Application of the REAL-score prognostic index in decision making in rectal cancer surgery.

BACKGROUND: Colorectal anastomosis leak (AL) is the most feared complication of rectal cancer surgery (1-19%) as it increases morbidity and mortality and worsens oncological outcomes in terms of local recurrence and survival. The publication of the REAL-score index makes it possible to predict the risk of AL and compare the expected results with those obtained. METHOD: Observational, descriptive, longitudinal and retrospective study of patients operated on for rectal cancer at the Miguel Servet University Hospital, in Zaragoza, Spain, in 2019. Statistical analysis of morbidity and mortality outcome variables and the REAL-score index using ROC curves. RESULTS: Of 80 patients operated on for rectal cancer, colorectal anastomosis was performed in 52 and temporary ileostomy in 11 (21.2%). Morbidity was high (38.4%), but severe only in 7.7% (Clavien-Dindo IIIb), with no deaths. There were four dehiscences: one type B and three type C. A direct relationship between high risk of AL and the practice of temporary stoma is observed when the cut-off point of the REAL-score exceeds 14.74%. CONCLUSIONS: REAL-score can help in decision-making in rectal cancer surgery. Above a cut-off point, the risk of AL would imply a selective ileostomy.

ANTECEDENTES: La dehiscencia de la anastomosis colorrectal (DA) es la complicación más temida de la cirugía del cáncer de recto (1-19%), pues incrementa la morbimortalidad y empeora los resultados oncológicos en términos de recidiva local y supervivencia. La publicación del índice REAL-score permite predecir el riesgo de DA y comparar los resultados esperados con los obtenidos. MÉTODO: Estudio observacional, descriptivo, longitudinal y retrospectivo, de pacientes intervenidos de cáncer de recto en el Hospital Universitario Miguel Servet, en Zaragoza, España, en 2019. Análisis estadístico de variables resultado de morbimortalidad y del índice REAL-score mediante curvas ROC. RESULTADOS: De 80 pacientes intervenidos de cáncer de recto, se realizó anastomosis colorrectal en 52 e ileostomía temporal en 11 (21.2%). La morbilidad fue alta (38.4%), pero grave solo en el 7.7% (Clavien-Dindo IIIb), sin ningún fallecimiento. Hubo cuatro dehiscencias: una de tipo B y tres de tipo C. Se observa una relación directa entre alto riesgo de DA y la práctica de estoma temporal cuando el punto de corte del REAL-score supera el 14.74%. CONCLUSIONES: El REAL-score puede ayudar en la toma de decisiones en la cirugía del cáncer de recto. Por encima de un punto de corte, el riesgo de DA implicaría ileostomía selectiva.

[Quality improvement program of nosocomial infection in colorectal cancer surgery]. / Programa de mejora de la infección nosocomial en cirugía por cáncer colorrectal.

BACKGROUND AND OBJECTIVE: The surgical-site infection (SSI) is a complication of colorectal neoplasia surgery. The objectives of the study were to identify the SSI risk factors associated with colon surgery and to describe a strategy of quality improvement using surgical-site rates. PATIENTS AND METHOD: Prospective cohort study of in-patients undergoing neoplasia colorectal surgery between 1st July 2002 to 30th June 2003. A descriptive analysis was implemented. Benchmarking was used as tool of quality improvement, and the outcomes were measured using the standardized infection ratio (SIR). To define the risk factors, the Chi square test and logistic regression test were used in univariate and multivariate analysis, respectively. RESULTS: 148 patients were included in the study. The SSI accumulative incidence rate (IA) was 10.14%, and the incidence rate was 6.47 SSI per 1000 days. The SIR was 1.53 the first semester and 1.02 the second one. The multivariate analysis identified two risk factors associated with SSI: unscheduled admission (odds ratio [OR] = 7.47, 95% confidence interval [CI] 2.03-27.48) and a risk index of American Society of Anaesthesiologists (ASA) > or = 3 (OR = 6.77, IC 95%, 1.15-39.84). CONCLUSIONS: An unscheduled admission and high risk ASA index were risk factors associated with SSI in patients undergoing colorectal surgery. The program of quality improvement based on benchmark achieved a reduction of SSI rates similar to the standard ones.