reto para las instituciones sanitarias. La métrica de indicadores de productividad en quirófano, como la tasa de diferimiento quirúrgico, nos brindará información para planear estrategias basadas en evidencia científica que nos permitan mejorar la calidad de la atención. Objetivo: determinar la tasa de diferimiento quirúrgico durante la pandemia COVID-19. Material y métodos: se realizó un estudio, retrospectivo, descriptivo y transversal en el que se analizaron 297 pacientes cuyas cirugías fueron diferidas durante el período comprendido del 11 de marzo de 2020 al 10 de marzo de 2021. Para el análisis de variables se efectuó estadística descriptiva, utilizando medidas de tendencia central y dispersión, frecuencias simples y proporciones. Adicionalmente se realizó un diagrama de Pareto. La información fue procesada con SPSS v-25.0. Resultados: la proporción de diferimiento fue de 7.34%;20.92% de las causas fueron atribuidas al paciente, 31.65% a causas médicas y 47.49% fueron logísticoadministrativas. Conclusión: las causas de diferimiento quirúrgico establecidas son evitables y revelan fracasos en los procesos logístico-administrativos que requieren planes de mejora continua. (Spanish) [ FROM AUTHOR] Copyright of Revista Mexicana de Anestesiologia is the property of Colegio Mexicano de Anestesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Operative autonomy and supervision of the surgical resident: A look at the COVID-19 pandemic / Autonomía y supervisión operatorias del residente de cirugía: Una mirada en la pandemia por COVID-19

Introducción. Al declararse la pandemia por SARS-CoV-2, se establecieron múltiples cambios en los sistemas de salud y en las instituciones hospitalarias, influyendo en la actividad quirúrgica global. El objetivo de este estudio fue evaluar el impacto de la pandemia en los niveles de autonomía y supervisión operatorias de los residentes de cirugía. Métodos. Estudio analítico cuasi-experimental, que incluyó los procedimientos quirúrgicos registrados por residentes de cirugía general de la Universidad de La Sabana, de febrero de 2019 a agosto de 2021. Se analizaron la autonomía y la supervisión mediante la escala Zwisch en los periodos prepandemia y pandemia. Resultados. Se recolectaron datos de 10.618 procedimientos en el periodo establecido, la mayoría realizados con abordaje abierto (57,4 %) y en rotaciones tronculares de cirugía general (65 %). Los procedimientos realizados más frecuentes fueron apendicectomía (18,6 %), colecistectomía (18,4 %) y herniorrafías (8,6 %). Se encontró una disminución estadísticamente significativa en los niveles globales de autonomía y supervisión entre los periodos analizados de 2, 4/4, 0 a 2, 2/4, 0 (p<0,001). Discusión. La disminución en la autonomía percibida por los residentes podría corresponder al impacto negativo en la motivación intrínseca de los individuos, en la disminución objetiva en el logro de las competencias esperadas en su proceso de formación quirúrgica y a la pérdida del relacionamiento colectivo propiciado por los aislamientos y limitaciones vividos. Conclusión. La pandemia por COVID-19 impactó negativamente en la autonomía y supervisión operatoria de los residentes de cirugía general de la Universidad de La Sabana, Chía, Colombia.

Introduction. Changes in health systems and hospital institutions due to the coronavirus pandemic influenced global surgical activity. The objective of this study was to evaluate the impact of the pandemic on the levels of autonomy and supervision in general surgery residents. Methods. Quasi-experimental analytical study. It included the surgical procedures recorded by general surgery residents of the University of La Sabana from February 2019 to August 2021. Autonomy and supervision were analyzed using the Zwisch scale in the pre-pandemic and pandemic periods. Results. 10,618 procedures were collected in the established period. Most surgeries were performed with an open approach (57,4%), in rotations of general surgery (65%). The most frequent procedures performed were appendectomy (18,6%), and cholecystectomy (18,4%), and herniorrhaphy (8,6%). There was a decrease in levels of autonomy and supervision compared between the analyzed periods from 2, 4/4, 0 to 2, 2/4, 0 (p<0.001). Discussion. The decrease in the autonomy perceived by the residents could correspond to the negative impact on the intrinsic motivation of the individuals, a decrease in the achievement of the competencies expected in their surgical training process, and the loss of the collective relationship produced by the isolation and limitations experienced. Conclusion. The COVID-19 pandemic had a negative impact on autonomy and supervision in general surgery residents of the University of La Sabana, Chia, Colombia

Impact of the COVID-19 pandemic on pancreatic surgery. Analysis in a public and a private institution / Impacto de la pandemia COVID-19 en la cirugía pancreática. Análisis en dos instituciones, una pública y otra privada

RESUMEN Antecedentes: la pandemia de COVID-19 ha introducido cambios drásticos en el sistema de salud. Las cirugías electivas son una de las actividades quirúrgicas que más han descendido durante la pandemia. Objetivo: analizar el impacto de la pandemia de COVID-19 en la cirugía pancreática en una institución pública y otra privada. Se comparó, en cada institución, con el número de cirugías en el mismo período del año pasado. Material y métodos: se revisaron en una base prospectiva los pacientes que recibieron una cirugía pancreática en las dos instituciones entre el 10/3/20 y el 24/6/20. Se determinaron los datos epide miológicos, el tipo de resección pancreática, el diagnóstico anatomopatológico, la morbilidad y la mor talidad. Se compararon con los pacientes en ambas instituciones que recibieron cirugía pancreática durante el período 10/3/19 al 24/6/19. Resultados: durante la pandemia se realizaron 23 resecciones pancreáticas (13 duodenopancreatec tomías cefálicas, 9 pancreatectomías izquierdas y 1 pancreatectomía total). El 70% (16/23) fueron adenocarcinomas. La morbilidad alcanzó el 34,7% y no se registró mortalidad. Ningún paciente ni miembro del equipo quirúrgico se infectó con coronavirus. La pandemia no tuvo impacto en el núme ro de cirugías en el centro privado (22 vs. 20, p = 0,88), mientras que en el centro público hubo una reducción significativa en el número de cirugías (14 vs. 3, p = 0,009). Conclusión: la cirugía pancreática se puede hacer con seguridad durante la pandemia. En el centro privado se mantuvo el número de cirugías pancreáticas. En el centro público, con máxima prioridad para pacientes con COVID-19, hubo un descenso significativo.

ABSTRACT Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective surgeries are the surgical activities with greater decline during the pandemic. Objective: The aim of this paper is to analyze the impact of the COVID-19 pandemic in pancreatic sur gery in a public and a private institution. The number of surgeries performed in each institution was compared with those performed in same period of the previous year. Material and methods: Data from a prospective database of all the patients who underwent pancrea tic surgery between March 10, 2020, and June 3, 2020, were analyzed. The epidemiological data, type of pancreatic resection, pathology diagnosis, morbidity and mortality were determined in each insti tution and compared with patients who underwent pancreatic surgery in both institutions between March 3, 2019, and June 24, 2019. Results: 23 pancreatic resections were performed during the pandemic (13 cephalic pancreaticoduo denectomies, 9 left pancreatectomies and 1 total pancreatectomy); 70% (16/23) were adenocarcino mas. There were 34.7% complications and no deaths were reported. None of the patients was infected with coronavirus. The pandemic had no impact on the number of pancreatic resections in the private institution (22 vs. 20, p = 0.88), while the number of pancreatic surgeries was significantly lower in the public center (14 vs. 3, p = 0.009). Conclusion: Pancreatic surgery can be safely performed during the pandemic. The number of pancrea tic surgeries did not decline during the pandemic. The priority for treating patients with COVID-19 at the public center resulted in a significant decrease in pancreatic surgeries.

Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. / Impacto de la pandemia COVID-19 en la cirugía de columna en un centro de segundo nivel.

INTRODUCTION: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.

Risk of thrombosis recurrence among patients with COVID-19 and surgery-associated venous thromboembolism.

INTRODUCTION: Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. METHODS: A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. RESULTS: A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p =  0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p =  0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p =  0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40-2.05). CONCLUSIONS: In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

[Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital.

INTRODUCTION: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.

Limitaciones de los estudiantes en el curso de cirugía de pregrado durante la pandemia de COVID-19.

OBJECTIVE: To know the limitations that the students encountered during the undergraduate surgery course during COVID-19 pandemic. METHOD: Through an online questionnaire, students were asked about the evaluation of the undergraduate surgery course, the limitations encountered during the course, both those perceived by themselves, and the limitations they perceived in teachers. Questions were asked about the total evaluation of the surgery course and the clinical part of the course. RESULTS: 63 students of the subject of surgery were included. The most mentioned limitations of the students were the availability of schedule and teaching material. The most mentioned limitation in relation to the teachers was the lack of technical knowledge. A relationship was found between the evaluation of the course and the interaction between the teacher and the student. CONCLUSIONS: The medical education have undergone great changes, especially the clinical part. There are several limitations in this process that can be improved by teachers and students and the perception of the quality of the course is related to the degree of interaction that teachers had with the students.

OBJETIVO: Conocer las limitaciones que los estudiantes encontraron durante el curso de pregrado de cirugía durante la pandemia de COVID-19. MÉTODO: Mediante un cuestionario en línea, se interrogó a los estudiantes acerca de la evaluación del curso de cirugía de pregrado y las limitaciones encontradas durante el curso, tanto las percibidas por ellos mismos como las que percibieron en sus maestros. Se preguntó acerca de la evaluación total del curso de cirugía y de la parte clínica del curso. RESULTADOS: Se incluyeron 63 estudiantes de la materia de cirugía. Las limitaciones de los estudiantes más mencionadas fueron la disponibilidad de horario y de material didáctico. La limitación más mencionada en relación a los maestros fue la falta de conocimientos técnicos. Se encontró relación entre la evaluación del curso y la interacción que se tuvo entre el maestro y el estudiante. CONCLUSIONES: La educación en medicina ha sufrido grandes cambios, sobre todo la parte clínica. Existen diversas limitaciones en este proceso que pueden mejorarse por parte de maestros y estudiantes, y la percepción de la calidad del curso está relacionada con el grado de interacción que los maestros tuvieron con los estudiantes.

Cirugía bariátrica y metabólica en la crisis COVID-19: estrategias frente a dos pandemias

Tras su aparición en Wuhan a finales de 2019, la pandemia del SARS-CoV-2 ha traído graves consecuencias a nivel mundial, estando España entre los países más afectados. La crisis sanitaria implicó la cancelación de cirugías por patología maligna y benigna, entre estas la cirugía bariátrica y metabólica. Los pacientes con obesidad mórbida, además de verse afectados por el retraso de las intervenciones, son considerados pacientes con riesgo elevado de presentar COVID-19 grave. Es por esto por lo que una vez alcanzada la mejoría de la situación epidemiológica en los diferentes centros y se disponga de los recursos necesarios, debería reiniciarse de forma progresiva esta actividad quirúrgica. Nuestro objetivo es revisar la literatura publicada referente a las principales recomendaciones perioperatorias para realizar cirugía bariátrica y metabólica de forma segura durante la pandemia por COVID-19.Alternate : Since its first appearance in Wuhan at the end of 2019, the SARS-CoV-2 pandemic has brought serious repercussions worldwide, Spain being among the most affected countries. This health crisis resulted in the cancellation of surgeries pertaining to both malignant and benign pathologies, including bariatric and metabolic surgery. Patients with morbid obesity, besides their delay in surgical interventions, are at high risk of contracting severe COVID-19. For this reason, once the epidemiological situation has improved in our hospitals and the necessary resources become again available, this surgical activity should be progressively restarted. The goal of this paper is to review the published literature regarding the main perioperative recommendations concerning safe bariatric and metabolic surgery during the COVID-19 pandemic.

Changing characteristics of emergency surgery during COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. METHODS: Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. RESULTS: One hundred and ninety-three emergency surgeries were analyzed; 106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days; 2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%; 2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%; 2020-24.1%). CONCLUSION: Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

ANTECEDENTES: En otros países, han notado diversos cambios en las características de los pacientes sometidos a cirugía de emergencia durante la pandemia de COVID-19. En México no existe información sobre este tema. MÉTODO: Estudiamos a los trabajadores del gobierno mexicano que requirieron tratamiento quirúrgico de emergencia por el servicio de cirugía general de un Hospital General del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE), durante los periodos de marzo-agosto de 2019 (no expuestos) y marzo-agosto de 2020 (expuestos). El análisis incluyó: datos demográficos, datos de laboratorio, diagnósticos postoperatorios, duración de los síntomas, días de estancia en emergencias y estadía postoperatoria. RESULTADOS: Se analizaron 193 cirugías de emergencia; 106 en 2019 y 87 en 2020 (una disminución del 18%). En la pandemia, el número de días entre el inicio de los síntomas y la cirugía fue mayor: 2019, 7.6 ± 4.6 días; 2020, 14 ± 6.7 días (p < 0.0001). Además, disminuyeron los casos de apendicitis aguda (2019-60,3%; 2020-42,5%) y aumentaron los de colecistitis litiásica aguda (2019-12,2%; 2020-24,1%). CONCLUSIÓN: Durante la pandemia de COVID-19, hubo cambios notables en las características de los trabajadores del gobierno mexicano que ameritaron cirugías de emergencia.

[Evaluation of the effectiveness of the new perioperative model to recover surgical activity during the COVID-19 pandemic]. / Evaluación de la efectividad del nuevo modelo perioperatorio para recuperar la actividad quirúrgica durante la pandemia de COVID-19.

INTRODUCTION: The first wave of the COVID-19 pandemic caused the cancellation of elective interventions. After the improvement of the epidemiological situation, new models of care were applied in hospitals to restart the programmed surgical activity. The aim was to evaluate the effectiveness of the organizational model established to recover surgical activity during the transition period of the COVID-19 pandemic. METHODS: Retrospective observational study comparing patients who underwent schedule surgery from September 1 until October 31, 2020, study group, with a control group of the same period of time corresponding to the year 2019 at the General Hospital from the Vall d'Hebron University Hospital. RESULTS: The total population included 1,825 patients, 888 in the study group and 937 in the control group. Global surgical activity decreased 6.43% during the study period compared to the same period in 2019, with a 25.5% decrease in cancer surgeries. Seven patients became infected with SARS-CoV-2 during their hospital stay. In hospital mortality was 0.9% in the study group compared to 0.7% in control group (p=0.8). The survival rate in cancer patients at 90 days was lower in the study group (95.7% vs 98.7%; p=0.02). CONCLUSIONS: The change in the management model during the transition period of the COVID-19 pandemic allowed the recovery of programmed surgical activity to levels similar to those existing prior to the pandemic with a greater impact on cancer surgery.

Differences in the evolution and management of acute appendicitis in patients with COVID-19: a case-control study.

BACKGROUND: The COVID-19 pandemic has generated uncertainty about the management of appendicitis. AIM: The aim of this study was to evaluate differences in the evolution and treatment of acute appendicitis in patients with COVID-19 infection compared to patients without the infection. METHODS: A case-control study of adult patients hospitalized for acute appendicitis was performed, having as cases those who presented COVID-19. Data were extracted from the medical records. The logistic regression model was used to calculate crude (cOR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals (95% CI). RESULTS: We evaluated 38 cases and 76 controls, the mean age of the patients was 38.2 years (± 16.8), of whom 55.3% were women. Multivariate analysis showed, in cases, a lower probability of intraoperative findings (aOR: 0.21; 95% CI: 0.05-0.90) and a surgery time of more than 60 min (aOR: 0.21; 95% CI: 0.06-0.80), while there was a greater probability of management by open surgery (aOR: 3.83; 95% CI: 1.42-10.32) and a hospitalization time of more than 3 days after surgery (aOR: 3.33; 95% CI: 1.34-8.26). CONCLUSION: Significant differences were observed in terms of intraoperative findings, type of surgery, intraoperative time, and hospitalization time in patients with acute appendicitis and COVID-19.

ANTECEDENTES: La pandemia de COVID-19 ha generado incertidumbre sobre el manejo de la apendicitis. OBJETIVO: Evaluar las diferencias en la evolución y el tratamiento de la apendicitis en pacientes con COVID-19 en comparación con los pacientes sin la infección. MÉTODOS: Se realizó un estudio de casos y controles de pacientes adultos hospitalizados por apendicitis aguda, teniendo como casos aquellos que presentaron COVID-19. Los datos se extrajeron de las historias clínicas. Se utilizó el modelo de regresión logística para calcular las odds ratios (OR) crudas y ajustadas con sus respectivos intervalos de confianza del 95% (IC 95%). RESULTADOS: Se evaluaron 38 casos y 76 controles, la edad media de los pacientes fue de 38.2 años (± 16.8), de los cuales el 55,3% eran mujeres. El análisis multivariante mostró, en los casos, una menor probabilidad de hallazgos intra operatorios (ORa: 0,21; IC 95%: 0.05-0.90) y un tiempo de cirugía superior a 60 min (ORa: 0.21; IC 95%: 0.06-0.80), mientras que hubo una mayor probabilidad de manejo mediante cirugía abierta (ORa: 3.83; IC 95%: 1.42-10.32) y un tiempo de hospitalización superior a tres días tras la cirugía (ORa: 3.33; IC 95%: 1.34-8.26). CONCLUSIONES: Se observaron diferencias significativas en cuanto a los hallazgos intraoperatorios, el tipo de cirugía, el tiempo intraoperatorio y el tiempo de hospitalización en pacientes con apendicitis aguda y COVID-19.

Selección de lo mejor del año 2022 en cardiopatías congénitas

Resumen En este artículo se muestran las publicaciones que se han considerado más relevantes sobre cardiopatías congénitas en el último año. En el campo del intervencionismo se comentarán las principales novedades publicadas en las últimas guías de 2021, así como algunos artículos interesantes sobre la implementación de materiales y técnicas en el tratamiento percutáneo de lesiones cardiacas congénitas. En cuanto a la imagen se centrará en los artículos relacionados con el revolucionario avance de la 4D-RMN y el eco 3D en el estudio de las cardiopatías congénitas. Existen estudios interesantes en cuanto al síndrome infamatorio multisistémico pediátrico vinculado al SARS-CoV-2 (MIS-C) y también en el ámbito de la miocardiopatía hipertrófica en edad infantil. En cuanto a la cirugía en esta franja de edad se ha considerado interesante comentar un estudio en relación con la técnica híbrida de tratamiento del ventrículo izquierdo hipoplásico. Por último, en esta ocasión en lo referente a las arritmias en las cardiopatías congénitas, la atención se centra en la fibrilación auricular, por las peculiaridades existentes en este tipo de pacientes. This paper shows a selection of the most relevant articles in congenital heart diseases in the last year. About intervencional procedures, we comment the latest guidelines in 2021, as well as some interesting papers on the implementation of materials and techniques in the field of percutaneous treatment of congenital heart diseases. In cardiac imaging, we focus on articles related to the revolutionary advance of 4D-NMR and 3D echo in the study of these congenital diseases. Respect pediatrics, there are interesting studies about multisystem inflammatory syndrome linked to SARS-CoV-2 (MIS-C) and also in the field of hypertrophic cardiomyopathy. Related to surgery, we comment the hybrid technique for treating hypoplastic left ventricle. Finally, regarding arrhythmias in congenital heart disease, we focus our attention on atrial fibrillation, due to the peculiarities that exist in this type of patients.

Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic.

INTRODUCTION: During the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. METHODS: Retrospective manual chart review and data collection of patients' charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. RESULTS: A total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. CONCLUSIONS: It is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

Evolutionary analysis of patient's morbidity and mortality in emergency surgical care during the pandemic: Retrospective comparison between first and second waves of COVID-19.

INTRODUCTION: Since the beginning of the pandemic, morbidity and mortality in emergency care of surgical patients have been the subject of several studies. However, most of these have compared this variable with that of the pre-COVID period, ignoring its evolution during the pandemic itself. In order to analyze this possible change, we performed a comparative study of morbidity and mortality in emergency surgery between the first and second waves of the pandemic in our center. METHODS: Retrospective longitudinal study including all patients over the age of 18 admitted and/or operated in the emergency setting in the two maximum incidence periods (MIP) of COVID-19 infection (1st MIP: 22/03/2020-31/05/2020; 2nd MIP: 26/08/2020-30/11/2020). The incidence of SARS-CoV-2 infection, treatment received, early morbidity and mortality and possible risk factors for complications were analyzed. RESULTS: A total of 173 patients were analyzed (1st MIP: 66; 2nd MIP: 107). The incidence of COVID-19 was higher in the second period (14.95% vs. 4.54%). SARS-CoV-2 infection was associated with a higher rate of complications; however, no statistically significant differences were observed in morbimortality rate, either in the total sample (P = .746) or in patients with a positive COVID-19 test (P = .582) between both periods. Surgical treatment was found to be associated with a lower complication rate in both the first (P = .006) and second waves (P = .014), and it was more frequent in the second MIP (70.1% vs 57.6%), although statistical significance was not reached (P = .065). CONCLUSIONS: No significant differences were observed in morbidity and mortality of patients admitted and/or operated in the emergency setting in the two periods of maximum incidence of SARS-CoV-2 at our center. Surgical treatment was associated with lower morbidity and mortality rates, and it was more frequent in the second MIP.