ABSTRACT
INTRODUCTION: The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial. METHODS: Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence with 22 individual components of ERAS pathways were assessed in all patients, regardless of whether they were treated in a self-designed ERAS centre. Each centre had a three-month recruitment period between October 2019 and September 2020. The primary outcome was moderate-to-severe postoperative complications within 30 days after surgery. Secondary outcomes were overall postoperative complications, adherence to the ERAS pathway, 30 day-mortality and hospital length of stay (LOS). RESULTS: A total of 743 patients in 72 Spanish hospitals were included, 211 of them (28.4 %) from self-declared ERAS centres. A total of 245 patients (33 %) experienced postoperative complications, graded as moderate-to-severe complications in 172 patients (23.1 %). There were no differences in the incidence of moderate-to-severe complications (22.3% vs. 23.5%; OR, 0.92 (95% CI, 0.59 to 1.41); P = 0.068), or overall postoperative complications between the self-declared ERAS and non-ERAS groups (33.6% vs. 32.7%; OR, 1.05 (95 % CI, 0.70 to 1.56); P = 0.825). The overall rate of adherence to the ERAS pathway was 52% [IQR 45 to 60]. There were no differences in postoperative outcomes between higher (Q1, > 60 %) and lower (Q4, ≤ 45 %) ERAS adherence quartiles. CONCLUSIONS: Neither the partial application of perioperative ERAS measures nor treatment in self-designated ERAS centres improved postoperative outcomes in patients undergoing gastric surgery for cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03865810.
Subject(s)
Enhanced Recovery After Surgery , Stomach Neoplasms , Adult , Humans , Perioperative Care , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Stomach Neoplasms/surgery , Stomach Neoplasms/complicationsABSTRACT
Una de las principales causas de morbimortalidad en la mujer gestante es el sangrado que se produce tras el parto. La hemorragia posparto tardía (HPT) es aquel sangrado excesivo que se produce entre las 24 h posteriores al parto y las 12 semanas. Sus causas son multifactoriales y, aunque con frecuencia no compromete la vida de la paciente, puede llegar a hacerlo. Una vez diagnosticada, es necesario un tratamiento rápido y multidisciplinar, restaurando el volumen y monitorizando la respuesta al tratamiento. Presentamos el caso de una paciente que sufrió una HPT en la que se objetivó, tras ser transfundida, la persistencia de anemia mediante determinación de hemoglobina total continua utilizando un cooxímetro de pulso, iniciando la reposición de volumen y hemoderivados ayudados por dicha tecnología. El cuadro se resuelve tras suturar en quirófano un seudoaneurisma de la arteria uterina izquierda responsable de la hemorragia, evolucionando la paciente satisfactoriamente (AU)
One of the major causes of morbidity and mortality in pregnant women is bleeding after childbirth. Secondary postpartum hemorrhage consists of excessive bleeding occurring between 24 hours and 12 weeks after delivery. Its causes are multifactorial and, although it is rarely life threatening, serious risks may arise. When diagnosed, rapid multidisciplinary treatment is necessary to restore blood volume and monitor treatment response. We report the case of a patient who developed secondary postpartum hemorrhage. After transfusion, determination of continuous total haemoglobin by pulse co-oximetry revealed persistent anemia. Consequently, blood volume replacement was initiated. The case was resolved after surgical suturing of a pseudoaneurysm of the left uterine artery, which had caused the bleeding. The patient subsequently made a good recovery (AU)
