Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo / Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure

Introducción: La obesidad y las enfermedades asociadas a ella suponen un importante problema, y no solo sanitario, sino también económico, ya que muchas de esas patologías son subsidiarias de tratamiento farmacológico de por vida. La cirugía bariátrica y metabólica, a priori, disminuye la demanda de medicamentos de estos pacientes, pero puede condicionar otro tipo de necesidades farmacológicas. El objetivo del estudio es demostrar si existe un descenso real del gasto farmacológico tras la cirugía bariátrica. Material y métodos: Análisis retrospectivo transversal de los pacientes intervenidos en nuestro centro entre 2012 y 2016, comparando las distintas comorbilidades y los gastos farmacológicos asociados a ellas un mes antes y a los 2años de la cirugía. Resultados: Fueron intervenidos 400 pacientes. Se presentaron los resultados mostrando para cada una de las técnicas quirúrgicas estudiadas las diferencias entre la resolución de las distintas comorbilidades y el ahorro farmacológico generado. La comorbilidad más coste-efectiva del estudio fue la diabetes mellitus tipo2 (DM2). La técnica quirúrgica con mejores resultados fue el bypass metabólico, presentando una diferencia de costes tras la cirugía de 507euros mensuales (p<0,001). Conclusiones: En un seguimiento de 2años tras la cirugía bariátrica se produce un descenso en la prevalencia de las enfermedades asociadas a la obesidad y del gasto farmacológico asociado a ellas, lo que demuestra que este tipo de intervención resulta eficiente a medio plazo. (AU)

Introduction: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. Material and methods: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. Results: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). Conclusions: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term. (AU)

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < 0.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Metaanálisis: una forma básica de entender e interpretar su evidencia / Meta-Analysis: A Basic Way To Understand And Interpret Your Evidence

El metaanálisis es un método sistemático para sintetizar resultados de diferentes estudios empíricos sobre el efecto de una variable independiente, sea de intervención o tratamiento, en un resultado final preciso. Desarrollado principalmente en la investigación médica y psicológica como una herramienta para sintetizar información empírica sobre los resultados de un tratamiento, ahora el metaanálisis se usa cada vez más en las ciencias de la salud, formando parte de las revisiones sistemáticas, como una herramienta de inferencia estadística. Sin embargo, a pesar de sus indiscutibles propiedades para la síntesis de la información dispersa en la literatura y para la resolución de controversias con un alto grado de evidencia, adolece de distintos problemas en la consecución de estos objetivos. Es necesario conocer su entramado metodológico, aunque sea a un nivel básico, para valorar su validez en el logro de dichos objetivos. (AU)

Meta-analysis is a systematic method to synthesise results from different empirical studies on the effect of an independent variable, whether an intervention or treatment, on a precise outcome. These studies were mainly developed in medical and psychological research as a tool to synthesise empirical information on the results of treatment. They are currently increasingly used in health sciences, forming part of systematic reviews, as a tool for statistical inference. However, despite their undoubted usefulness for synthesising information scattered in the literature and for resolving controversies with a high grade of evidence, these studies also show various problems in achieving their aims. Familiarity with their methodological framework is essential, even at a basic level, to assess their validity in achieving their objectives. (AU)

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. / Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Melanoma esofágico primario: descripción de un caso / Primary esophageal melanoma: report of a case

Introducción: el melanoma esofágico primario es un tumor muy poco frecuente que constituye únicamente el 0,1-0,2% de las enfermedades malignas del esófago. El objetivo del estudio fue presentar el manejo de un nuevo caso clínico diagnosticado y tratado en nuestro centro. Caso clínico: paciente de 67 años que presentaba clínica de disfagia a sólidos sin otros antecedentes ni lesiones cutáneas asociadas. Se le realizó una gastroscopia, apreciándose una formación polipoide en tercio distal esofágico sugestiva de neoplasia. La biopsia fue positiva para melanoma con marcadores inmunohistoquímicos S100 y HMB45 positivos; citoqueratinas y CEA negativos. La tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) no mostraron infiltración local ni metástasis a distancia. Se practicó una esofaguectomía de Ivor-Lewis con linfadenectomía regional. La estancia postoperatoria fue de tres semanas sin producirse complicaciones postoperatorias reseñables. El estudio anatomopatológico de la pieza confirmó el diagnóstico de melanoma esofágico primario. Discusión: el pronóstico del melanoma primario de esófago es infausto, debido a que se trata de un tumor agresivo que suele diagnosticarse en fases avanzadas de la enfermedad, con presencia de invasión local y metástasis. El tratamiento de elección actualmente es la cirugía, obteniéndose resultados limitados con el resto de terapias adyuvantes (AU)

Introduction: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. Case report: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. Discussion: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results (AU)

Primary esophageal melanoma: report of a case.

INTRODUCTION: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. CASE REPORT: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. DISCUSSION: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.