Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis.

BACKGROUND: Several univariate and multivariate studies have already identified the number of stapler firings for laparoscopic rectal transection for rectal cancer as an independent risk factor for anastomotic leakage. The aim of this study was to perform a systematic review and meta-analysis of the anastomotic leakage rate in laparoscopic rectal surgery according to the need of using one or two stapler firings for rectal transection. METHODS: PubMed, Ovid, the Cochrane Library database and ClinicalTrials.gov were searched. All of the statistical analyses were performed using Revman software. RESULTS: Five studies were included (1267 patients). The overall anastomotic leakage rate was 5.5% [0.7-8.4%]. Anastomotic leak occurred in 3.5% (17/491) of the cases where 1 stapler firing was used versus 6.7% (50/786) of the cases in which 2 firings were needed (50/786). Two stapler firings were significantly associated with an increased risk of anastomotic leakage (OR 2.44, 95% CI 1.34-4.42, p = 0.003, I2 = 1%). CONCLUSIONS: Our systematic review and meta-analysis suggest that two firings imply a higher rate of anastomotic leak than a single firing after laparoscopic rectal surgery with a double stapling technique. Coloproctologists should strive to reduce the number of linear stapler firings and try to transect the rectum with a single firing.

Perfil del usuario de un servicio de urgencias hospitalarias. Hiperfrecuentación / Characteristics of hospital emergency departments users. Frequent users

Objetivo: Describir la población que acude a Urgencias hospitalarias e identificar las causas de dichas visitas, así como describir el perfil de los que las visitan de forma repetitiva. Método: Estudio descriptivo de visitas y personas que acudieron en 2013. Se han clasificado como infrecuentes si realizaron de una a 3 visitas al año, frecuentes si realizaron de 4 a 9, e hiperfrecuentadores 10 o más. Resultados: En 2013 hubo 86.673 visitas. Se produjeron más visitas en verano y diciembre, y con más visitas en martes, lunes y domingo. El diagnóstico más frecuente fue «lesiones y envenenamientos» (24,3%) y el segundo fue «síntomas, signos y estados mal definidos» (17,1%). En la mayoría de las visitas el destino al alta fue el domicilio (90,6%). En 2013 visitaron urgencias 51.672 personas (50,8% mujeres y 10,2% menores de 15 años). Las personas entre 31 y 50 años y los mayores de 65 años acudieron frecuentemente. Las tasas de frecuentación eran mayores en las personas de zonas cercanas al hospital. Un total de 237 personas (0,5%) realizaron 10 o más visitas en el año. De ellas, 81 acudieron por causas no justificadas. Conclusiones: Las visitas debidas a «estados mal definidos» no son despreciables, sería interesante profundizar en estas causas para establecer medidas. La distancia parece determinante a la hora de acudir al hospital. No se observa relación entre el nivel socioeconómico y frecuentación. La hiperfrecuentación aumentó con la edad y con patología crónica asociada, aunque los hiperfrecuentadores con visitas no justificadas eran más jóvenes

Objective: To present an assessment of the different profiles of patients that visit the emergency department, including a description of the illness leading to such visits, as well to describe the profiles of individuals who visit with high frequency. Method: The study was carried out during 2013. Users were classified as infrequent if they made 1 to 3 visits per year, frequent if they made 4 to 9, and hyper-frequent if they visited at least 10 times. Results: There were 86,673 visits in 2013. There were more visits in July, August and December. Tuesday, followed by Monday and Sunday, were the days that had the highest frequency of visits. The most frequent diagnosis at discharge was "injuries and poisonings" (24.3%), followed by "poorly defined signs, symptoms and status (17.1%) of the visits corresponded to poorly defined states. The discharge to home rate was 90.6%. Out of the 51,672 people who visited the hospital in 2013, 50.8% were female, and 10.2% were under 15 years. Those patients between The ages of 31 and 50, and those over 65 had the highest frequency rate. People living closer to the hospital had higher frequency rate .There were 237 people (0.5%) who made at least 10 visits, and among those, 81 people for no justifiable reason. Conclusions: An in-depth analysis of the visits due to "poorly defined signs, symptoms and status" would be interesting. The distance to the hospital seems to be determining factor for frequent visits. There is no relationship between socioeconomic status and the number of visits. The frequency of visits increases with age and associated chronic disease, although the high-frequency users with unjustified visits were younger

[Characteristics of hospital emergency departments users. Frequent users]. / Perfil del usuario de un servicio de urgencias hospitalarias. Hiperfrecuentación.

OBJECTIVE: To present an assessment of the different profiles of patients that visit the emergency department, including a description of the illness leading to such visits, as well to describe the profiles of individuals who visit with high frequency. METHOD: The study was carried out during 2013. Users were classified as infrequent if they made 1 to 3 visits per year, frequent if they made 4 to 9, and hyper-frequent if they visited at least 10 times. RESULTS: There were 86,673 visits in 2013. There were more visits in July, August and December. Tuesday, followed by Monday and Sunday, were the days that had the highest frequency of visits. The most frequent diagnosis at discharge was "injuries and poisonings" (24.3%), followed by "poorly defined signs, symptoms and status (17.1%) of the visits corresponded to poorly defined states. The discharge to home rate was 90.6%. Out of the 51,672 people who visited the hospital in 2013, 50.8% were female, and 10.2% were under 15 years. Those patients between The ages of 31 and 50, and those over 65 had the highest frequency rate. People living closer to the hospital had higher frequency rate .There were 237 people (0.5%) who made at least 10 visits, and among those, 81 people for no justifiable reason. CONCLUSIONS: An in-depth analysis of the visits due to "poorly defined signs, symptoms and status" would be interesting. The distance to the hospital seems to be determining factor for frequent visits. There is no relationship between socioeconomic status and the number of visits. The frequency of visits increases with age and associated chronic disease, although the high-frequency users with unjustified visits were younger.