Importancia de los parámetros clínicos analíticos de la sepsis grave en la uropatía obstructiva

INTRODUCTION. Obstructive uropathy (OU) is very prevalent. Its level of bacteremia is high, complicating up to 40% of cases with severe sepsis.   OBJECTIVE The purpose of this clinical case report is to describe medical profiles of patients with Obstructive Uropathy at the HCU of Valladolid. MATERIALS AND METHODS All patients of legal age urgently admitted with the diagnosis of UO were included. An observational and descriptive prospective study was designed to classify patients into two groups: severe sepsis patients and non-severe sepsis patients. A descriptive and inferential statistical analysis was carried out, considering a p <0.05 as significant. The quantitative variables were expressed in an interquartile range; medians and the qualitative ones in percentages and absolute numbers. Demographic and clinical data were analysed using Pearson's Chi-square test (Ӽ2) for categorical variables, and the U - Mann - Whitney test was used for continuous variables. OUTCOMES: Our series consists of 65 patients. UO occurred preferentially in men (63.07%).  The most frequent comorbidities were HBP and obesity. In the majority of patients, OU was incomplete and secondary to lithiasis. 64.61% of them developed severe sepsis. The urine culture was positive in 20.63% of the cases, being Escherichia coli the most frequent microorganism. Urinary diversion was urgently performed in 40% of the patients. CONCLUSION: There is an analytical profile characteristic of severe sepsis maintained over time, consisting of an increased percentage of neutrophils and procalcitonin and decreased amount of bicarbonate in the bloodINTRODUCCIÓN: La uropatía obstructiva (UO) es muy prevalente. Su nivel de bacteriemia es elevado complicándose hasta en el 40% de los casos con una sepsis grave. OBJETIVO: Describir el perfil clínico del paciente con UO del HCU de Valladolid. MATERIAL Y MÉTODOS: Se diseña un estudio observacional y descriptivo prospectivo. Se incluyó a todo paciente mayor de edad ingresado con carácter de urgencia con el diagnóstico de UO. Los pacientes fueron clasificados en dos grupos en función de si desarrollando sepsis grave (SG) o no (NSG). Se realizó un análisis estadístico descriptivo e inferencial considerándose una p < 0,05 como significativa.  Las variables cuantitativas se expresaron en rango intercuartílico y medianas y las cualitativas en porcentajes y números absolutos. Los datos demográficos y clínicos se analizaron mediante el test Chi - cuadrado de Pearson (Ӽ2) para las variables categóricas, y para las variables continuas el test U - Mann - Whitney. RESULTADOS: Nuestra serie consta de 65 pacientes. La UO ocurrió preferentemente en varones (63,07%). La HTA y la obesidad fueron las comorbilidades más frecuentes. La mayoría de la UO eran incompletas y secundarias a litiasis. El 64,61% desarrolló una SG. El Cultivo de orina fue positivo en el 20,63% de los casos siendo el microorganismo más frecuente la E. coli. En el 40% de los pacientes se realizó una derivación urinaria urgente. CONCLUSIÓN: Existe un perfil analítico característico de SG mantenido en el tiempo que consiste en la elevación en sangre del porcentaje de neutrófilos, de procalcitonina y disminución de bicarbonato

Importancia de los parámetros clínicos analíticos de la sepsis grave en la uropatía obstructiva

INTRODUCCIÓN: La uropatía obstructiva (UO) es muy prevalente. Su nivel de bacteriemia es elevado complicándose hasta en el 40% de los casos con una sepsis grave. OBJETIVO: Describir el perfil clínico del paciente con UO del HCU de Valladolid. MATERIAL Y MÉTODOS: Se diseña un estudio observacional y descriptivo prospectivo. Se incluyó a todo paciente mayor de edad ingresado con carácter de urgencia con el diagnóstico de UO. Los pacientes fueron clasificados en dos grupos en función de si desarrollando sepsis grave (SG) o no (NSG). Se realizó un análisis estadístico descriptivo e inferencial considerándose una p 0,05 como significativa.  Las variables cuantitativas se expresaron en rango intercuartílico y medianas y las cualitativas en porcentajes y números absolutos. Los datos demográficos y clínicos se analizaron mediante el test Chi - cuadrado de Pearson (Ӽ2) para las variables categóricas, y para las variables continuas el test U - Mann - Whitney. RESULTADOS: Nuestra serie consta de 65 pacientes. La UO ocurrió preferentemente en varones (63,07%). La HTA y la obesidad fueron las comorbilidades más frecuentes. La mayoría de la UO eran incompletas y secundarias a litiasis. El 64,61% desarrolló una SG. El Cultivo de orina fue positivo en el 20,63% de los casos siendo el microorganismo más frecuente la E. coli. En el 40% de los pacientes se realizó una derivación urinaria urgente. CONCLUSIÓN: Existe un perfil analítico característico de SG mantenido en el tiempo que consiste en la elevación en sangre del porcentaje de neutrófilos, de procalcitonina y disminución de bicarbonato

Valoración inmunológica en la detección de la infección perioperatoria en pacientes intervenidos por cáncer de colon

Objective: evaluate the usefulness of quantification in the concentration of leukocytes and lymphocyte subpopulations in blood to identify the presence of anastomotic leak, in patients operated on for colon cancer, even before the appearance of clinical symptoms. Methods: Prospective observational study that consists of extracting different blood samples the day before surgery at 24 hours, 72 hours, and 120 hours post-surgery, to determine the lymphocyte subpopulations in patients that required a scheduled surgical intervention of colon cancer. Results: Sixty-two patients who underwent surgery for colon cancer were analysed for a period of 22 months, 7 of which presenting anastomotic leak. It was observed that presenting 379 cells/mm3 of LTCD4 at 72 hours after surgery indicated an anastomotic leak risk of 19.7 times more than those who had higher figures (p = 0.025). Conclusions: The monitoring of the lymphocyte subpopulations and more specifically of the LTCD4 during the perioperative period in colon cancer can serve to early detect the presence of anastomotic leak.Objetivos: Evaluar la utilidad de la cuantificación en la concentración de leucocitos y subpoblaciones linfocitarias en sangre para identificar la presencia de fuga anastomótica, en pacientes intervenidos de cáncer de colon, incluso antes de la aparición de síntomas clínicos. Método: Estudio prospectivo observacional que consiste en extraer diferentes muestras de sangre el día previo a la intervención, a las 24 horas, 72 horas y 120 horas post-cirugía, para determinar las subpoblaciones linfocitarias en pacientes que requirieron una intervención quirúrgica programada de cáncer de colon. Resultados: Se analizaron 62 enfermos intervenidos de cáncer de colon durante un periodo de 22 meses, de los cuales 7 pacientes presentaron fuga anastomótica, observándose que presentar ≤ 379 células/mm3 de LTCD4 a las 72 horas de la cirugía indicaba un riesgo de fuga anastomótica de 19,7 veces más respecto de aquellos que tienen cifras superiores (p=0,025). Conclusión: La monitorización de las subpoblaciones linfocitarias y más concretamente de los LTCD4 durante el periodo perioperatorio en el cáncer de colon puede servir para detectar de manera precoz la presencia de fuga anastomótica

Valoración inmunológica en la detección de la infección perioperatoria en pacientes intervenidos por cáncer de colon

Objetivos: Evaluar la utilidad de la cuantificación en la concentración de leucocitos y subpoblaciones linfocitarias en sangre para identificar la presencia de fuga anastomótica, en pacientes intervenidos de cáncer de colon, incluso antes de la aparición de síntomas clínicos. Método: Estudio prospectivo observacional que consiste en extraer diferentes muestras de sangre el día previo a la intervención, a las 24 horas, 72 horas y 120 horas post-cirugía, para determinar las subpoblaciones linfocitarias en pacientes que requirieron una intervención quirúrgica programada de cáncer de colon. Resultados: Se analizaron 62 enfermos intervenidos de cáncer de colon durante un periodo de 22 meses, de los cuales 7 pacientes presentaron fuga anastomótica, observándose que presentar ≤ 379 células/mm3 de LTCD4 a las 72 horas de la cirugía indicaba un riesgo de fuga anastomótica de 19,7 veces más respecto de aquellos que tienen cifras superiores (p=0,025). Conclusión: La monitorización de las subpoblaciones linfocitarias y más concretamente de los LTCD4 durante el periodo perioperatorio en el cáncer de colon puede servir para detectar de manera precoz la presencia de fuga anastomótica

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery