Cómo minimizar los cambios radiológicos laterales en la osteotomía valguizante de adición medial de rodilla

Objetivo: estudiar la relación entre posición del injerto en Osteotomía Valguizante de Adición (OVA) en rodilla, los cambios radiológicos experimentados por la rótula y la pendiente tibial y su correlación clínica. Material y métodos: estudio retrospectivo de 10 pacientes operados de OVA. Medimos el cambio experimentado tras la osteotomía en Índice de Catón y la pendiente tibial y su relación con la ubicación del injerto. Valoración clínica mediante test de Lisholm y WOMAC. Resultados: edad media de 49.5 años, seguimiento medio de 32,2 meses. Se observa un cambio estadísticamente significativo de 1,45º en la pendiente tibial y de 0,15 unidades (Índice Catón) en la altura de la patela, pero sin correlación con la clínica. La ubicación del injerto en el cuadrante posterior se halló en el 80% de los casos. Conclusión : la osteotomía valguizante de adición medial tiene buenos resultados clínicos. Los cambios en la pendiente tibial y en la patela son menores cuanto más posterior es la ubicación del injerto.Objectives: we investigated changes in patellar height and tibial inclination angle after open-wedge high tibial osteotomy, the effect of these changes on patient satisfaction and the correlation with the graft position. Methods: retrospective study of 10 knees who underwent open-wedge proximal tibial osteotomy with allograft and medial plate for medial compartment. Were measured pre- and postoperatively tibial inclination angle, and patellar height (Caton Index), and we study the correlation of these changes with the location of the graft. Clinical evaluations were made using the Lysholm and WOMAC score. Results: the mean age was 49.5 years, the mean follow up was 32,2 months. The mean increase in the tibial inclination angle was 1,45 ° (p<0.05) and the mean of decrease in patellar height was 0.15 Units Caton Index (p<0.05). There weren’t correlation between radiological changes and patients satisfaction. The graft localization was posterior in 80% of patients. Conclusion: the open-wedge tibial osteotomy has good results and high clinical satisfaction. Changes in the tibial slope and the patellar height are lower if the graft position is posterior

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

Delaying surgery for patients with a previous SARS-CoV-2 infection

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Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p&lt;0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology