Resultados de morbimortalidad en cáncer colorrectal en paciente quirúrgico frágil. Implementación de un Área de Atención al Paciente Quirúrgico Complejo / Colorectal carcinoma in the frail surgical patient. Implementation of a Work Area focused on the Complex Surgical Patient improves postoperative outcome
Cir. Esp. (Ed. impr.)
; 96(3): 155-161, mar. 2018. graf, tab
Article
in Spanish
| IBECS
| ID: ibc-171863
Responsible library:
ES1.1
Localization: BNCS
RESUMEN
INTRODUCCIÓN:
La edad avanzada y la presencia de comorbilidades repercuten en la morbimortalidad postoperatoria del paciente quirúrgico frágil. El objetivo de este estudio es valorar los resultados de morbimortalidad tras cirugía por cáncer colorrectal en el paciente quirúrgico frágil tras la implementación de un Área de Atención al paciente Quirúrgico Complejo (AAPQC).MÉTODOS:
Estudio retrospectivo con recogida prospectiva de datos. Un total de 91 pacientes consecutivos considerados como frágiles (ASAIV o ASAIII con Barthel < 80 i/o Pfeiffer>3) fueron intervenidos entre 2013 y 2015 con diagnóstico de cáncer colorrectal con intención curativa. Grupo I (AAPQC) 35 pacientes incluidos en AAPQC durante 2015. Grupo II (No AAPQC) 56 pacientes intervenidos entre 2013 y 2014 previa implementación del AAPQC. Se analizó homogeneidad de grupos, complicaciones, estancia media, mortalidad, reintervenciones, reingresos y costes en función del GRD.RESULTADOS:
No se encontraron diferencias significativas en edad, sexo, ASA, índex de masa corporal, estadio tumoral y tipo de intervención quirúrgica entre los dos grupos. Las complicaciones mayores (Clavien-DindoIII-IV) (11,4% vs. 28,5%, p = 0,041), la estancia media (12,6 ± 6 días vs. 15,2 ± 6 días, p = 0,043), los reingresos (11,4% vs. 28,3%, p = 0,041) y el peso específico del episodio (3,29 ± 1 vs 4,3 ± 1, p = 0,008) fueron significativamente menores en el grupo AAPQC. No hubo diferencias en re intervenciones (6,2% vs. 5,3%) ni mortalidad (6,2% vs 7,1%). El 96,9% de pacientes del grupo I manifestó una atención y calidad de vida satisfactoria.CONCLUSIONES:
La implementación de una AAPQC en pacientes frágiles que deben ser intervenidos de cáncer colorrectal comporta una reducción de las complicaciones, estancia y reingresos, y es una medida coste-efectivaABSTRACT
INTRODUCTION:
Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA).METHODS:
Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASAIII or IV, Barthel<80 and/or Pfeiffer>3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. GroupI 35 patients optimized by the CSPA during 2015. Group II 56 No-CSPA patients, treated prior to CSPA implementation, during 2014-2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG).RESULTS:
There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-DindoIII-IV) (12.5% vs. 28.5%, P = .04), hospital stay (12.6 ± 6 days vs. 15.2 ± 6 days, P = 0.041), readmissions (12.5% vs. 28.3%, P < 0.041), and patient episode cost weighted according to DRG (3.29 ± 1 vs. 4.3 ± 1, P = 0.008) were statistically inferior in Group CSPA. There were no differrences in reoperations (6.2% vs. 5.3%) or mortality (6.2% vs. 7.1%). 96.9% of patients of Group I manifested having received a satisfactory attention and quality of life.CONCLUSIONS:
Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement
Full text:
Available
Collection:
National databases
/
Spain
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
/
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Goal 9: Noncommunicable diseases and mental health
/
Target 3.4: Reduce premature mortality due to noncommunicable diseases
/
Colon and Rectum Cancers
Database:
IBECS
Main subject:
Colorectal Neoplasms
/
Comprehensive Health Care
Type of study:
Observational study
Aspects:
Patient-preference
Limits:
Aged
/
Humans
Language:
Spanish
Journal:
Cir. Esp. (Ed. impr.)
Year:
2018
Document type:
Article
Institution/Affiliation country:
Hospital Sant Joan Despí Moisès Broggi/España