Endovascular repair versus open surgery in patients in the treatment of the ruptured of aneurysms abdominal. / Reparación endovascular versus cirugía abierta en el tratamiento de la rotura de aneurisma abdominal.

INTRODUCTION: Rupture of abdominal aortic aneurysm is still a difficult challenge for the vascular surgeon due to the high perioperative mortality. The aim of our study is to describe the characteristics of the population as well as to compare morbidity and mortality in patients undergoing open surgery or endovascular repair in our center. METHODS: Database with 82 rAAA between January 2002-December 2014, studying two cohorts, open surgery and endovascular repair. Epidemiologic, clinical, surgical techniques, perioperative mortality and complications are analyzed. RESULTS: 82 rAAA cases were operated (men: 80, women: 2). Mean age 72±9.6 years. 76.8% (63 cases) was performed by open surgery. BACKGROUND: smokers 59, 7%, alcoholism 19.5%, DM 10.9%, AHT: 53.6%, dyslipidemia 30.5%. The most frequent clinical presentation was abdominal pain with lumbar irradiation: 50 cases (20.7% associating syncope). Overall hospital mortality was 58.5%. Hemodynamic shock prior to intervention was associated with increased mortality (p <.001). Anemia, leukocytosis, aneurysm size, sex and age did not show a statistically significant difference with respect to mortality (p>.05). The presence of iliac aneurysms was associated with increased mortality (p <.0045). Perioperative mortality in endovascular repair was 42%, and in open surgery was 63.5% (p>.05). Hospital stay was lower in the endovascular group (p=.3859). CONCLUSIONS: Hemodynamic shock and the presence of concomitant iliac aneurysms have a statistically significant association with perioperative mortality in both groups. We found clinically significant differences in mortality, complications and hospital stay when comparing both groups with better results for EVAR, without statistically significant differences.

[Nutritional screening in hospitalized patients with vascular disease - The relationship of nutritional risk with clinical and economic outcomes in a surgery department]. / Cribado nutricional del paciente con patología vascular hospitalizado: relación del riesgo nutricional con los resultados clínicos y económicos en un servicio quirúrgico.

INTRODUCTION: Introduction: disease-related malnutrition has a negative impact on the outcome in surgical patients. Our objective was to assess the prevalence of nutritional risk in the field of vascular surgery, as well as its consequences on patient outcome and health expenditure. Patients and methods: this is a prospective, observational study conducted during 6 months in a vascular surgery ward at the University Hospital of León, Spain. The Malnutrition Universal Screening Tool was used to obtain data on admission and then every 7 days until hospital discharge. Clinical variables, surgical intervention performed, medical-surgical complications, hospital stay, healthcare costs, and early readmissions were studied. Results: a total of 104 patients, 84.6 % males, with a mean age of 69 (SD: 13) years were enrolled. Of these, 46.2 % were admitted due to peripheral arterial disease; 10.6 % had a positive MUST at the time of admission and 19.2 % at discharge; 100 % of malnourished patients at admission remained in the same situation at discharge. During hospitalization, in 29 patients (27.9 %) the nutritional situation worsened. In all, 81.25 % of patients who experienced worsening of their MUST score had been admitted urgently (p < 0.05). Patients who required urgent surgery significantly worsened in terms of their nutritional status (p < 0.001). Patients with worsening nutritional status obtained higher rates for: surgical reintervention (p < 0.05), pharmaceutical expense (p = 0.017), total hospital expense (€1,000/patient/admission), transfers to chronic care centers (p = 0.0002), and number of early readmissions (p = 0.017). Conclusion: patients with nutritional risk suffered an increase in medical-surgical complications, hospital stay, healthcare costs, and re-admission rates. Therefore, we consider that an implementation of screening procedures and the development of further studies in the vascular surgery setting are necessary.

INTRODUCCIÓN: Introducción y objetivos: la desnutrición relacionada con la enfermedad produce un impacto negativo en la evolución del paciente quirúrgico. Nuestro objetivo es valorar la prevalencia del riesgo nutricional en el ámbito de la cirugía vascular y sus consecuencias en la evolución del paciente y el gasto sanitario. Pacientes y métodos: estudio observacional prospectivo realizado durante 6 meses en la planta de cirugía vascular del Hospital Universitario de León. Se utilizó la herramienta Malnutrition Universal Screening Tool (MUST) para recoger datos al ingreso y cada 7 días hasta el alta hospitalaria. Se estudiaron las variables clínicas, la intervención quirúrgica realizada, las complicaciones médico-quirúrgicas, la estancia hospitalaria, los costes sanitarios y los reingresos precoces. Resultados: el estudio contó con 104 pacientes, de los que el 84,6 % eran varones, cuya media de edad era de 69 años (DE: 13). El 46,2 % habían ingresado por enfermedad arterial periférica. El 10,6 % presentaban un MUST positivo al ingreso y el 19,2 % lo presentaban al alta; el 100 % de los pacientes desnutridos al ingreso permanecían en la misma situación al alta. Durante la hospitalización, en 29 pacientes (27,9 %) empeoró la situación nutricional. El 81,25 % de los pacientes que sufrieron empeoramiento del MUST habían ingresado de forma urgente (p < 0,05). Los pacientes que habían precisado una cirugía urgente empeoraron significativamente en términos de su estado nutricional (p < 0,001). Los pacientes con empeoramiento del estado nutricional obtuvieron mayores porcentajes de: reintervención quirúrgica (p < 0,05), gasto farmacéutico (p = 0,017), gasto hospitalario total (1000 €/paciente/ingreso), traslados a centros de cuidados crónicos (p = 0,0002) y número de reingresos precoces (p = 0,017). Conclusiones: los pacientes en riesgo nutricional se asociaron a un incremento de las complicaciones médico-quirúrgicas, de la estancia hospitalaria, del coste sanitario y de la tasa de reingresos, por lo que consideramos necesaria la implantación de cribados y el desarrollo de estudios en el ámbito de la cirugía vascular.