Cirugía robótica en patología quirúrgica benigna y maligna: urología, cirugía general y digestiva, cirugía cardiotorácica, ginecología, endocrinología, oftalmología y cirugía de cabeza y cuello. Capítulo II: cirugía urológica, ginecológica, general y digestiva

Cirurgia robòtica; Tècniques quirúrgiques; InnovacióCirugía robótica; Técnicas quirúrgicas; InnovaciónRobotic surgery; Surgical techniques; InnovationS'ha avaluat, de manera específica, l’eficàcia o l’efectivitat, la seguretat i l’eficiència de la cirurgia assistida per robot en comparació amb la cirurgia oberta o la cirurgia laparoscòpica en un grup d’indicacions de patologia benigna o maligna en les especialitats de cirurgia urològica, ginecològica i general i digestiva. De manera addicional, s’ha analitzat l’activitat de la cirurgia robòtica a Espanya per a les indicacions ginecològiques en els últims cinc anys.Se ha evaluado, de forma específica, la eficacia o la efectividad, la seguridad y la eficiencia de la cirugía asistida por robot en comparación con la cirugía abierta o la cirugía laparoscópica en un grupo de indicaciones de patología benigna o maligna en las especialidades de cirugía urológica, ginecológica y general y digestiva. De forma adicional, se ha analizado la actividad de la cirugía robótica en España para las indicaciones ginecológicas en los últimos cinco años.The aim of the study is to determine whether robot-assisted surgery has sufficient evidence to be included in the common portfolio of the UK NHS healthcare services. To this end, the efficacy or effectiveness, safety and efficiency of robot-assisted surgery compared to open surgery or laparoscopic surgery in a group of indications of benign or malignant pathology in the specialities of urological, gynaecological and general and digestive surgery has been specifically evaluated. In addition, the activity of robotic surgery in Spain for gynaecological indications in the last five years has been analysed.Este documento ha sido realizado por la Agència de Qualitat i Avaluació Sanitàries de Catalunya en el marco de la financiación del Ministerio de Sanidad para el desarrollo de las actividades del Plan anual de Trabajo de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del SNS, aprobado en el Pleno del Consejo Interterritorial del SNS de 28 de octubre de 2020 (conforme al Acuerdo del Consejo de Ministros de 9 de diciembre de 2020)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care