[Surgical suspensions, a quality factor in pediatric surgical patient care]. / Suspensiones quirúrgicas, un factor de calidad en la asistencia al paciente quirúrgico pediátrico.

OBJECTIVE: To identify the factors that influence surgical suspensions (SQ) in a pediatric surgery service, to estimate its economic impact and to analyze the effect that strategies aimed at increasing efficiency and improving medical-surgical care would have. MATERIALS AND METHODS: Retrospective analysis of SQ in 2015, depending on the patient, organization or professionals, time of year, schedule (morning or afternoon) and type of surgery: major ambulatory surgery (CMA) or with hospital admission. Implementation of corrective measures against the main causes and subsequent comparative analysis in 2016 and 2017, comparing the results using Chi2 and Fisher's test. Evaluation of the economic impact based on lost operating hours. RESULTS: The SQ rate in 2015 was 8.9%: 90.7% attributable to the patient, 6.8% to organizational factors and 2.7% to professionals. There were no significant differences according to the time of year or between morning or afternoon, but they were significantly more frequent in CMA (10.84% vs. 2.63%, p <0.001). After introducing improvement measures, SQ decreased significantly in 2016 and 2017 (6.2 and 4.9% respectively, p<0.01), mainly patient-dependent (80 and 73.9%, respectively, p=0.03). There were no differences between CMA and surgeries with admission and there was a decrease in the associated costs (€ 40,946 in 2015, € 18,217 in 2017). CONCLUSIONS: SQ represent an inconvenience for the patient, professionals and institution, that can be minimized with the implantation of simple, feasible and contrasted measures, that increase the efficiency and, probably, the satisfaction of users and professionals.

OBJETIVOS: Identificar los factores que influyen en las suspensiones quirúrgicas (SQ) en un servicio de cirugía pediátrica, estimar su impacto económico y analizar el efecto que tendrían estrategias dirigidas a incrementar la eficiencia y mejorar la atención médico-quirúrgica. MATERIAL Y METODOS: Análisis retrospectivo de las SQ en 2015, según dependieran del paciente, la organización o los profesionales, la época del año, el horario (mañana o tarde) y el tipo de cirugía: régimen de cirugía mayor ambulatoria (CMA) o con ingreso hospitalario. Implantación de medidas correctoras frente a las principales causas y análisis comparativo posterior en los años 2016 y 2017, comparando los resultados mediante Chi2 y test de Fisher. Valoración del impacto económico en base a horas de quirófano perdidas. RESULTADOS: La tasa de SQ en 2015 fue del 8,9%: 90,7% atribuibles al paciente, 6,8% a factores organizativos y 2,7% a profesionales. No hubo diferencias significativas según la época del año ni entre mañana o tarde, pero sí fueron significativamente más frecuentes en CMA (10,84% vs. 2,63%; p<0,001). Tras introducir medidas de mejora las SQ disminuyeron significativamente en 2016 y 2017 (6,2 y 4,9% respectivamente, p<0,01), fundamentalmente las dependientes de paciente (80 y 73,9%, respectivamente, p=0,03). No hubo diferencias entre CMA y cirugías con ingreso y se produjo una disminución de los costes asociados (40.946 € en 2015, 18.217 € en 2017). CONCLUSIONES: Las SQ suponen inconvenientes para el paciente, los profesionales y la institución, que pueden ser minimizados con la implantación de medidas sencillas, factibles y contrastadas, que aumenten la eficiencia y, probablemente, la satisfacción de usuarios y profesionales.

[Evaluation of quality of life in patients operated on for gastroesophageal reflux in the pediatric age]. / Valoración de la calidad de vida en los pacientes intervenidos por reflujo gastroesofágico en la edad pediátrica.

AIM: To assess the quality of life and symptoms of GER patients who underwent laparoscopy in our hospital before and after surgery. MATERIAL AND METHODS: We collect data from patients operated laparoscopically for gastroesophageal reflux disease (GER) in our center before and after surgery in 3 items: nutritional studies, diagnostic methods, interviews with the families of patients about symptoms (preferably differing in digestive or respiratory symptoms) and quality of life; also, determined the age, gender, personal history and surgical technique of patients. RESULTS: 30 patients have been operated for GER, 22 men and 8 women, 11 months to 14 years (median age 5 years) of whom 12 (40%) had some degree of encephalopathy. The most common surgical technique used is Nissen (73% cases). Most patients had significant alterations in their daily activities before surgery. The most common symptom was gastrointestinal (70% cases), although all showed improvement, families of children with respiratory symptoms related predominantly greater reduction in the clinic after surgical correction. All improved in its growth curve. CONCLUSIONS: Surgery for GER patients have a significant improvement in their quality of life, not only by the reduction of their symptoms but also in enhancing from the nutritional status. Patients with respiratory symptoms have a higher satisfaction with surgical treatment than those with gastrointestinal clinical.