ABSTRACT
Introducción Analizar la efectividad y calidad de la colecistectomía laparoscópica en régimen ambulatorio (CLCMA) frente al manejo convencional de la colecistectomía laparoscópica con estancia (CLEST).Material y métodos Estudio retrospectivo donde se analizan todos los pacientes ASA I-II, durante 6 años, intervenidos mediante colecistectomía laparoscópica (CL). Se establecen 2 cohortes de pacientes: grupo CLCMA (n = 141 pacientes) y grupo CLEST (n = 286 pacientes).La efectividad se analizó evaluando morbimortalidad, reintervenciones, reingresos y estancia. El análisis de calidad del grupo CLCMA se realizó mediante encuestas de satisfacción y posterior valoración mediante indicadores de satisfacción. Resultados No existieron diferencias estadísticamente significativas entre ambos grupos (CLEST vs CLCMA) en morbilidad (5,24 vs 4,26), reintervenciones (2,45 vs 1,42) ni en reingresos (1,40 vs 3,55). No hubo mortalidad postoperatoria. El 82% de los pacientes del grupo CLCMA fueron alta el mismo día de la intervención, siendo la estancia media de este grupo 1,16 días, mientras que en el grupo CLEST fue de 2,94 días (p = 0,003). El índice de satisfacción global fue de un 82% y el indicador de satisfacción de la asistencia recibida fue del 81%, ambos por encima del estándar previamente fijado. Conclusiones La CLCMA es tan efectiva y segura como la CLEST programada, con un buen nivel de calidad percibida (AU)
Introduction To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST).Material and methods A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients).The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. Results There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. Conclusions CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality (AU)
Subject(s)
Humans , Cholecystectomy/methods , Cholelithiasis/surgery , Cholecystectomy, Laparoscopic/methods , Retrospective Studies , Laparoscopy/methods , Ambulatory Surgical Procedures/methodsABSTRACT
INTRODUCTION: To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST). MATERIAL AND METHODS: A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients). The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. RESULTS: There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. CONCLUSIONS: CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality.
Subject(s)
Ambulatory Surgical Procedures , Cholecystectomy, Laparoscopic/methods , Hospitalization , Adult , Aged , Aged, 80 and over , Clinical Protocols , Female , Humans , Male , Middle Aged , Patient Satisfaction , Quality of Health Care , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
Introducción El objetivo del estudio es analizar la fiabilidad de la colecistectomía laparoscópica (CL) realizada en el ámbito de cirugía mayor ambulatoria (CMA) para generalizar su uso y conseguir una mejor gestión de los recursos sanitarios. Material y método Estudio retrospectivo en el que se analizan 110 pacientes intervenidos de CL entre septiembre de 2004 y noviembre de 2008. Los criterios de selección fueron ausencia de cirugía abdominal supramesocólica previa, ausencia de ingresos previos por colecistitis aguda, ausencia de litiasis en la vía biliar principal y pruebas de función hepática normales, ausencia de ingesta de anticoagulantes orales o antiagregantes plaquetarios y clasificación I y II de la American Society of Anesthesiologists. Todos los pacientes fuern intervenidos bajo el protocolo de CMA previamente establecido. Resultados Se intervino a 81 mujeres y 29 varones, con una media de edad de 51,03 años (rango: 2477). Cincuenta y siete pacientes presentaban antecedentes médicos o quirúrgicos. Resultados La morbilidad general fue del 6,36% con una mortalidad del 0%. La tasa de conversión fue del 0,9%. Ochenta y siete pacientes (79,1%) fueron dados de alta a las 6h de la intervención, cumpliendo así el régimen de CMA. La estancia hospitalaria global media fue de 1,49 días (mediana 0). La tasa de reintervenciones fue del 1,81% y la tasa de reingresos tras el alta fue del 0,9%.ConclusionesLa realización de CL en CMA es factible y segura. Debería estar integrada en la actividad de las unidades de CMA, siempre que exista una correcta selección de los pacientes y un especial interés por parte de los cirujanos que la realicen (AU)
Introduction The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. Material and method Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. Results The patients included 81 women and 29 men, with a mean age of 51.03 years (range 2477), of which 57 had a medical and / or surgical history. Results The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was0.9%.ConclusionsThe performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it (AU)
Subject(s)
Humans , Hospitals, Community , Outcome Assessment, Health Care , Ambulatory Surgical Procedures/methods , Cholecystectomy, Laparoscopic/methods , SpainABSTRACT
INTRODUCTION: The aim of our study was to analyze the reliability of laparoscopic cholecystectomy (LC) in an Ambulatory Surgery unit, in order to encourage its use and achieve better management of health resources. MATERIAL AND METHOD: Retrospective study of 110 patients operated on for LC between September 2004 and November 2008. The selection criteria were: absence of prior supramesocolic abdominal surgery, no previous admission for acute cholecystitis, absence of stones in the bile ducts and normal liver function tests, no intake of oral anticoagulants or antiplatelet agents and ASA I-II. All patients were operated using a previously established Major Ambulatory Surgery (MAS) protocol. RESULTS: The patients included 81 women and 29 men, with a mean age of 51.03 years (range 24-77), of which 57 had a medical and / or surgical history. The overall morbidity was 6.36% with a mortality of 0%. The conversion rate was 0.9%. A total of 87 patients (79.1%) were discharged at 6h after surgery, thus fulfilling the criteria of the MAS system. The mean overall hospital stay was 1.49 days (median 0). The reoperation rate WAS 1.81% and the rate of readmission after discharge was 0.9%. CONCLUSIONS: The performance of outpatient laparoscopic cholecystectomy is feasible and safe. It should be integrated into the activities of Major Ambulatory Surgery, ensuring careful selection of patients and interest by surgeon who performs it.
Subject(s)
Ambulatory Surgical Procedures/methods , Cholecystectomy, Laparoscopic/methods , Hospitals, Community , Outcome Assessment, Health Care , Adult , Aged , Female , Humans , Male , Middle Aged , SpainABSTRACT
BACKGROUND: Despite the increasing use of breast-conserving therapy, modified radical mastectomy retains an important role in primary as well as in salvage treatment of breast cancer. Nevertheless, a significant number of patients will eventually develop a local recurrence (LR). AIMS: To identify the potential prognostic factors at the time of the first isolated LR, and to compare the expression of several parameters of the molecular biology of breast carcinomas by primary tumors and paired isolated LRs. METHODS: We analyzed the medical records from 1,087 women who underwent mastectomy for breast cancer, out of which 98 developed LRs as the first manifestation of tumor progression. We investigated the prognostic value of various classical prognostic factors, at the time of mastectomy as well as when the diagnosis of LR was made. In addition, by using tissue microarrays and immunohistochemical techniques, we analyzed the expression of estrogen (ER), progesterone (PR) and androgen receptors (AR), ki67, p53, c-erbB-2 and apolipoprotein D in primary tumors and paired isolated LRs from a subset of patients (n = 25). RESULTS: Patients who developed distant metastases as well as patients with local recurrent disease showed a significantly higher percentage of larger tumors, node-positive status and higher tumoral grade than patients without evidence of tumoral recurrence. Furthermore, patients with LR had a better outcome compared with those with distant metastases, although the former received less frequently adjuvant systemic therapy and/or radiotherapy. Tumor size, histological grade, ER and PR status, and a shorter disease-free interval (<12 months) were significantly associated with overall survival amongst mastectomized patients that developed isolated LR. There was a significant concordance between primary tumors and LRs regarding the expression of the following factors: ER, PR and p53. However, we were not able to demonstrate similar findings for AR, c-erbB-2 and ki67. In addition, ER, PR and p53 status in the LRs were significantly associated with a poorer overall survival. CONCLUSIONS: Based on classical clinicopathological factors as well as on some new biological parameters we have been able to identify subgroups of mastectomized patients with LR differing in their prognosis. Thus, at the present time it would be possible to select group of patients candidates for further and individualized therapeutic strategies.
