Implantación de un protocolo fast-track en cistectomía radical en un hospital terciario / The results of implementing a fast-track protocol in radical cystectomy in a tertiary hospital

Introducción: La cistectomía radical (CR) es el procedimiento urológico asociado a las tasas más altas de morbimortalidad y estancia hospitalaria. La aplicación de programas fast-track pretende acelerar la recuperación posquirúrgica y su aplicación en cistectomía radical ha reportado resultados positivos. Objetivos: Valorar los resultados del protocolo fast-track en CR en nuestro hospital, en términos de morbimortalidad y estancia hospitalaria, comparando dichos resultados con los de los pacientes intervenidos de CR siguiendo el protocolo clásico. Así, averiguar si la aplicación del protocolo fast-track supone una reducción del número y gravedad de complicaciones y una menor estancia hospitalaria. Material y métodos: Estudio de cohortes ambispectivo de pacientes intervenidos de CR, desde enero de 2010 a octubre de 2012, por ambos protocolos, tanto clásico como fast-track. Se analizan las características de los pacientes, las variables intraoperatorias, complicaciones postoperatorias (según clasificación Clavien) y estancia hospitalaria y en reanimación. Resultados: Se incluyeron 99 pacientes, 51 siguiendo el protocolo clásico y 48 el protocolo fast-track, siendo grupos homogéneos. La estancia hospitalaria y en reanimación fue mayor en el grupo clásico que en el fast-track (29 y 2 días respectivamente frente a 17 y 1 días) Hubo menor sangrado intraoperatorio en el grupo fast-track (600 ml) que en el clásico (1.000 ml). De los 99 pacientes, 31 (60,8%) del grupo clásico presentaron alguna complicación postoperatoria mientras que en el fast-track fueron 14 (29,2%), la mayoría menores (grados 1 y 2 Clavien). En el análisis multivariado resultó significativo el tipo de protocolo y el número de comorbilidades. Conclusiones: La implantación del protocolo fast-track en CR se asoció a una disminución significativa de complicaciones intra- y postoperatorias y de estancia hospitalaria

Background: Radical cystectomy (RC) is the urological procedure associated with the highest rates of morbidity, mortality and hospital stay. The implementation of fast-track programs seeks to speed postsurgical recovery. Its application to radical cystectomy has yielded positive results. Objectives: To assess the results of the fast-track protocol in RC at our hospital, in terms of morbidity, mortality and hospital stay, comparing these results with those of patients who underwent RC following the classic protocol. To thereby ascertain whether the implementation of the fast-track protocol represents a reduced number and severity of complications and shorter hospital stays. Material and methods: Ambispective cohort study of patients who underwent RC between January 2010 and October 2012 by either protocol (classic and fast-track). We analyzed the patient characteristics, intraoperative variables, postoperative complications (according to the Clavien classification), hospital stay and recovery stay. Results: Ninety-nine patients were included, 51 following the classic protocol and 48 following the fast-track protocol. The groups were homogeneous. The hospital stay and recovery stay were longer in the classic group than in the fast-track group (29 and 2 days, respectively, vs. 17 and 1 day). There was less intraoperative bleeding in the fast track group (600 mL) than in the traditional group (1,000 mL). Of the 99 patients, 31 (60.8%) of the classic group presented a postoperative complication, while the fast-track group had 14 (29.2%), most of which were minor (Clavien degrees 1 and 2). In the multivariate analysis, the type of protocol and the number of comorbidities were significant. Conclusions: The implementation of the fast-track protocol in RC was associated with a significant reduction in intraoperative and postoperative complications and hospital stay

The results of implementing a fast-track protocol in radical cystectomy in a tertiary hospital.

BACKGROUND: Radical cystectomy (RC) is the urological procedure associated with the highest rates of morbidity, mortality and hospital stay. The implementation of fast-track programs seeks to speed postsurgical recovery. Its application to radical cystectomy has yielded positive results. OBJECTIVES: To assess the results of the fast-track protocol in RC at our hospital, in terms of morbidity, mortality and hospital stay, comparing these results with those of patients who underwent RC following the classic protocol. To thereby ascertain whether the implementation of the fast-track protocol represents a reduced number and severity of complications and shorter hospital stays. MATERIAL AND METHODS: Ambispective cohort study of patients who underwent RC between January 2010 and October 2012 by either protocol (classic and fast-track). We analyzed the patient characteristics, intraoperative variables, postoperative complications (according to the Clavien classification), hospital stay and recovery stay. RESULTS: Ninety-nine patients were included, 51 following the classic protocol and 48 following the fast-track protocol. The groups were homogeneous. The hospital stay and recovery stay were longer in the classic group than in the fast-track group (29 and 2 days, respectively, vs. 17 and 1 day). There was less intraoperative bleeding in the fast track group (600mL) than in the traditional group (1,000mL). Of the 99 patients, 31 (60.8%) of the classic group presented a postoperative complication, while the fast-track group had 14 (29.2%), most of which were minor (Clavien degrees 1 and 2). In the multivariate analysis, the type of protocol and the number of comorbidities were significant. CONCLUSIONS: The implementation of the fast-track protocol in RC was associated with a significant reduction in intraoperative and postoperative complications and hospital stay.

Análisis de los factores que condicionan el ingreso de los pacientes quirúrgicos en una unidad de críticos. Un estudio prospectivo sobre 764 pacientes intervenidos durante 1 año en un hospital universitario y de referencia / Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital

Objetivo. Valorar qué factores determinan el ingreso de los pacientes quirúrgicos en una unidad de críticos tras la cirugía. Material y métodos. Se incluyó un censo del 10% de todos los pacientes intervenidos por los servicios de Cirugía General, Cirugía Torácica, Cirugía Maxilofacial, Cirugía Vascular, Urología y Otorrinolaringología durante el año 2012. Se realizó un estudio prospectivo, observacional. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Se compararon aquellos pacientes ingresados en críticos con los ingresados en planta, y los intervenidos de urgencia con los programados, mediante la χ2 de Pearson con un intervalo de confianza del 95%. Resultados. e introdujeron en el estudio 764 pacientes, siendo ingresados 304 en críticos tras la cirugía y 460 en planta. Los antecedentes patológicos mostraron asociación estadísticamente significativa con el ingreso de los pacientes en críticos, así como el ser marcado con alto riesgo por las escalas de predicción de riesgo quirúrgico. La complejidad y duración de la cirugía mostraron una asociación estadísticamente significativa con el ingreso en críticos, así como el presentar complicaciones intraoperatorias. La cirugía de urgencia no se asoció significativamente con el ingreso en críticos de los pacientes quirúrgicos, aunque estos pacientes sí presentaron significativamente mayor número de complicaciones intraoperatorias y posoperatorias, y más exitus que los sometidos a cirugía programada. Conclusiones. Un mayor índice de ingreso en críticos de los pacientes intervenidos de urgencia se presume disminuiría la morbimortalidad quirúrgica. Protocolos específicos de ingreso para cirugía de urgencia y una mayor disponibilidad de camas podrían ser útiles en este sentido (AU)

Objective. Assess what factors determine the income of surgical patients in critical care unit after surgery. Material and methods. It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ2 of Pearson correlation with a confidence interval of 95%. Results. Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. Conclusions. A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard (AU)

[Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital]. / Análisis de los factores que condicionan el ingreso de los pacientes quirúrgicos en una unidad de críticos. Un estudio prospectivo sobre 764 pacientes intervenidos durante 1 año en un hospital universitario y de referencia.

OBJECTIVE: Assess what factors determine the income of surgical patients in critical care unit after surgery. MATERIAL AND METHODS: It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ(2) of Pearson correlation with a confidence interval of 95%. RESULTS: Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. CONCLUSIONS: A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard.

Infarto agudo de miocardio por trombosis en una paciente portadora de stent liberador de fármaco tras retirada de antiagregación / No disponible

No disponible

[Perioperative mortality: retrospective cross-sectional study of surgical patients who died between 2004 and 2008 in a tertiary care hospital]. / Mortalidad perioperatoria de los pacientes quirúrgicos: estudio transversal retrospectivo de los pacientes fallecidos en el periodo 2004 a 2008 en un hospital terciario.

OBJECTIVE: Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. MATERIAL AND METHODS: A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient's cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. RESULTS: From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who died during surgery; that pattern was similar but less marked in patients dying within 48 hours. The patients who died within 48 hours had a higher rate of postoperative hemodynamic complications; the patients who died during the week following surgery had higher rates of septic, neurologic, and respiratory complications. CONCLUSIONS: Emergency surgery stands out as an important predictor of death during or after surgery; other significant risk factors are postoperative complications.

Síndrome de Horner durante analgesia epidural para trabajo de parto causada por una posible extensión subdural / No disponible

No disponible