Análisis evolutivo de morbimortalidad en cirugía de urgencias durante la pandemia: comparación retrospectiva entre primera y segunda ola de COVID-19 / Evolutionary analysis of patient's morbidity and mortality in emergency surgical care during the pandemic: Retrospective comparison between first and second wave of COVID-19

Introducción: Desde el comienzo de la pandemia, la morbimortalidad en la atención urgente al paciente quirúrgico ha sido objeto de estudio. Sin embargo, la mayoría de los estudios compararon dicha variable con la propia de la época pre-COVID, obviando la evolución de la misma durante la propia pandemia. Con el objetivo de analizar este posible cambio, realizamos un estudio comparativo de morbimortalidad en cirugía de urgencias entre la primera y segunda ola de la pandemia en nuestro centro. Material y métodos: Estudio retrospectivo longitudinal que incluyó a todos los pacientes mayores de 18 años ingresados y/o intervenidos quirúrgicamente de forma urgente en los dos periodos de máxima incidencia (PMI) de infección por COVID-19 (1.er: 22/03/2020-31/05/2020; 2.° PMI: 26/08/2020-30/11/2020). Se analizó la incidencia de infección por SARS-CoV-2, el tratamiento recibido, la morbimortalidad precoz y los posibles factores de riesgo de complicaciones. Resultados: Se analizaron 173 pacientes (1.er: 66; 2.° PMI: 107). La incidencia de COVID-19 fue mayor en el segundo periodo (14,95% vs. 4,54%). La infección por SARS-CoV-2 se asoció a una mayor tasa de complicaciones, sin embargo, no se observaron diferencias estadísticamente significativas en la morbimortalidad general (p = 0,746) ni en la de los pacientes COVID positivos (p = 0,582) entre ambos periodos. El tratamiento quirúrgico se asoció con una menor tasa de complicaciones tanto en la primera (p = 0,006) como en la segunda ola (p = 0,014). Dicho tratamiento quirúrgico fue más frecuente en el segundo PMI (70,1 vs. 57,6%) aunque no se alcanzó la significación estadística al respecto de esta afirmación (p = 0,065).(AU)

Introduction: Since the beginning of the pandemic, morbidity and mortality in emergency care of surgical patients have been the subject of several studies. However, most of these have compared this variable with that of the pre-COVID period, ignoring its evolution during the pandemic itself. In order to analyze this possible change, we performed a comparative study of morbidity and mortality in emergency surgery between the first and second waves of the pandemic in our center. Material and methods: Retrospective longitudinal study including all patients over the age of 18 admitted and/or operated in the emergency setting in the two maximum incidence periods (MIP) of COVID-19 infection (1st MIP: 22/03/2020–31/05/2020; 2nd MIP: 26/08/2020–30/11/2020). The incidence of SARS-CoV-2 infection, treatment received, early morbidity and mortality and possible risk factors for complications were analyzed. Results: A total of 173 patients were analyzed (1st MIP: 66; 2nd MIP: 107). The incidence of COVID-19 was higher in the second period (14.95% vs. 4.54%). SARS-CoV-2 infection was associated with a higher rate of complications, however, no statistically significant differences were observed in morbimortality rate, either in the total sample (p = 0.746) or in patients with a positive COVID-19 test (p = 0.582) between both periods. Surgical treatment was found to be associated with a lower complication rate in both the first (p = 0.006) and second wave (p = 0.014), and it was more frequent in the second PMI (70.1 vs. 57.6%) although statistical significance was not reached (p = 0.065). (AU)

Evolutionary analysis of patient's morbidity and mortality in emergency surgical care during the pandemic: Retrospective comparison between first and second waves of COVID-19.

INTRODUCTION: Since the beginning of the pandemic, morbidity and mortality in emergency care of surgical patients have been the subject of several studies. However, most of these have compared this variable with that of the pre-COVID period, ignoring its evolution during the pandemic itself. In order to analyze this possible change, we performed a comparative study of morbidity and mortality in emergency surgery between the first and second waves of the pandemic in our center. METHODS: Retrospective longitudinal study including all patients over the age of 18 admitted and/or operated in the emergency setting in the two maximum incidence periods (MIP) of COVID-19 infection (1st MIP: 22/03/2020-31/05/2020; 2nd MIP: 26/08/2020-30/11/2020). The incidence of SARS-CoV-2 infection, treatment received, early morbidity and mortality and possible risk factors for complications were analyzed. RESULTS: A total of 173 patients were analyzed (1st MIP: 66; 2nd MIP: 107). The incidence of COVID-19 was higher in the second period (14.95% vs. 4.54%). SARS-CoV-2 infection was associated with a higher rate of complications; however, no statistically significant differences were observed in morbimortality rate, either in the total sample (P = .746) or in patients with a positive COVID-19 test (P = .582) between both periods. Surgical treatment was found to be associated with a lower complication rate in both the first (P = .006) and second waves (P = .014), and it was more frequent in the second MIP (70.1% vs 57.6%), although statistical significance was not reached (P = .065). CONCLUSIONS: No significant differences were observed in morbidity and mortality of patients admitted and/or operated in the emergency setting in the two periods of maximum incidence of SARS-CoV-2 at our center. Surgical treatment was associated with lower morbidity and mortality rates, and it was more frequent in the second MIP.

[Evolutionary analysis of patient´s morbidity and mortality in emergency surgical care during the pandemic: retrospective comparison between the first and second waves of COVID-19.] / Análisis evolutivo de morbimortalidad en cirugía de urgencias durante la pandemia: comparación retrospectiva entre primera y segunda ola de COVID-19.

INTRODUCTION: Since the beginning of the pandemic, morbidity and mortality in emergency care of surgical patients have been the subject of several studies. However, most of these have compared this variable with that of the pre-COVID period, ignoring its evolution during the pandemic itself. In order to analyze this possible change, we performed a comparative study of morbidity and mortality in emergency surgery between the first and second waves of the pandemic in our center. MATERIAL AND METHODS: Retrospective longitudinal study including all patients over the age of 18 admitted and/or operated in the emergency setting in the two maximum incidence periods (MIP) of COVID-19 infection (1st MIP: 22/03/2020-31/05/2020; 2nd MIP: 26/08/2020-30/11/2020). The incidence of SARS-CoV-2 infection, treatment received, early morbidity and mortality and possible risk factors for complications were analyzed. RESULTS: A total of 173 patients were analyzed (1st MIP: 66; 2nd MIP: 107). The incidence of COVID-19 was higher in the second period (14.95% vs. 4.54%). SARS-CoV-2 infection was associated with a higher rate of complications, however, no statistically significant differences were observed in morbimortality rate, either in the total sample (p=0.746) or in patients with a positive COVID-19 test (p=0.582) between both periods. Surgical treatment was found to be associated with a lower complication rate in both the first (p=0.006) and second wave (p=0.014), and it was more frequent in the second PMI (70.1 vs. 57.6%) although statistical significance was not reached (p= 0.065). CONCLUSIONS: No significant differences were observed in morbimortality of patients admitted and/or operated in the emergency setting in the two periods of maximum incidence of SARS-CoV-2 in our center. Surgical treatment was associated with a lower morbimortality rate, and it was more frequent in the second MIP.

Carcinoma papilar intraquístico no invasivo de mama en varón. Caso clínico / Noninvasive intracystic papillary carcinoma of the male breast. A case report

El carcinoma ductal in situ CDIS representa entre el 0 y el 7% de los cánceres de mama diagnosticados en varones. El carcinoma papilar intraquístico (CPI) no invasivo es una de las formas de CDIS, y por tanto una presentación extraordinariamente infrecuente de cáncer de mama. La ecografía es la técnica de imagen que mayor información aporta en el estudio de estas lesiones. El tratamiento de los casos de CDIS en varones continúa siendo un tema controvertido. Presentamos un caso de carcinoma intraquístico no invasivo de mama tratado con mastectomía parcial seguida de radioterapia y tratamiento con tamoxifeno. Sin signos de recidiva tras un año de seguimiento (AU)

Ductal carcinoma in situ (DCIS) represents between 0% and 7% of breast cancers diagnosed in men. Noninvasive intracystic papillary carcinoma is a form of DCIS and is therefore an extremely rare presentation of breast cancer. The imaging technique that provides the greatest information on these lesions is ultrasonography. Treatment of DCIS in men continues to be controversial. We present a case of noninvasive intracystic papillary carcinoma treated with partial mastectomy followed by radiotherapy and tamoxifen therapy. After 1 year of follow-up, the patient shows no signs of recurrence (AU)

[Noninvasive intracystic papillary carcinoma of the male breast. A case report]. / Carcinoma papilar intraquístico no invasivo de mama en varón. Caso clínico.

Ductal carcinoma in situ (DCIS) represents between 0% and 7% of breast cancers diagnosed in men. Noninvasive intracystic papillary carcinoma is a form of DCIS and is therefore an extremely rare presentation of breast cancer. The imaging technique that provides the greatest information on these lesions is ultrasonography. Treatment of DCIS in men continues to be controversial. We present a case of noninvasive intracystic papillary carcinoma treated with partial mastectomy followed by radiotherapy and tamoxifen therapy. After 1 year of follow-up, the patient shows no signs of recurrence.