Rehabilitación multimodal y cirugía intestinal por enfermedad de Crohn: Factores asociados a estancia hospitalaria prolongada / «Fast track» and intestinal surgery for Crohn’s disease: Factors associated with prolonged hospital stay

OBJETIVO: Los objetivos del trabajo fueron determinar los factores asociados a una estancia postoperatoria (EP) prolongada en pacientes con resección intestinal por enfermedad de Crohn (EC) con un protocolo de rehabilitación multimodal (RM). MÉTODOS: Se incluyó a los pacientes intervenidos entre enero de 2013 y diciembre de 2015 por EC. Para la RM se siguió un protocolo de 8 puntos. Las variables estudiadas fueron: edad, sexo, EP, ASA, localización y patrón de la EC, presencia de enfermedad perianal, índice de Harvey-Bradshaw, resección previa, tipo de cirugía actual (mínimamente invasiva vs. laparotomía) y Clavien-Dindo. Se realizó un estudio inferencial para identificar los factores asociados a una EP > de 6 días y un modelo logístico multivariante. RESULTADOS: Se intervino a 52 pacientes. La EP mediana fue de 8 días (RI: 5-11). En el análisis univariante, la localización (L1 vs. L2-3), el patrón (B2 vs. B3), la existencia de enfermedad perianal, la cirugía previa, el tipo de cirugía realizada, el Harvey-Bradshaw y el grado de Clavien-Dindo se asociaron todos ellos con una EP inferior o superior a 6 días. El modelo parsimonioso que mejor ajusta para predecir una EP >6 días es el que contiene la variable Harvey-Bradshaw (OR: 6,49; IC 95%: 1,46-28,8) y el tipo de cirugía efectuado (OR: 0,23; IC 95%: 0,05-0,95). CONCLUSIONES: La estancia prolongada tras cirugía resectiva por EC se relaciona más con el tipo o gravedad de la enfermedad y de cirugía realizada que con otras características del paciente. Los pacientes con EC requieren una buena coordinación entre prehabilitación, RM y transferencia de cuidados postoperatorios

OBJECTIVE: The aim of this study was to determine factors associated with a prolonged postoperative stay (PS) in patients operated on with bowel resection for Crohn's disease (CD) included in an enhanced recovery program (ERP). METHODS: We included patients operated on for CD between January 2013 and December 2015. ERP was organized following an 8-point protocol. Variables studied were: age, sex, PS, ASA, location and type of CD, presence of perianal disease, Harvey-Bradshaw index, previous resection, type of surgery (minimally invasive vs. laparotomy) and Clavien Dindo. An inferential study was performed to identify factors related with a PS > 6 days and multivariate analysis. RESULTS: A total of 52 patients were operated on. The median PS was 8 days (IR: 5-11). In the univariate analysis, location (L1 vs. L2-3), type (B2 vs. B3), presence of perianal disease, prior surgery, type of surgery performed, Harvey-Bradshaw index and Clavien-Dindo were associated with a PS > or< than 6 days. The model that best adjusts to predict a PS > 6 days contained the variable Harvey-Bradshaw (OR: 6,49; 95% CI: 1,46-28,8) and the type of surgery (OR: 0,23; 95%CI: 0,05-0,95). CONCLUSION: A prolonged postoperative stay after bowel resection for CD is more related to the type or severity of the disease and the type of surgery performed, than with other patient factors. Patients with CD need good coordination between prehabilitation, ERP and postoperative management

«Fast track¼ and intestinal surgery for Crohn's disease: Factors associated with prolonged hospital stay. / Rehabilitación multimodal y cirugía intestinal por enfermedad de Crohn: Factores asociados a estancia hospitalaria prolongada.

OBJECTIVE: The aim of this study was to determine factors associated with a prolonged postoperative stay (PS) in patients operated on with bowel resection for Crohn's disease (CD) included in an enhanced recovery program (ERP). METHODS: We included patients operated on for CD between January 2013 and December 2015. ERP was organized following an 8-point protocol. Variables studied were: age, sex, PS, ASA, location and type of CD, presence of perianal disease, Harvey-Bradshaw index, previous resection, type of surgery (minimally invasive vs. laparotomy) and Clavien Dindo. An inferential study was performed to identify factors related with a PS> 6 days and multivariate analysis. RESULTS: A total of 52 patients were operated on. The median PS was 8 days (IR: 5-11). In the univariate analysis, location (L1 vs. L2-3), type (B2 vs. B3), presence of perianal disease, prior surgery, type of surgery performed, Harvey-Bradshaw index and Clavien-Dindo were associated with a PS>or< than 6 days. The model that best adjusts to predict a PS> 6days contained the variable Harvey-Bradshaw (OR: 6,49; 95% CI: 1,46-28,8) and the type of surgery (OR: 0,23; 95%CI: 0,05-0,95). CONCLUSION: A prolonged postoperative stay after bowel resection for CD is more related to the type or severity of the disease and the type of surgery performed, than with other patient factors. Patients with CD need good coordination between prehabilitation, ERP and postoperative management.

Anal intraepitelial neoplasia: A narrative review.

Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.

Neoplasia intraepitelial anal: una revisión de conjunto / Anal intraepitelial neoplasia: a narrative review

La neoplasia intraepitelial anal (AIN) constituye un importante problema de salud en ciertos grupos de riesgo como los pacientes con inmunodepresión de diverso origen, varones que mantienen relaciones sexuales con otros hombres, y mujeres con antecedentes de alteraciones en la citología cervical y/o vaginal. Está bien demostrada su relación con la infección del virus del papiloma humano (HPV), sin embargo se desconocen muchos de los factores implicados en la progresión y regresión de la infección viral a la displasia y al carcinoma anal. La pruebas diagnósticas de elección son la citología del canal anal y la anuscopia de alta resolución con biopsias dirigidas, aunque existe controversia sobre la necesidad de realización de la misma en poblaciones de riesgo. El tratamiento del AIN depende de los factores de riesgo y la necesidad de tratamiento local es controvertida debido a la alta tasa de recurrencia y morbilidad de las técnicas utilizadas. La biopsia quirúrgica está justificada sólo ante lesiones macroscópicas sugestivas de progresión. La vacunación frente al HPV para una prevención primaria en pacientes de alto riesgo ha sido debatida entre diferentes grupos, sin embargo no existe consenso sobre su implantación ni tampoco sobre la realización de un cribado en esta población (AU)

Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population (AU)