Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study.

BACKGROUND: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic. MATERIAL AND METHODS: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March-April 2020), non-peak (May-June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay. RESULTS: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27-3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0-29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31-4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72). CONCLUSION: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.

P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study.

BACKGROUND: COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery. MATERIAL AND METHODS: Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study. MAIN OUTCOME: 30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (ß estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI). RESULTS: 4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); ß value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82). CONCLUSION: The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.

Manejo del hogar de cuadros diarreicos agudos del lactante y uso de la terapia de rehidratación oral en la comunidad rural de Cumbo estado Miranda / Home management of acute diarrhea in unweaned children and the use of oral rehydration in the rural community of Cumbo Miranda state

Se realizó un estudio para determinar mediante una encuesta la capacidad de los representantes cuidadores de lactantes de la comunidad rural de Cumbo. Estado Miranda, para reconocer la importancia de los signos de deshidratación y las medidas básicas a implementar ante casos de diarrea en los lactantes. Tras un muestreo simple al azar, fueron encuestados 59 cuidadores. Se observó una baja tasa de analfabetismo en los encuestados. El 89,83 por ciento reconoce el potencial peligro representado por las diarreas. Los signos de deshidratación más reconocidos por los cuidadores fueron: ojos hundidos, signo del pliegue, saliva espesa y signos de alteración neurológica. El 66,10 por ciento reconoció la utilidad del suero de rehidratación. El 77,97 por ciento de los cuidadores conocen la técnica de preparación del mismo. 81,35 por ciento de los cuidadores poseía como fuente de información al médico, los promotores de salud y las unidades de rehidratación oral comunitaria; todos ellos presentes en la propia comunidad rural. Se enfatiza la importancia de reforzar campañas educativas en momentos de alto riesgo epidemiológico de enfermedades diarreicas.

Infección urinaria y resistencia bacteriana / Urinary tract infection and bacterial resistance

La infección urinaria es causa frecuente de morbilidad en la consulta pediátrica. El conocer los aspectos epidemiológicos y patogénicos, así como la repercusión del diagnóstico y tratamiento precoz de infecciones del sistema urinario, es de gran importancia para la prevención de la enfermedad renal progresiva. En la patogénesis de este padecimiento se involucran factores diversos como la virulencia y resistencia bacteriana, el riesgo poblacional y los mecanismos de defensa de huésped. La resistencia bacteriana ha incrementado en los últimos años y repercutido en el aumento de fracasos terapéuticos en pacientes tratados con antibióticos orales de uso corriente. En este trabajo se valoran los resultados que arrojaron 4454 urocultivos obtenidos de pacientes pediátricos que acudieron a dos centros hospitalarios de Caracas. Con ello se destacó la resistencia elevada de E.coli a los antibióticos de uso rutinario, según esquemas terapéuticos establecidos en los últimos años. Además, se plantean los posibles mecanismos por los que la bacteria ha adquirido resistencia, y se enfatiza la necesidad de realizar urocultivos para determinar periódicamente la resistencia bacteriana, con el fin de adecuar el tratamiento a cada paciente