ABSTRACT
PURPOSE: The aim of this study was to see whether the application of the enhanced recovery programme for colorectal resection improves the results and, in turn, the influence of complexity and size of the hospitals in applying this and its results. METHODS: A multi-centric prospective study was controlled with a retrospective group. The prospective operation group included 300 patients with elective colorectal resection due to cancer. The centres were divided depending on size and complexity in large reference centres (group 1) and area and basic general hospitals (group 2). The retrospective control group included 201 patients with the same characteristics attended before the application of the programme. Completion of categories of the protocol, complications, perioperative mortality and stay in hospital were recorded. RESULTS: The introduction of the programme achieved a reduction in mortality (1 vs. 4 %), morbidity (26 vs. 39 %) and preoperative (<24 h vs. 3 days) and postoperative (7 vs. 11 days) stays (p < 0.01). There was greater fulfilment of protocol in group 2 with the mean number of items completed at 8.46 and 60 % completed compared with the hospitals in group 1 (7.70 completed items and 55 % completion). The size of the hospital had no relation to the rate of complications (21.3 vs. 26.5 %). In smaller sized and less complex hospitals, the average length of stay was 1.88 days less than in those of greater size (6.45 vs. 8.33 days). CONCLUSION: Patients treated according to an enhanced recovery programme develop significantly fewer complications and have a shorter hospital stay. The carrying out of protocol is greater in smaller and less complex hospitals and is directly related to a shorter stay in hospital.
Subject(s)
Colorectal Surgery/statistics & numerical data , Health Facility Size/statistics & numerical data , Recovery of Function , Aged , Female , Guideline Adherence , Humans , Length of Stay , Male , Prospective Studies , Retrospective StudiesABSTRACT
Introducción: En el presente artículo analizamos los resultados y complicaciones de la colecistectomía laparoscópica en octogenarios. Pacientes y método: Estudio retrospectivo sobre pacientes con edad ≥80 años, sometidos a una colecistectomía laparoscópica entre enero de 2002 y agosto de 2007. Los parámetros analizados fueron: presentación, estado general, riesgo anestésico, tasa de conversión, morbilidad y estancia hospitalaria. Se realizó una comparación con pacientes geriátricos de entre 70 y 79 años. Para el análisis estadístico utilizamos la prueba de la χ2 y la t de Student. La significación se estableció para valores de p<0,05. Resultados: Se intervino a 64 pacientes (el 63%, mujeres), con una media de edad de 83,7 años. La cirugía fue programada en 40 (62,5%) casos y urgente en 24. La tasa de conversión fue del 10,9% y la media de estancia hospitalaria, 3,9 días. Dos enfermos fueron reoperados y hubo dos decesos. Conclusiones: La colecistectomía laparoscópica es la técnica de elección para el tratamiento de la colelitiasis sintomática en octogenarios. La colecistitis aguda del anciano debe ser tratada mediante abordaje laparoscópico, salvo contraindicación, preferentemente antes de que aparezcan complicaciones (AU)
Introduction: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. Patients and method: Retrospective study in patients older than 80 years, who underwent laparoscopic cholecystectomy between January 2002 and August 2007. Variables analysed were presentation, physical condition, anaesthetic risk, conversion rate, morbidity and hospital stay. A comparison was made with patients aged between 70 and 79 years old. The χ2 and Student's t tests were used for statistical analysis. The level of significance was defined as a p value less than 0.05. Results: A total of 64 patients were operated on, of which 39 (63%) were women and 25 men, with a mean age 83.7 years. Surgery was scheduled in 40 (62.5%) cases and urgent in 24 cases. The conversion rate to open cholecystectomy was 10.9% and the average hospital stay was 3.9 days. Two patients required re-intervention and two patients died. Conclusions: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in octogenarians. The laparoscopic approach should be considered for the management of acute cholecystitis in the very old (except where contraindicated) before the development of complications (AU)
Subject(s)
Humans , Female , Male , Middle Aged , Aged , Cholecystectomy, Laparoscopic/instrumentation , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/epidemiology , Cholelithiasis/surgery , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Intraoperative Complications/epidemiology , Intraoperative Complications/surgery , Cholecystectomy, Laparoscopic/trends , Cholecystectomy, Laparoscopic , Cholelithiasis/complications , Retrospective Studies , /instrumentation , /methods , Postoperative Complications/epidemiology , Postoperative Complications/surgeryABSTRACT
INTRODUCTION: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. PATIENTS AND METHOD: Retrospective study in patients older than 80 years, who underwent laparoscopic cholecystectomy between January 2002 and August 2007. Variables analysed were presentation, physical condition, anaesthetic risk, conversion rate, morbidity and hospital stay. A comparison was made with patients aged between 70 and 79 years old. The chi(2) and Student's t tests were used for statistical analysis. The level of significance was defined as a p value less than 0.05. RESULTS: A total of 64 patients were operated on, of which 39 (63%) were women and 25 men, with a mean age 83.7 years. Surgery was scheduled in 40 (62.5%) cases and urgent in 24 cases. The conversion rate to open cholecystectomy was 10.9% and the average hospital stay was 3.9 days. Two patients required re-intervention and two patients died. CONCLUSIONS: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in octogenarians. The laparoscopic approach should be considered for the management of acute cholecystitis in the very old (except where contraindicated) before the development of complications.
Subject(s)
Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Age Factors , Aged, 80 and over , Cholecystectomy, Laparoscopic/adverse effects , Female , Humans , Male , Retrospective StudiesABSTRACT
Objetivo: analizar las complicaciones y resultados de la esclerosis y la esclero-microcirugía en el tratamiento estético de las varices en las extremidades inferiores. Método: Se realizó un estudio prospectivo, observacional y no randomizado a pacientes sometidos a esclerosis de varices entre enero de 2001 y enero de 2006. el esclerosante elegido fue polidocanol y la técnica francesa. Como técnicas quirúrgicas complementarias se practicaron desconexiones selectivas y flebectomías. Se registraron todas las complicaciones y se valoró estéticamente el resultado final, por el paciente y el facultativo, mediante una escala subjetiva. Resultados: Fueron tratados 141 pacientes, 95 mediante esclerosis pura y 46 con esclero-microcirugía, todos del sexo femenino, con una edad media de 41.5 años. En un 42% de los casos habían recibido terapia hormonal anticonceptiva o sustitutiva y un 325 tratamiento previo de sus varices. El número medio de sesiones fue de 5 (máximo 21). La complicación más frecuente fue la presencia de tenues hiperpigmentaciones postesclerosis (16%). Se revisó a los enfermos dos meses después de la finalización de la terapia. Los resultados fueron buenos o muy buenos para un 94% de los pacientes encuestados. Durante el seguimiento a largo plazo un 24% presentaron recidivas varicosas subsidiarias de un nuevo tratamiento. conclusiones: La esclerosis, con o sin microcirugía, es un buen tratatmiento estético para las varices conexcelente tolerancia y baja morbilidad
Objective: To analyse complications and results of sclerotherapy and sclero-microsurgery in the cosmetic varicose veins treatment placed on lower limbs. Method: We made a prospective, observational and non-randomised study addressed to patients submitted to sclerotherapy for varicose veins between January 2001 and January 2006. We choose polydocanol as sclerosant and the French technique. the complementary surgical tecniques were selective disconnections and phlebectomies. all complications were recorded and the final outcome was evaluated in aesthetic terms by both, patients and clinician through a subjective rating scale. Results: A total of 141 patients were treated, 95 by means of pure sclerotherapy and 46 with microsurgery. all of them were female patients with a mean age of 41.5 years, 42% of whom had received contraceptive or replacement hormonetherapy and another 32% had already been treated for varicose veins. The average number of sclerotherapy sessions was 5 (with a maximum of 21). the most frequent complication was the presence of faint hyperpigmentation following sclerotherapy (16%). Patients were reviewed two months after therapy had finished. Results were good or very good in 94% of the patients surveyed. During the long term follow-up 24%presented recurrent varicose veins that could benefit from renewed treatment. Conclusions: Sclerotherapy, with or without microsurgery, is good cosmetic therapy for varicose veins with high tolerance and low morbidity rates
Subject(s)
Female , Adult , Aged , Adolescent , Middle Aged , Humans , Varicose Veins/therapy , Sclerosing Solutions/administration & dosage , Microsurgery/methods , Telangiectasis/therapy , BandagesABSTRACT
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