Factores pronósticos en la cirugía del síndrome del túnel carpiano / Prognostic factors in carpal tunnel syndrome surgerydj

Introducción: El síndrome del túnel carpiano es la neuropatía periférica más frecuente y afecta casi al 3% de la población general. Aunque los estudios electromiográficos se han convertido en el patrón oro para diagnóstico, en la actualidad existe controversia entre la correlación de los datos clínicos y electromiografía para su diagnóstico. Este trabajo tiene como objetivo el estudio de esta correlación, y determinar los posibles factores pronósticos en esta patología. Material y métodos: Se revisaron retrospectivamente a 139 pacientes intervenidos quirúrgicamente entre Enero de 1995 y Diciembre de 2008. A todos se les realizó preoperatoriamente un estudio electromiográfico donde se recogió latencia y velocidad de conducción motoras, velocidad de conducción sensitiva y exploración clínica, en especial los signos de Tinel y Phalen, con el fin de correlacionarlos con la sintomatología postoperatoria final. Para establecer si hubo o no diferencias estadísticamente significativas se determinaron mediante la T-Student y χ². Resultados: Preoperatoriamente existe una correlación clínica (p < 0.05) entre los signos clínicos de Tinel y Phalen con el grado electrofisiológico de compresión. Igualmente, existe correlación entre la persistencia de la clínica en el postoperatorio con la afectación de la latencia y velocidad de conducción motora objetivada en los estudios electrofisiológicos preoperatorios. Conclusión: Los estudios electrofisiológicos en el diagnóstico del síndrome del túnel carpiano poseen un valor añadido pronóstico con respecto al resultado final tras la cirugía.

Introduction: Carpal tunnel syndrome is the most frequent peripheral neuropathy and it affects nearly 3% of the general population. Although electromyography tests have become the gold standard for diagnosis, currently there is controversy between the correlation of clinical data and electromyography for diagnosis. The purpose of this work is to study this correlation and determine the possible prognostic factors in this pathology. Material and methods: 139 patients who underwent surgery were reviewed retrospectively between January 1995 and December 2008. All patients had an electromyography preoperatively to obtain motor conduction rate and latency, sensitive conduction rate and clinical examination, especially the Tinel and Phalen signs in order to correlate them with the final postoperative symptoms. In order to establish if there were statistically significant differences, these were determined through the T-Student and χ2. Results: Preoperatively, there is a clinical correlation (p < 0.05) between the Tinel and Phanel clinical signs with the compression electrophysiological grading. Likewise, there is a correlation between clinical persistence in the postoperative period with motor conduction rate and latency involvement specified in the preoperative electrophysiological tests. Conclusion: Electrophysiological tests in the diagnosis of carpal tunnel syndrome have an added prognostic value with regards to the final result after surgery.

[Prognosis factors in carpal tunnel syndrome surgery]. / Factores pronósticos en la cirugía del síndrome del túnel carpiano.

INTRODUCTION: Carpal tunnel syndrome is the most frequent peripheral neuropathy and it affects nearly 3% of the general population. Although electromyography tests have become the gold standard for diagnosis, currently there is controversy between the correlation of clinical data and electromyography for diagnosis. The purpose of this work is to study this correlation and determine the possible prognostic factors in this pathology. MATERIAL AND METHODS: 139 patients who underwent surgery were reviewed retrospectively between January 1995 and December 2008. All patients had an electromyography preoperatively to obtain motor conduction rate and latency, sensitive conduction rate and clinical examination, especially the Tinel and Phalen signs in order to correlate them with the final postoperative symptoms. In order to establish if there were statistically significant differences, these were determined through the T-Student and chi2. RESULTS: Preoperatively, there is a clinical correlation (p < 0.05) between the Tinel and Phanel clinical signs with the compression electrophysiological grading. Likewise, there is a correlation between clinical persistence in the postoperative period with motor conduction rate and latency involvement specified in the preoperative electrophysiological tests. CONCLUSION: Electrophysiological tests in the diagnosis of carpal tunnel syndrome have an added prognostic value with regards to the final result after surgery.

[Cost-effectiveness of a hallux valgus day-surgery program]. / Coste-efectividad del proceso hallux valgus en cirugía mayor ambulatoria.

INTRODUCTION: The development of one-day surgery units has shown to be a better use of health resources without reducing quality. The objective of this study was to evaluate the effectiveness and quality criteria of ambulatory surgery program in the Hallux valgus process. MATERIAL AND METHODS: A retrospective study was conducted on a sample of 753 patients who underwent a Hallux valgus process at our institution between 2002 and 2012 (292 in ambulatory surgery cohort and 461 in hospitalization group). The cost-process was evaluated using the Weighted Care Unitas a measuring unit. Secondary data were collected as regards discharge criteria and patient satisfaction. RESULTS: A significant difference was found between Weighted Care Unit spending on in-patient surgery and out-patient surgery. Both samples were comparable and no differences were found between diagnosis and intervention. The admission rate after ambulatory surgery was 2.39%, and the substitution index increased to 56.04%. The ambulatory surgery program was given a satisfaction rating of 84.6 out of 100. CONCLUSIONS: The results of our study indicate that it is possible to maximize the substitution index of the Hallux valgus process leading to a better use of resources and a high degree of patient satisfaction.

Coste-efectividad del proceso hallux valgus en cirugía mayor ambulatoria / Cost-effectiveness of a hallux valgus day-surgery program

Introducción. El desarrollo de las unidades de cirugía mayor ambulatoria ha puesto de manifiesto una mejor utilización de los recursos sanitarios sin mermar la calidad de los mismos. El objetivo del trabajo es valorar la eficacia del programa de cirugía mayor ambulatoria en el proceso Hallux valgus y sus criterios de calidad. Material y métodos. Se analizan retrospectivamente todos los pacientes intervenidos del proceso Hallux valgus en nuestro centro entre de 2002 y 2012 obteniendo una muestra de 753 pacientes (292 en el grupo de cirugía mayor ambulatoria y 461 en el grupo de hospitalización). Se recogen los datos relativos al paciente y los datos relativos al coste, proceso utilizando como unidad de medida la unidad ponderada asistencial. Secundariamente se recogieron los datos en cuanto a los criterios de alta y satisfacción de los pacientes. Resultados. Se encontró una diferencia muy significativa entre el gasto en la unidad ponderada asistencial de pacientes hospitalizados y los que se intervinieron en cirugía mayor ambulatoria. Ambas muestras eran comparables y no se encontraron diferencias demográficas ni de tipos de intervención. El índice de ingreso poscirugía mayor ambulatoria fue de 2,39% y el de sustitución creció hasta el 56,04%. Se obtuvo un índice de satisfacción de 84,6 puntos sobre 100 en el programa de cirugía ambulatoria. Conclusiones. Los resultados de nuestro estudio indican que es posible incrementar al máximo el índice de sustitución del proceso Hallux valgus consiguiendo una mejor utilización de los recursos y con un alto grado de satisfacción de los pacientes (AU)

Introduction. The development of one-day surgery units has shown to be a better use of health resources without reducing quality. The objective of this study was to evaluate the effectiveness and quality criteria of ambulatory surgery program in the Hallux valgus process. Material and methods. A retrospective study was conducted on a sample of 753 patients who underwent a Hallux valgus process at our institution between 2002 and 2012 (292 in ambulatory surgery cohort and 461 in hospitalization group). The cost-process was evaluated using the Weighted Care Unitas a measuring unit. Secondary data were collected as regards discharge criteria and patient satisfaction. Results. A significant difference was found between Weighted Care Unit spending on in-patient surgery and out-patient surgery. Both samples were comparable and no differences were found between diagnosis and intervention. The admission rate after ambulatory surgery was 2.39%, and the substitution index increased to 56.04%. The ambulatory surgery program was given a satisfaction rating of 84.6 out of 100. Conclusions. The results of our study indicate that it is possible to maximize the substitution index of the Hallux valgus process leading to a better use of resources and a high degree of patient satisfaction (AU)

[Bone healing after surgery for seudarthrosis of the carpal scaphoid]. / Consolidación tras la cirugía de la seudoartrosis del escafoides carpiano.

INTRODUCTION: The controversy around the treatment of carpal scaphoid pseudoarthrosis has an important place in traumatology. The purpose of this paper is to compare bone healing after surgery for carpal scaphoid pseudarthrosis. MATERIAL AND METHODS: This is a retrospective study of the 50 cases of carpal scaphoid pseudarthrosis treated from 1992 to 2010. Data on sex, age, involved side, and smoking were collected. Pseudarthrosis was typified according to the Herbert and Fisher classification. We considered the surgical technique used, the time elapsed between the initial trauma and surgery, the presence or absence of healing, and the postoperative healing time and complications. RESULTS: The sample included 49 males (98%) and one female (2%). According to Herbert and Fisher, 45 patients (90%) had D1 pseudarthrosis and 5 patients (10%) had D2 pseudarthrosis. Mean time between the fracture and surgery was 30 months (2-345). The surgical technique used was percutaneous without opening and curettage of the pseudarthrosis focus in 8 patients (16%), curettage and osteosynthesis screw in 7 patients (14%), and curettage, graft and internal fixation with Kirschner nails or screws in the remaining 34 patients (70%). Thirty-four patients (68%) achieved bone healing. CONCLUSIONS: The delayed diagnosis and treatment of scaphoid pseudarthrosis is the most important prognostic factor affecting surgical success (p < 0.001).