Unidad de diagnóstico rápido (UDR) en patología tumoral

Objetivos: Desarrollar una UDR, vinculada al Servicio de Urgencias Hospitalario (SUH), proporcionando prioridad en el radiodiagnóstico y mayor accesibilidad a las consultas de especializada, supone un abordaje de la patología tumoral más dinámico. Nuestro objetivo fue analizar el impacto de la UDR en el manejo de dicha patología. Metodología: Estudio descriptivo, retrospectivo, de base poblacional, realizado en la Clínica USP-Palmaplanas, hospital de 150 camas Analizando el manejo del total de pacientes con tumores atendidos en la UDR desde abril 2006 a marzo 2008. Se utilizaron los indicadores de actividad y calidad creados para dicho fin. Resultados: Total pacientes atendidos en la UDR 2473, total pacientes con diagnóstico de patología tumoral 73. Tiempo de espera desde su atención en el SUH hasta valoración en la UDR (<48h 41%, 2-4 días 36%), tiempo de espera desde atención inicial- final en las UDR (mismo día 17%, <8 días 64%), tiempo de espera desde alta UDR hasta su atención para el abordaje terapéutico (<48h en el 91%), se cursaron 11 ingresos hospitalarios tras el diagnóstico desde la UDR. Conclusiones: La UDR permite agilizar el diagnóstico y tratamiento precoces de la patología tumoral, mejorando claramente la eficiencia y la seguridad con una reducción en la estancia media hospitalaria y en la carga emocional del paciente.Objectives: The implementation of a Hospital Emergency Unit based RDU in order to prioritise diagnostic imaging and the access to specialised outpatient clinics, has dynamized the management of patients first diagnosed with cancer. Our objective was to analyze the impact of an RDU in the management of this group of patients. Methods: Descriptive, retrospective study of the population seen at USP Palmaplanas Clinic, a 150 bed hospital, which analyses the management of patients seen in the RDU from April 2006 to March 2008. Activity and quality indicators were created to support this study. Results: Total number of patients seen in the RDU: 2473. 73 of these patients were diagnosed with possible cancer. Waiting times to be seen in RDU from the Emergency Unit: <48 hours in 41% of the cases, 2-4 days in 36%. Waiting times from first visit at RDU to last visit: same day in 17%, <8 days in 64%. Waiting times from first visit to RDU to treatment: <48 hours in 91% of the cases. 11 patients were admitted to hospital for management. Discussion: RDU allows a dynamic management of patients with cancer, from first diagnosis to early treatment, improving patient care, efficiency and safety. It also reduces hospital stay and reduces patients’ emotional distress

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit.

This is the peer reviewed version of the following article: , (2018), Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit. Colorectal Dis, 20: 15-32. doi:10.1111/codi.14362, which has been published in final form at https://doi.org/10.1111/codi.14362. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP. CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection