Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case-control study.

INTRODUCTION: After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI. METHODS: Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors. RESULTS: We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65). CONCLUSIONS: The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.

Cuidados paliativos prolongados, a propósito de un caso / Prolonged paliative care: case report

Actualmente, las recomendaciones sobre cuidados paliativos sugieren que éstos se inicien lo más tempranamente posible, con el objetivo de mejorar la calidad de vida del paciente y su familia, con un enfoque biopsicosocial. A pesar de ello, aún persiste en gran parte del personal de salud la idea de que los cuidados paliativos son estrictamente cuidados de fin de vida, por lo que se asocia inconscientemente un paciente en una fase final de su enfermedad. Algunos estudios sugieren que, a pesar de las recomendaciones, la práctica habitual aún mantiene esta costumbre. Adicionalmente, no existe una duración establecida para definir cuánto deberían durar estos cuidados. A continuación, el reporte de un caso de cáncer de tiroides papilar, neoplasia conocida por su curso relativamente benigno, para tratarse de un cáncer, de lenta progresión. Este fue diagnosticado de forma tardía, con metástasis pulmonar e insuficiencia respiratoria como primer motivo de consulta, hace 8 años. Esto contrasta enormemente con la duración promedio de cuidados paliativos alrededor del mundo, que se estima es de 19 días. El reporte de este caso pretende contrastar estas realidades y mostrar un ejemplo de cuidados paliativos prolongados, los beneficios y también posibles consecuencias que éstos han tenido en la vida del paciente.

Currently, recommendations about palliative care suggest that they should be started as early in the course of the disease as possible, with the goal of improving quality of life for patients and their families, with a biopsychosocial approach. Despite this, there's still a pervasive idea among healthcare givers that palliative care is given exclusively at the end of life, thus there's a subconscious association with a patient in the final stages of their disease. Studies suggest that despite recommendations, actual practice maintains this custom. Additionally, there's no definitive duration for palliative care. The following is a case report of papillary thyroid cancer, a disease known for a relatively benign course compared to other forms of cancer, and slow progression. This disease was diagnosed in an advanced stage, with pulmonary metastasis and respiratory failure, 8 years ago. This is in stark contrast with the average duration of palliative care around the world, which is estimated to be 19 days. This report intends to highlight this difference and show an example of prolonged palliative care, the benefits and potential consequences that these may have had on the patient's life.

Description of reinfection of joint prosthesis after 2-stage replacement (infection of the 2nd stage prosthesis): A multicenter study.

INTRODUCTION: Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery. METHODS: Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018. RESULTS: We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases). CONCLUSIONS: The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate.

Enhancing physicians' radiology diagnostics of COVID-19's effects on lung health by leveraging artificial intelligence.

Introduction: This study aimed to develop an individualized artificial intelligence model to help radiologists assess the severity of COVID-19's effects on patients' lung health. Methods: Data was collected from medical records of 1103 patients diagnosed with COVID-19 using RT- qPCR between March and June 2020, in Hospital Madrid-Group (HM-Group, Spain). By using Convolutional Neural Networks, we determine the effects of COVID-19 in terms of lung area, opacities, and pulmonary air density. We then combine these variables with age and sex in a regression model to assess the severity of these conditions with respect to fatality risk (death or ICU). Results: Our model can predict high effect with an AUC of 0.736. Finally, we compare the performance of the model with respect to six physicians' diagnosis, and test for improvements on physicians' performance when using the prediction algorithm. Discussion: We find that the algorithm outperforms physicians (39.5% less error), and thus, physicians can significantly benefit from the information provided by the algorithm by reducing error by almost 30%.

Infección de prótesis articular por Pseudomonas stutzeri: Reto terapéutico asociado a múltiples graves complicaciones / Pseudomonas stutzeri prosthetic joint infection: a therapeutic challenge associated with multiple severe complications

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Respuesta a «Cómo limitar los sesgos en estudios cuasiexperimentales» / Reply to "How to limit bias in quasiexperimental studies"

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Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular / Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection

INTRODUCCIÓN: Existe un creciente aumento de las infecciones de prótesis articular (IPA) por bacterias resistentes a las cefalosporinas utilizadas en la profilaxis quirúrgica. La sustitución de estas por glucopéptidos no ha demostrado mejorar los resultados pero sí su asociación. MÉTODOS: Estudio comparativo de la asociación de teicoplanina y cefazolina antes de la cirugía de artroplastia frente a cefazolina sola de un grupo control previo. RESULTADOS: En el periodo control hubo 16 IPA de 585 cirugías, mientras que en el grupo de intervención fueron 6 de 579 (incidencia 2,7% vs. 1,03%; RR 0,4, p = 0,04). En el grupo control, 11 de las infecciones fueron causadas por bacterias grampositivas frente a 4 en el de intervención (1,8% vs. 0,7%, p = 0,08). CONCLUSIONES: La adición de teicoplanina a cefazolina en la profilaxis de la cirugía de artroplastia se asoció a una reducción de la incidencia de IPA, a expensas de un descenso de las causadas por grampositivos

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P = .04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P = .08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria

Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study.

OBJECTIVES: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal. METHODS: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function. RESULTS: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis. CONCLUSION: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.

Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection. / Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular.

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P=.04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P=.08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria.

[Popliteal Artery Aneurysms: Literature Review and presentation of case.] / Aneurismas de la Arteria Poplitea: Revisión bibliográfica y presentación de un caso.

INTRODUCTION: The popliteal artery aneurysm (AAP) is localized and irreversible walls of the popliteal artery dilation. It is rare pathology is the second most common location of true aneurysms after aortic, and the first location within the peripheral aneurysms. It is characterized by affecting mainly men at an average age of 65, whose manifestations are mainly ischemic, finishing lower limb amputation in a frequency ranging as appropriate between 7 and 20 percent. Our goal is to make the presentation of a case of AAP with subacute arterial ischemia, along with a literature review of the topic. CASE PRESENTATION: the case of a 63 year old who consulted for lower limb pain 96 hours of evolution, with absence of pulses is presented a diagnosis of advanced subacute ischemia was performed resvascularizable not in the context of a clinically unstable patient. emergency amputation is decided. In dissecting the presence of PSA objective. DISCUSSION: The AAP have an incidence of 0.1 to 1%, have variable clinical. Arteriography is the gold standard for diagnosis. The treatment of choice is surgical, presenting new therapeutic options. The anatomical variations of the branches of the PA are variable to consider. Aneurysms are most commonly associated with contralateral popliteal (57.1%). CONCLUSIONS: We conclude that our conduct was appropriate considering the state of the patient.

INTRODUCCIÓN: El aneurisma de la arteria poplítea (AAP) es la dilatación localizada e irreversible de las paredes de la Arteria Poplítea. Es patología poco frecuente, constituye la segunda ubicación más frecuente de aneurismas verdaderos luego de los aórticos, y la primera ubicación dentro de los aneurismas periféricos. Se caracteriza por afectar a principalmente a hombres a una edad promedio de 65 años, cuyas manifestaciones son principalmente de origen isquémico, acabando en amputación del miembro inferior en una frecuencia que oscila según los casos entre un 7 y un 20 por ciento. Nuestro objetivo es realizar la presentación de un caso de AAP con isquemia arterial subaguda, junto con una actualización bibliográfica del tema. PRESENTACION DE CASO: Se presenta el caso de un paciente de 63 años de edad quien consultó por dolor de miembro inferior 96 horas de evolución, con ausencia de pulsos. Se realizó el diagnóstico de isquemia subaguda evolucionada, no resvascularizable en el contexto de un paciente clínicamente inestable. Se decide amputación de urgencia. En la disección se objetiva la presencia de un AAP CONCLUSIONES: Concluimos que nuestra conducta fue adecuada considerando el estado del paciente. DISCUCIÓN: : Los AAP tienen una incidencia de entre el 0,1 al 1%, presentan clínica variable. La arteriografía es gold standard para su diagnóstico. El tratamiento de elección es quirúrgico, presentándose nuevas opciones terapéuticas. Las variaciones anatómicas de las ramas de la AP son una variable a considerar. Los aneurismas asociados con mayor frecuencia son los poplíteos contralaterales (57,1%).

Chemical properties and assessment of the antioxidant capacity of native species from the genus Ugni / Características químicas y evaluación de la capacidad antioxidante de especies del género Ugni

Introduction: Ugni molinae Turcz., Ugni candollei Barn. (Berg) and Ugni selkirkii (Hook. et Arn.) Berg are Chilean species that share morphological characteristics and they are distributed in geographic locations with very diverse habitats. Its is considered important for the characterization of the Chilean flora to determine if there are similarities in the sort of chemical compounds among species with close morphological relations, growing in different habitats and their consequent biological activity. Objective: to assess the chemical composition and the antioxidant capacity of leaf extracts from the Chilean species of the genus Ugni, and to compare with the U. molinae characteristics. Methods: composition of chemical compounds was determined by chromatographic methods (HPLC-ESI-MS). The antioxidant capacity was assessed by DPPH, ABTS and by stabilization of the hydroxyl radical. Results: as expected, given the great morphological similarity existing among the three species of Ugni that grow in Chile, similarities were found in their chemical composition. Nevertheless, it was also expectable to find variations among them. Thus, U. candollei and U. selkirkii are the species that present greater content and variety of phenolic and terpenic compounds. These species exert greater antioxidant capacity in comparison toU. molinae. U. candollei hightlights for its flavonoid content such as glycosides and quercetin derivatives, and the species U. selkirkii, is important in galotannins. U. molinae is characterized in ellagic acids derivatives. Conclusion: these data and the morphological characteristics could become a useful toll in order to determine the closeness degree among these species(AU

Introducción: Ugni molinae Turcz., Ugni candollei (Barn.) Berg y Ugni selkirkii (Hook. et Arn.) Berg son especies chilenas que comparten características morfológicas y se distribuyen en lugares geográficos con muy diversos hábitats. Se considera importante para la caracterización de la flora chilena determinar si hay similitudes en el tipo de compuestos químicos entre especies con relaciones morfológicas cercanas, que crecen en diferentes hábitats y su actividad biológica consecuente. Objetivo: evaluar la composición química y la capacidad antioxidante de extractos de hojas de las especies chilenas del género Ugni, y compararlas con las características de la especie U. molinae. Métodos: la composición química se determinó por métodos cromatográficos (HPLC-ESI-MS). La capacidad antioxidante se evaluó por los métodos DPPH, ABTS, y la estabilización del radical hidroxilo. Resultados: como era de esperar, dada la gran similitud morfológica existente entre las tres especies de Ugni que crecen en Chile, se encontraron similitudes en su composición química. Sin embargo, también era esperable encontrar variaciones entre ellas. Por lo tanto, U. candollei y U. selkirkii son las especies que presentan mayor contenido y variedad de compuestos fenólicos y terpénicos. Estas especies ejercen una mayor capacidad antioxidante en comparación con U. molinae. U. candollei se caracteriza por su contenido en flavonoides como quercetina glucósidos y sus derivados, y la especie U. selkirkii, por la presencia de galotaninos. U. molinae se caracteriza por contener derivados del ácido elágico. Conclusión: estos datos y las características morfológicas podrían convertirse en una herramienta útil para determinar el grado cercanía entre estas especies(AU)

Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología / Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology

Introducción y objetivos: Los pacientes ingresados en el Servicio de Otorrinolaringología (ORL) están aumentando en edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en ORL. Métodos: Estudio observacional retrospectivo de los pacientes ≥ 14 años ingresados desde el 1 de enero del 2009 hasta el 30 de junio del 2013 en ORL; desde mayo del 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), defunción, reingresos y estancia hospitalaria. Resultados: Los pacientes con AC fueron de mayor edad (4,5 años, intervalo de confianza del 95% [IC del 95%], 2,8 a 6,3), con más ingresos urgentes (odds ratio [OR] 1,4; IC del 95%, 1,1 a 1,8), mayor peso administrativo (0,3637; IC del 95%, 0,0710 a 0,6564), mayor número de diagnósticos (1,3; IC del 95%, 1 a 1,6), ICh (0,4; IC del 95%, 0,2 a 0,6) y también de defunción (OR 4,1; IC del 95%, 1,1 a 15,7). Al ajustar, observamos que la AC redujo el 28,6% la estancia en ORL, 0,8 días (IC del 95%, 0,1 a 1,6; p = 0,038). Este descenso supone un ahorro, al menos, de 165.893 Euros. Conclusiones: Los enfermos ingresados en ORL están aumentando su edad, comorbilidad y complejidad. La AC se asocia a una disminución de la estancia y los costes en ORL, similares a lo observado en otros servicios quirúrgicos (AU)

Introduction and objectives: Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. Methods: This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. Results: There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least Euros 165,893. Conclusions: Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-manage (AU)

Asistencia compartida (comanagement) con Medicina Interna en el Servicio de Ginecología / Comanagement with Internal Medicine in a Gynecology Department

Objetivo. Las pacientes hospitalizadas en Ginecología están aumentando su edad y complejidad, dificultando la labor de los ginecólogos. Estudiamos el efecto de la asistencia compartida (AC) con Medicina Interna (MI) sobre la estancia hospitalaria de las enfermas ingresadas en Ginecología. Material y método. Comparamos las pacientes ≥ 14 años dadas de alta de Ginecología en 2013, con AC con MI, con las del 2012, sin AC. Analizamos edad, ingreso urgente, cirugía sí/no, peso administrativo, número total de diagnósticos, índice de comorbilidad de Charlson (ICh), estancia hospitalaria, fallecimiento y reingresos. Resultados. En el año 2013 observamos incrementos del 20,6% en el número de diagnósticos y del 46,2% en el ICh. La estancia media ajustada se redujo en 0,5 días (IC 95% 0,2 a 0,7; p < 0,001). Conclusiones. La AC con MI se asocia a una disminución de la estancia media en Ginecología, en línea con lo observado en otros servicios quirúrgicos (AU)

Objective. There has been an increase in the age and complexity of patients hospitalized in gynecology departments, which has affected the work of gynecologists. We studied the effect of comanagement (CM) with Internal Medicine (IM) on hospital stay among gynecology inpatients. Material and methods. We compared patients aged ≥ 14 years old discharged from the gynecology department in 2013 who underwent CM with IM with patients who did not undergo CM and who were discharged in 2012. We analyzed age, emergency admission, surgery yes/no, administrative weight, number of diagnoses, the Charlson comorbidity index (CCI), hospital stay, fallecimiento, and readmissions. Results. In 2013, we observed increases of 20.6% in the number of diagnoses and of 46.2% in the CCI. The adjusted length of stay was reduced by 0.5 days (95% CI 0.2 to 0.7; p < 0.001). Conclusions. CM with IM is associated with a decrease in length of stay in gynecology, in line with that observed in other surgical departments (AU)

¿Tienen los cirujanos más dificultades en la atención de los pacientes hospitalizados no intervenidos respecto a los intervenidos? / Do surgeons have more difficulties in the hospital care of non-surgery patients than with surgery patients?

OBJETIVO: Un porcentaje variable de los enfermos ingresados en los servicios quirúrgicos no son operados por diversas razones. Nuestro objetivo es comprobar si los cirujanos tienen más dificultades en la atención de los pacientes ingresados no operados que en los operados. MATERIAL Y MÉTODOS: Hemos incluido a todos los pacientes de edad ≥ 14 años dados de alta el año 2010 de Cirugía General, Ginecología, Urología y Otorrinolaringología. Las variables principales fueron la estancia, mortalidad, reingresos y número de interconsultas solicitadas a servicios médicos. Las variables secundarias: edad, sexo, número de ingresos urgentes, número total de diagnósticos y el índice de comorbilidad de Charlson (ICh). RESULTADOS: Entre el 8,7 y el 22,8% de los pacientes ingresados en estos servicios no son operados. Los pacientes no operados tienen significativamente mayores estancia, mortalidad, reingresos y solicitudes de interconsultas que los operados, con significativamente mayores edad (excepto Urología), número de diagnósticos, ingresos urgentes e ICh (excepto Urología). CONCLUSIONES: Los pacientes ingresados en los servicios quirúrgicos que no son operados tienen mayor mortalidad, reingresos y solicitudes de interconsultas que los operados, probablemente por su mayor complejidad médica y urgencia del ingreso. Ello podría indicar una mayor dificultad en su manejo por parte de los cirujanos

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons

Resultados de una intervención de descolonización de Staphylococcus aureusen pacientes portadores a los que se indica una prótesis articular / Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty

INTRODUCCIÓN: La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus. MATERIAL Y MÉTODOS: Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010. RESULTADOS: En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de de IPA por S.aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04). CONCLUSIÓN: En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S.aureus consiguió un descenso significativo de la incidencia de IPA por S.aureus respecto a un control histórico

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S. aureuscarriers helps to reduce the incidence of PJI by S. aureus. MATERIAL AND METHODS: An S. aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S. aureuscompared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P = .04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group

Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.

INTRODUCTION AND OBJECTIVES: Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. METHODS: This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. RESULTS: There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893. CONCLUSIONS: Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services.

DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients?

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons.