Prevalencia preoperatoria de portadores asintomáticos de COVID-19 en hospitales de Cataluña durante la primera ola tras el reinicio de la actividad quirúrgica / Pre-operative prevalence of asymptomatic carriers of COVID-19 in hospitals in Catalonia during the first wave after the resumption of surgical activity

Introducción La pandemia producida por COVID-19 ocasionó la cancelación de los procedimientos quirúrgicos no esenciales en marzo de 2020. Con el reinicio de la actividad quirúrgica, los pacientes que se sometían a una cirugía fueron uno de los primeros grupos poblacionales a los que se realizó test PCR de forma sistemática. El objetivo de este estudio fue determinar la prevalencia de portadores asintomáticos de SARS-CoV-2 tras el reinicio de la actividad quirúrgica no esencial. Métodos Estudio observacional multicéntrico retrospectivo de los pacientes programados para cirugía o que se sometieron a cirugía urgente en Cataluña entre el 20 de abril y el 31 de mayo de 2020. Se revisaron los resultados microbiológicos de los test PCR preoperatorios, las historias clínicas y se realizó una encuesta epidemiológica a los pacientes con PCR positiva para SARS-CoV-2. Resultados Un total de 10.838 pacientes programados para una intervención quirúrgica o a los que se realizó una cirugía urgente fueron sometidos a cribado para COVID-19. Ciento dieciocho pacientes (1,09%) fueron positivos para SARS-CoV-2 en las 72h previas a la cirugía. La prevalencia de portadores asintomáticos fue del 0,7% (IC95%: 0,6-0,9%). La primera semana del estudio presentó la prevalencia más alta de portadores asintomáticos [1,9% (IC95%: 1,1-3,2%)]. Conclusiones Los bajos niveles de portadores asintomáticos de infección por COVID-19 obtenidos en la población quirúrgica de los hospitales de Cataluña tras el reinicio de la actividad quirúrgica muestran que la mayoría de pacientes se pudieron someter a procedimientos quirúrgicos sin los riesgos de las complicaciones asociadas al COVID-19 en el periodo perioperatorio (AU)

Introduction The COVID-19 pandemic led to the cancellation of non-essential surgical procedures in March 2020. With the resumption of surgical activity, patients undergoing surgery were one of the first population groups to be systematically tested for PCR. The aim of this study was to determine the prevalence of asymptomatic SARS-CoV-2 carriers after the resumption of non-essential surgical activity. Methods Retrospective multicenter observational study of patients scheduled for surgery or undergoing emergency surgery in Catalonia between 20 April and 31 May 2020. The microbiological results of preoperative PCR tests and clinical records were reviewed, and an epidemiological survey was conducted on patients with positive PCR for SARS-CoV-2. Results A total of 10,838 patients scheduled for surgery or who underwent emergency surgery were screened for COVID-19. One hundred and eighteen patients (1.09%) were positive for SARS-CoV-2 in the 72hours prior to surgery. The prevalence of asymptomatic carriers was 0.7% (95%CI: 0.6% - 0.9%). The first week of the study presented the highest prevalence of asymptomatic carriers [1.9% (95%CI: 1.1%-3.2%)]. Conclusions The low levels of asymptomatic carriers of COVID-19 infection obtained in the surgical population of hospitals in Catalonia after the resumption of surgical activity, shows that most patients were able to undergo surgical procedures without the risks of COVID-19 associated complications in the perioperative period (AU)

Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera / Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture

La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. Métodos: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d’Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. Resultados: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p=0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p=0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p=0,002). Conclusión: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días.(AU)

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. Methods: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d’Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. Results: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). Conclusion: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.(AU)

Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture. / Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera.

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.

Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera / Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture

La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. MÉTODOS: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d'Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. RESULTADOS: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p = 0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p = 0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p = 0,002). CONCLUSIÓN: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality

Damage Control Resuscitation en el paciente traumático / Damage Control Resuscitation in polytrauma patient

El shock hemorrágico es una de las principales causas de muerte en los pacientes politraumáticos graves. Para aumentar la supervivencia de estos pacientes se ha desarrollado una estrategia combinada de tratamiento conocida como Control de Daños. Los objetivos de este artículo son analizar el concepto actual de la Reanimación de Control de Daños y sus tres niveles de tratamiento, describir la mejor estrategia transfusional y abordar la coagulopatía aguda del paciente traumático como entidad propia. Se describen también los potenciales cambios que podrían producirse en los próximos años en esta estrategia de tratamiento

Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described

Damage Control Resuscitation in polytrauma patient. / Damage Control Resuscitation en el paciente traumático.

Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described.

¿Disminuye la probabilidad de transfusión el recuperador postquirúrgico en los pacientes con hemoglobinas bajas? / No disponible

No disponible

[Risk factors for transfusion in primary knee arthroplasty]. / Factores predictivos de transfusión en la artroplastia primaria de rodilla.

OBJECTIVE: Transfusion is becoming safer but is not free of risk. It is important to establish a good approach to transfusion management and calculate real losses. Risk factors for transfusion should be identified. MATERIAL AND METHODS: This was a prospective study of 102 patients who did not receive intraoperative autotransfusion of shed blood, selected from a group of 127 who were undergoing primary knee arthroplasty. We initially calculated the amount of blood shed. Then, by multivariate logistic regression analysis we identified the model that best predicted that a patient would require transfusion. Receiver operating characteristic curves were constructed and the area under the curves calculated. RESULTS: Mean (SD) blood loss was calculated to be 1786 (710) mL. The best model considered initial hemoglobin (Hb), weight, height, and sex as predictive factors: Probability = 1/ (1+e(-Z)), where Z = 11.542 - 1.074 x initial Hb (g/dL) - 0.039 x Weight (kg) + 0.031 x Height (cm) + 0.267 x (sex: male=1 or female=0). The area under the ROC curve was 0.805 (0.44). CONCLUSION: Initial Hb, which can be modified before surgery, is one of the factors that most affects whether or not the patient will need a transfusion. Therefore, one of our first objectives in the process of managing transfusion is to improve preoperative Hb values.

Factores predictivos de transfusión en la artroplastia primaria de rodilla / Risk factors for transfusion in primary knee arthroplasty

OBJETIVO: La transfusión cada vez es más segura perono está exenta de riesgos. Es importante tener una buenaestrategia transfusional y calcular las pérdidas reales.Se deben buscar los factores que puedan predecir la probabilidadde que un paciente sea transfundido.MATERIAL Y MÉTODOS: Estudio prospectivo observacionalagrupando 127 pacientes intervenidos de artroplastiaprimaria de rodilla, seleccionando a los 102pacientes sin autotransfusión preoperatoria. Inicialmentecalculamos las pérdidas producidas en el grupo estudiado.Posteriormente, mediante regresión logística multivariantese combinaron las variables analizadas paraobtener el mejor modelo predictivo de que un pacientesea transfundido. Hemos obtenido las diferentes curvasROC y se ha calculado el área bajo la curva ROC.RESULTADOS: Las pérdidas calculadas fueron 1.786 mL± 710 mL. De todos los modelos predictivos, la asociaciónde la hemoglobina inicial, el peso, la talla y el sexo es laque dio mejor valor predictivo. El modelo es: Probabilidad(p) = 1/ (1+e-Z) en donde Z = 11,542 – 1,074 x Hgb inicial(g/dl) – 0,039 x Peso (Kg) + 0,031 x Talla (cm) + 0,267x (sexo, hombre1/ mujer 0); su área bajo la curva ROC esde 0,805 ± 0,44.CONCLUSIÓN: La hemoglobina inicial, modificablepreoperatoriamente, es uno de los factores que másinfluyen en que un paciente sea transfundido. Por lo tanto,en el algoritmo transfusional uno de nuestros objetivosiniciales es mejorar la hemoglobina preoperatoria

OBJECTIVE: Transfusion is becoming safer but is notfree of risk. It is important to establish a good approachto transfusion management and calculate real losses.Risk factors for transfusion should be identified.MATERIAL AND METHODS: This was a prospective studyof 102 patients who did not receive intraoperative autotransfusionof shed blood, selected from a group of 127who were undergoing primary knee arthroplasty. We initiallycalculated the amount of blood shed. Then, by multivariatelogistic regression analysis we identified the modelthat best predicted that a patient would require transfusion.Receiver operating characteristic curves were constructedand the area under the curves calculated.RESULTS: Mean (SD) blood loss was calculated to be1786 (710) mL. The best model considered initial hemoglobin(Hb), weight, height, and sex as predictive factors:Probability = 1/ (1+e-Z), where Z = 11.542 – 1.074 xinitial Hb (g/dL) – 0.039 x Weight (kg) + 0.031 x Height(cm) + 0.267 x (sex: male=1 or female=0). The areaunder the ROC curve was 0.805 (0.44).CONCLUSION: Initial Hb, which can be modified beforesurgery, is one of the factors that most affects whetheror not the patient will need a transfusion. Therefore, oneof our first objectives in the process of managing transfusionis to improve preoperative Hb values