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.

Resultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon / Results of a national survey on the use of stents for the treatment of colonic obstruction

INTRODUCCIÓN: Difundimos una encuesta con el objetivo de conocer las indicaciones actuales para la utilización del stent de colon para el tratamiento de la obstrucción colónica en España y su adecuación a las guías internacionales. MÉTODOS: Estudio descriptivo de una encuesta distribuida por la Asociación Española de Cirujanos, la Societat Catalana de Cirurgía y la Sociedad Española de Endoscopia Digestiva. RESULTADOS: Se recibieron 340 respuestas válidas, un 25% de médicos digestólogos, y el 75% de cirujanos generales. Durante el último año el 44,4% de los encuestados valoró entre 10 a 20 COC. Un 52,2% indicó menos de 5 stents/año, y de estos el 75% se indicó como paso previo a una cirugía preferente y solo el 25% se realizó con intención paliativa. Un 55,3% de los participantes refirió conocer las guías oficiales. El 64% de los encuestados utilizaría el stent como paso previo a cirugía en ancianos con enfermedad localizada. El 75,9% colocaría stent con fines paliativos en jóvenes con carcinomatosis, y un 61,8% los utilizaría en neoplasias estadio IV en tratamiento con quimioterapia. Solo un 18,1% conocía el riesgo de perforación de colon tras stent en pacientes en tratamiento con antiangiogénicos. CONCLUSIONES: En España la indicación del stent de colon se reserva para casos seleccionados y varía según la especialidad y los años de experiencia del encuestado. La adecuación a las guías internacionales para la mayoría de los encuestados es moderada. Es importante insistir en el alto riesgo de perforación tras angiogénicos, pues la mayoría de profesionales lo desconocen

INTRODUCTION: We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. METHODS: Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociación Española de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva). RESULTS: 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. CONCLUSIONS: In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons

Results of a national survey on the use of stents for the treatment of colonic obstruction. / Resultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon.

INTRODUCTION: We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. METHODS: Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociación Española de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva). RESULTS: 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. CONCLUSIONS: In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons.

Síndrome de Horner y tromboflebitis séptica central: dos complicaciones infrecuentes tras la colocación de accesos venosos centrales / Horner syndrome and central line septic phlebitis: two uncommon complications after inserting central venous lines

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[Laparoscopic adrenalectomy]. / Adrenalectomía laparoscópica.

INTRODUCTION: In the last few years, laparoscopic adrenalectomy has become widely used in the management of adrenal disease. MATERIAL AND METHOD: We reviewed our experience of 24 patients who underwent laparoscopic adrenalectomy between 1998 and 2006. RESULTS: Surgery was indicated for Cushing's syndrome in 46% of the patients, aldosteronoma in 25%, incidentaloma in 21% and pheochromocytoma in 8%. A lateral transabdominal approach was employed in all patients. The mean age of the patients was 50.4 years (17 women and 7 men). Left unilateral adrenalectomy was performed in 63% of the patients, right unilateral adrenalectomy in 29% and bilateral adrenalectomy in 8%. The conversion rate was 4%. The mean operating time was 134 minutes in unilateral approaches and 245 minutes in bilateral approaches. The mean size of the gland was 4 cm. The complications rate was 4% and there was no mortality. Disease control was achieved in 96% of the patients after a mean follow-up of 49 months. CONCLUSIONS: Laparoscopic adrenalectomy should be considered the procedure of choice for the surgical management of benign adrenal disease.

Adrenalectomía laparoscópica / Laparoscopic adrenalectomy

Introducción. La adrenalectomía laparoscópica es una técnica que se ha popularizado en los últimos años en el manejo de la afección adrenal. Material y método. Revisamos nuestra experiencia de 24 casos de adrenalectomía laparoscópica entre 1998 y 2006. Resultados. En el 46% de los casos la indicación fue por síndrome de Cushing; en el 25%, aldosteronoma; en el 21%, incidentaloma, y en el 8%, feocromocitoma. El abordaje fue por vía transabdominal lateral en todos los pacientes. La media de edad de los pacientes fue 50,4 años y se trataba de 17 mujeres y 7 varones. Se realizó adrenalectomía unilateral izquierda en el 63% de los casos, unilateral derecha en el 29% y bilateral en el 8%. La tasa de conversión a cirugía abierta fue el 4%. La duración media de la intervención fue 134 min en los abordajes unilaterales y 245 min en los bilaterales. El tamaño medio de la glándula fue 4 cm. La tasa de complicaciones fue del 8% y no hubo mortalidad. Se consiguió control de la enfermedad de base en el 96% de los pacientes tras un seguimiento medio de 49 meses. Conclusiones. La adrenalectomía laparoscópica debe ser considerada como el procedimiento de elección para el tratamiento quirúrgico de las enfermedades adrenales benignas (AU)

Introduction. In the last few years, laparoscopic adrenalectomy has become widely used in the management of adrenal disease. Material and method. We reviewed our experience of 24 patients who underwent laparoscopic adrenalectomy between 1998 and 2006. Results. Surgery was indicated for Cushing's syndrome in 46% of the patients, aldosteronoma in 25%, incidentaloma in 21% and pheochromocytoma in 8%. A lateral transabdominal approach was employed in all patients. The mean age of the patients was 50.4 years (17 women and 7 men). Left unilateral adrenalectomy was performed in 63% of the patients, right unilateral adrenalectomy in 29% and bilateral adrenalectomy in 8%. The conversion rate was 4%. The mean operating time was 134 minutes in unilateral approaches and 245 minutes in bilateral approaches. The mean size of the gland was 4 cm. The complications rate was 4% and there was no mortality. Disease control was achieved in 96% of the patients after a mean follow-up of 49 months. Conclusions. Laparoscopic adrenalectomy should be considered the procedure of choice for the surgical management of benign adrenal disease (AU)

[Laparoscopic vs open splenectomy in the treatment of idiopathic thrombocytopenic purpura]. / Esplenectomía laparoscópica o esplenectomía abierta en el tratamiento de la púrpura trombocitopénica idiopática.

INTRODUCTION: Laparoscopic splenectomy (LS) is gaining acceptance as an effective and safe alternative to open splenectomy (OS) in the treatment of benign hematologic disorders unresponsive to medical treatment. Among these disorders, the most important is idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHOD: We compared a cohort of 20 patients who had undergone LS in the previous 7 years, with a historical cohort of 38 patients who underwent OS between 1985 and 1999. All patients in the two groups were diagnosed with ITP unresponsive to medical treatment. RESULTS: The mean age of the patients was 41 years in the LS group and 39.7 in the OS group. Mean spleen size and weight were 11 cm and 150 g in the LS group and 9.9 cm and 190 g in the OS group. Preoperative platelet count was 78 x 10(9) in the LS group and 69 x 10(9) in the OS group. Accessory spleens were detected in 15% of patients in the LS group and in 16% of those in the OS group. The mean operative time was 180 minutes in LS and 85 minutes in OS (p < 0.001). The complications rate was 25% in LS and 21% in OS. The mean length of hospital stay was 3 days in the LS group and 9.4 days in the OS group (p < 0.001). No differences were observed in early and complete long-term remission. CONCLUSIONS: Compared with OS, LS requires a longer operative time and reduces hospital stay. Detection of accessory spleens, complication rates, and effectiveness in terms of early and long-term remission are similar in both procedures. In our opinion, LS should be considered the procedure of choice for the treatment of benign hematological disorders unresponsive to medical therapy.

Esplenectomía laparoscópica o esplenectomía abierta en el tratamiento de la púrpura trombocitopénica idiopática / Laparoscopic vs open splenectomy in the treatment of idiopathic thrombocytopenic purpura

Introducción. La esplenectomía laparoscópica está ganando aceptación como alternativa segura y efectiva a la esplenectomía abierta en el tratamiento de trastornos hemáticos benignos refractarios a tratamiento médico, de los que la púrpura trombocitopénica idiopática es el más importante. Material y método. Comparamos una cohorte de 20 pacientes sometidos a esplenectomía laparoscópica (EL) en los últimos 7 años con una cohorte histórica de 38 casos sometidos a esplenectomía abierta (EA) entre 1985 y 1999. Todos los casos de ambos grupos estaban diagnosticados de púrpura trombocitopénica idiopática refractaria a tratamiento médico. Resultados. La media de edad de los pacientes del grupo EL era de 41 años, frente a 39,7 en el grupo EA. El tamaño medio y el peso medio del bazo fueron de 11 cm y 150 g en EL y 10,9 cm y 190 g en EA. El recuento plaquetario preoperatorio fue 78 x 109 en EL y 69 x109 en EA. Se detectaron bazos accesorios en el 15% de los casos del grupo EL y el 16% en el grupo EA. La duración media de la cirugía fue 180 min en EL y 85 min en EA (p < 0,001). La tasa de complicaciones fue del 25% en EL y el 21% en EA. La estancia media hospitalaria fue 3 días en el grupo EL y 9,4 días en el grupo EA (p < 0,001). No se observaron diferencias en las tasas de remisión precoz y remisión completa a largo plazo. Conclusiones. Comparada con la EA, la EL precisa mayor tiempo operatorio, son similares en la detección de bazos accesorios, la tasa de complicaciones y la efectividad en la remisión precoz y la remisión completa a largo plazo, y conlleva un menor tiempo de hospitalización. En nuestra opinión, la EL debe ser considerada el procedimiento de elección en el tratamiento de afecciones hemáticas benignas que no responden a tratamiento médico (AU)

Introduction. Laparoscopic splenectomy (LS) is gaining acceptance as an effective and safe alternative to open splenectomy (OS) in the treatment of benign hematologic disorders unresponsive to medical treatment. Among these disorders, the most important is idiopathic thrombocytopenic purpura (ITP). Patients and method. We compared a cohort of 20 patients who had undergone LS in the previous 7 years, with a historical cohort of 38 patients who underwent OS between 1985 and 1999. All patients in the two groups were diagnosed with ITP unresponsive to medical treatment. Results. The mean age of the patients was 41 years in the LS group and 39.7 in the OS group. Mean spleen size and weight were 11 cm and 150 g in the LS group and 9.9 cm and 190 g in the OS group. Preoperative platelet count was 78 x 109 in the LS group and 69 x 109 in the OS group. Accessory spleens were detected in 15% of patients in the LS group and in 16% of those in the OS group. The mean operative time was 180 minutes in LS and 85 minutes in OS (p < 0.001). The complications rate was 25% in LS and 21% in OS. The mean length of hospital stay was 3 days in the LS group and 9.4 days in the OS group (p < 0.001). No differences were observed in early and complete long-term remission. Conclusions. Compared with OS, LS requires a longer operative time and reduces hospital stay. Detection of accessory spleens, complication rates, and effectiveness in terms of early and long-term remission are similar in both procedures. In our opinion, LS should be considered the procedure of choice for the treatment of benign hematological disorders unresponsive to medical therapy (AU)

Neumorretroperitoneo secundario al lavado quirúrgico de un absceso perianal con agua oxigenada / Pneumoretroperitoneum secondary to surgical lavage of a perianal abscess with hydrogen peroxide

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