Eficacia y eficiencia de un programa especial para la disminución de la lista de espera de cirugía bariátrica en un hospital terciario / Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital

Introducción: La cirugía bariátrica es uno de los procedimientos quirúrgicos más realizados en España, sin embargo actualmente es la cirugía con mayor demora en la lista de espera quirúrgica (LEQ). Para disminuir la LEQ se pone en marcha un programa especial de autoconcertación, y se quiere valorar su utilidad, estudiando las repercusiones clínicas y económicas en una unidad de alto volumen de cirugía bariátrica. Métodos: Se realizó un estudio prospectivo de 3 meses comparando evolución, resultados y consumo de recursos perioperatorios de 45 pacientes operados de cirugía bariátrica, divididos en 2 grupos, pacientes operados en quirófano de forma estándar y pacientes operados en programación especial. Se tuvieron en cuenta factores epidemiológicos, asistenciales y económicos. Resultados: Se operaron 2 grupos homogéneos de pacientes, reduciendo con éxito la LEQ. La morbilidad fue similar en ambos grupos y el coste medio de las cirugías realizadas fue de 5.331,4euros, 5372,5±798,1euros para el grupo estándar y 5.290,3±685,1euros para el grupo de programación especial, sin diferencias significativas. Conclusiones: En centros hospitalarios donde se realiza alto volumen de cirugía bariátrica es factible incorporar programas especiales quirúrgicos que permiten la reducción en la demora de las listas de espera quirúrgica, manteniendo los criterios de calidad y sin suponer un mayor gasto al sistema sanitario. (AU)

Introduction: Bariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. Methods: A three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. Results: Two homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. Conclusions: In hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system. (AU)

Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital. / Eficacia y eficiencia de un programa especial para la disminución de la lista de espera de cirugía bariátrica en un hospital terciario.

INTRODUCTION: Bariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. METHODS: A three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. RESULTS: Two homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. CONCLUSIONS: In hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system.

Shortening of the Common Channel as a Rescue Surgery After Gastric Bypass Failure.

BACKGROUND: After Roux-en-Y gastric bypass (RYGB), up to 30% failures in weight loss have been reported. Among multiple solutions available, we report our experience with shortening of the common channel (SCC) by performing a limb distalization of the alimentary or the biliopancreatic limb. SETTINGS: University Hospital. METHODS: We reviewed data from 23 patients that underwent limb distalization between 2001 and 2019 due to inadequate weight loss after an initial RYGB in our center. All patients who failed to achieve an excess weight loss reduction of > 50% or maintained a body mass index (BMI) above 35 kg/m2 were included. Multiple variables were analyzed during the follow-up at five time points: initial, after RYGB, before SCC, after SCC, and current. RESULTS: The mean BMI prior to the RYGB was 51.8 kg/m2, after RYGB was 37.6 kg/m2, before SCC was 43.6 kg/m2, after SCC was 36.1 kg/m2, and the final BMI was 36.3 kg/m2. No morbidity was seen after SCC. Long-term associated nutritional deficiencies were only identified in 3 patients which had iron deficiency and 1 patient with vitamin D deficiency. Patients with associated comorbidities significantly improved or were withdrawn from medications after the RYGB, with minor variations after SCC. CONCLUSIONS: Limb distalization with SCC is a safe and effective technique for patients who failed to achieve an adequate weight loss after RYGB. There is a slight increase in excess of weight loss after the SCC compared with RYGB. In addition, no further weight regain was documented.

Correlation between the Bethesda system for thyroid nodules and post-thyroidectomy histopathological diagnosis / Correlación entre el sistema Bethesda de nódulos tiroideos y el diagnóstico histopatológico postiroidectomía

BACKGROUND: Thyroid nodules are a common clinical condition. Thyroid nodules may be identified with ultrasonography in roughly 50% of the population. The risk of malignancy varies between 4 and 15% of the nodules. Fine needle aspiration (FNA) with a cytopathology report using the Bethesda system is the most utilized methods to diagnose thyroid carcinoma. MATERIAL AND MEHOTDS: A retrospective, descriptive study was performed to investigate the correlation between the cytopathology of the FNA biopsies, and the final histopathology after thyroidectomy. RESULTS: A total of 128 nodules in 128 patients were studied; 24 males and 104 females. In the Bethesda category I, a 67% malignancy rate was reported, Bethesda II 14%, Bethesda III 28% for follicular lesions and 15% for atypia, Bethesda IV 36%, Bethesda V 79% and Bethesda VI 100%. CONCLUSION: The Bethesda system has been widely adopted internationally and has become an unassailable tool for the pathologist and clinicians for the evaluation and management of thyroid nodules. Since its implementation in the ABC Medical Center, the Bethesda system has granted the institution with favorable and reproducible results.

INTRODUCCIÓN: En la población general, los nódulos tiroideos representan una causa común de consulta al especialista; en poblaciones aleatorizadas, con el uso del ultrasonido se pueden observar hasta en un 50% de los pacientes. El nódulo tiroideo tiene un riesgo de malignidad del 4-15%. El método citopatológico más utilizado para el diagnóstico del cáncer tiroideo es la toma de biopsia por aspiración con aguja fina (BAAF) de los nódulos tiroideos y la utilización del sistema Bethesda para su reporte citopatológico. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo comparando los porcentajes de malignidad entre las piezas quirúrgicas y el reporte citopatológico de las BAAF utilizando el sistema Bethesda 2010. RESULTADOS: Se estudiaron 128 nódulos en 128 pacientes. En los nódulos Bethesda I se reportó un 67% de malignidad en la histopatología final; en los Bethesda II, un 14%,; en los Bethesda III, un 28% para atipia y un 15% para lesiones foliculares; en los Bethesda IV, un 36%; en los Bethesda V, un 79%; y en los Bethesda VI, un 100%. CONCLUSIÓN: El sistema Bethesda es una herramienta disponible y de gran utilidad para el patólogo y el clínico. Desde su implementación en el Centro Médico ABC ha demostrado ser comparable con los resultados reportados en la literatura internacional.