Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey.

BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Programa de Reducción de la Infección Quirúrgica del Observatorio de Infección en Cirugía (PRIQ-O). Documento de priorización y consenso Delphi de recomendaciones para la prevención de la infección de localización quirúrgica / Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection

La infección de localización quirúrgica es la complicación más frecuente y más evitable de la cirugía, pero las guías clínicas para su prevención tienen un seguimiento insuficiente. Presentamos los resultados de un consenso Delphi realizado por un panel de expertos de 17 sociedades científicas con revisión crítica de la evidencia científica y guías internacionales, para seleccionar las medidas con mayor grado de evidencia y facilitar su implementación. Se revisaron 40 medidas y se emitieron 53 recomendaciones. Se priorizan 10 medidas principales para su inclusión en bundles de prevención: ducha preoperatoria; correcta higiene quirúrgica de manos; no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica; profilaxis antibiótica sistémica adecuada; uso de abordajes mínimamente invasivos; descontaminación de la piel con soluciones alcohólicas; mantenimiento de la normotermia; protectores-retractores plásticos de herida; cambio de guantes intraoperatorio, y cambio de material quirúrgico y auxiliar antes del cierre de las heridas. (AU)

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure. (AU)

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection.

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Validation of prolonged length of stay as a reliable measure of failure to rescue in colorectal surgery.

BACKGROUND: Failure-to-rescue measures a hospital's response capacity to avoid the death of a patient after a complication. The aim of this study was to validate the use of prolonged length of stay to calculate failure-to-rescue rates as a substitute for traditional coding of complications in colorectal cancer surgery. METHOD: We performed a cross-sectional between-instruments agreement study. Our study population was comprised of 204 colorectal cancer surgical patients from a public academic hospital during 2017 and 2018. We obtained two failure-to-rescue indicators from administrative data: an indicator using International Classification of Diseases, tenth edition, (ICD-10) codes; and another one using a cut-off point of prolonged length of stay as a predictor of patients with complications. Then, they were compared with a reference indicator from clinical records. RESULTS: Failure-to-rescue rates were between 10 and 13.64 for the study site depending on which indicator was used. A hospital stay ≥10 days had the maximum Youden's index (0.6) and an area under the ROC curve of 0.87. This was used in the failure-to-rescue indicator using prolonged length, which obtained the highest agreement (any coefficient >0.75). CONCLUSION: ICD-10 codes identified complications poorly. Prolonged length of stay could be a valid replacement of ICD-10 codes when measuring failure-to-rescue in administrative databases for colorectal surgical patients.

Patient satisfaction, an indicator to consider in the colorectal cancer process.

Colorectal cancer (CRC) is one of the most relevant diseases worldwide because of its incidence, prevalence and mortalitye. It is the third most common tumor in men, after lung and prostate cancer, and the second most common tumor in women, after breast cancer. A recent systematic analysis showed global data referring to age-standardized incidence rates for CRC, which increased by 9.5% from 1990 to 2017, whereas mortality rates decreased by 13.5%. This might be due to the introduction of CRC prevention programs, which facilitate early identification and higher survival chances.

La satisfacción del paciente, un indicador a considerar en el proceso del cáncer colorrectal / Patient satisfaction, an indicator to consider in the colorectal cancer process

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¿Es la colecistectomía el tratamiento de elección en la colecistitis aguda alitiásica? Revisión sistemática de la literatura / Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature

Introducción y objetivos: actualmente no existe consenso entre colecistectomía o colecistostomía percutánea como elección terapéutica en la colecistitis aguda alitiásica. El objetivo de nuestro trabajo es revisar la evidencia científica acerca del tratamiento en estos pacientes según los hallazgos clínicos y radiológicos. Métodos: revisión sistemática de la literatura desde 2000 hasta 2016. La búsqueda se realizó usando PubMed, Índice Médico Español, Cochrane Library y Embase, siguiendo nuestros criterios de inclusión: idioma de publicación (inglés o español), pacientes adultos, etiología alitiásica y apropiado diseño de estudio. Resultados: se han identificado 1.013 artículos; finalmente, se han seleccionado para la revisión diez artículos que describían los resultados de pacientes tratados con colecistostomía percutánea y colecistectomía urgente, incluyendo cinco estudios observacionales controlados y cinco series de casos. No se han identificado estudios prospectivos o randomizados con los criterios de búsqueda. Los datos de la literatura y el examen de los resultados indicaron que, para la colecistitis aguda alitiásica, la colecistostomía percutánea puede ser un tratamiento definitivo sin requerir una colecistectomía electiva posterior. Conclusiones: la colecistostomía percutánea puede ser la primera opción de tratamiento en pacientes con colecistitis aguda alitiásica salvo en los casos que presenten perforación o gangrena vesicular. Los pacientes con bajo riesgo quirúrgico podrían beneficiarse de una colecistectomía, aunque ambas opciones de tratamiento pueden ser efectivas. La colecistostomía percutánea en pacientes con colecistitis aguda alitiásica puede ser un tratamiento definitivo sin necesidad de una colecistectomía electiva posterior. No obstante, la calidad de los estudios es, en general, baja y hace necesario tomar con cautela las recomendaciones finales (AU)

Background and objectives: there is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. Methods: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. Results: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. Conclusions: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution (AU)

Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature.

BACKGROUND AND OBJECTIVES: There is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. METHODS: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. RESULTS: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. CONCLUSIONS: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution.

Desarrollo y estudio piloto de un conjunto esencial de indicadores para los servicios de cirugía general / Development and pilot study of an essential set of indicators for general surgery services

INTRODUCCIÓN: En la actualidad no se dispone de un conjunto adecuado de indicadores para benchmarking en las unidades de cirugía general del Sistema Nacional de Salud. Este trabajo presenta la selección, el desarrollo y los resultados del estudio piloto de un primer grupo de indicadores para esta finalidad. MÉTODOS: Se realizó una selección y priorización de indicadores mediante un Delphi modificado con un grupo de expertos de la Asociación Española de Cirujanos. Los indicadores priorizados fueron sometidos a un estudio cualitativo de factibilidad y, para aquellos medidos por historia clínica, cuali-cuantitativo de fiabilidad en un hospital público. Se obtuvieron resultados de concordancia simple y estadístico kappa, ajustado y no ajustado por prevalencias y sesgos, para 3 evaluadores con un muestreo aleatorio sistemático de 30 casos por indicador. RESULTADOS: De los 13 indicadores propuestos, 12 resultaron factibles (5 de historia clínica y 7 de bases de datos). De los 5 de historia, 3 resultaron fiables (concordancia interobservador > 95% o índice kappa > 0,6 para compuestos y subindicadores, o bien kappa ajustado por prevalencias y sesgos > 0,6 en presencia de prevalencias extremas) y 2 necesitaron ser redefinidos a partir de los resultados obtenidos. CONCLUSIONES: Los 5 indicadores de historia clínica podrán utilizarse para comparar unidades quirúrgicas, mientras que los 7 indicadores factibles de bases de datos necesitarán mayor validación y ajuste de riesgo para permitir comparaciones entre servicios. Los resultados del centro evaluado muestran áreas de mejora en algunos procesos de la atención

INTRODUCTION:At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. METHODS: A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n = 30) for each of these indicators. RESULTS: Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement > 95%, adjusted kappa index > 0.6 or non adjusted kappa index > 0.6 for composites and its components) and 2 needed further refinement. CONCLUSIONS: Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital

Recomendaciones de 'no hacer': propuestas de la Asociación Española de Cirujanos al proyecto de ‘Compromiso por la calidad de las sociedades científicas’ / Recommendations of 'not-to-do': Proposals of the Spanish Association of Surgeons to the project ‘Commitment to quality of scientific societies’

INTRODUCCIÓN: La iniciativa del Ministerio de Sanidad 'Compromiso por la calidad de las sociedades científicas' tiene como objetivo disminuir las intervenciones innecesarias de los profesionales sanitarios. MÉTODOS: La Asociación Española de Cirujanos ha seleccionado a 22 expertos de las diferentes secciones que han participado en la identificación de 26 propuestas de 'no hacer' que se ordenaron por el impacto esperado que tendría su puesta en marcha según la metodología GRADE. A partir de estas propuestas, se ha utilizado una técnica de Delphi para seleccionar las 5 recomendaciones más importantes en relación con el impacto potencial que tendría su aplicación. RESULTADOS: Las 5 recomendaciones seleccionadas son: no realizar colecistectomía en pacientes con colelitiasis asintomática; no mantener sondaje vesical más de 48 h; no prolongar más de 24 h, tras un procedimiento quirúrgico, los tratamientos de profilaxis antibiótica; no realizar profilaxis antibiótica de rutina para la cirugía no protésica limpia y no complicada, y no emplear tratamiento antibiótico postoperatorio tras apendicitis no complicada. CONCLUSIÓN: La participación de la Asociación Española de Cirujanos en esta campaña ha permitido una reflexión sobre aquellas actuaciones que no aportan valor en el ámbito de nuestra especialidad y es esperable que la difusión de este proceso sirva para reducir su realización

INTRODUCTION: The initiative of the Spanish Ministry of Health 'Commitment to quality of scientific societies', aims to reduce unnecessary interventions of healthcare professionals. METHODS: The Spanish Association of Surgeons has selected 22 experts from the different sections that have participated in the identification of 26 proposals 'do not do' to be ordered by the expected impact its implementation would have according to the GRADE methodology. From these proposals, the Delphi technique was used to select 5 recommendations presented in more detail in this article. RESULTS: The 5 selected recommendations are: Do not perform cholecystectomy in patients with asymptomatic cholelithiasis; do not keep bladder catheterization more than 48 hours; do not extend antibiotic prophylaxis treatments more than 24 hours after a surgical procedure; do not perform routine antibiotic prophylaxis for uncomplicated clean and no prosthetic surgery; and do not use antibiotics postoperatively after uncomplicated appendicitis. CONCLUSION: The Spanish Association of Surgeons's participation in this campaign has allowed a reflection on those activities that do not add value in the field of surgery and it is expected that the spread of this process serves to reduce its performance

Development and pilot study of an essential set of indicators for general surgery services. / Desarrollo y estudio piloto de un conjunto esencial de indicadores para los servicios de cirugía general.

INTRODUCTION: At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. METHODS: A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators. RESULTS: Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement. CONCLUSIONS: Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital.

El CIE-10 y el protocolo quirúrgico / CIE-10 and the surgical protocol

No disponible

Recommendations of «not-to-do¼: Proposals of the Spanish Association of Surgeons to the project «Commitment to quality of scientific societies¼. / Recomendaciones de «no hacer¼: propuestas de la Asociación Española de Cirujanos al proyecto de «Compromiso por la calidad de las sociedades científicas¼.

INTRODUCTION: The initiative of the Spanish Ministry of Health «Commitment to quality of scientific societies¼, aims to reduce unnecessary interventions of healthcare professionals. METHODS: The Spanish Association of Surgeons has selected 22 experts from the different sections that have participated in the identification of 26 proposals «do not do¼ to be ordered by the expected impact its implementation would have according to the GRADE methodology. From these proposals, the Delphi technique was used to select 5 recommendations presented in more detail in this article. RESULTS: The 5 selected recommendations are: Do not perform cholecystectomy in patients with asymptomatic cholelithiasis; do not keep bladder catheterization more than 48hours; do not extend antibiotic prophylaxis treatments more than 24hours after a surgical procedure; do not perform routine antibiotic prophylaxis for uncomplicated clean and no prosthetic surgery; and do not use antibiotics postoperatively after uncomplicated appendicitis. CONCLUSION: The Spanish Association of Surgeons's participation in this campaign has allowed a reflection on those activities that do not add value in the field of surgery and it is expected that the spread of this process serves to reduce its performance.