Implementación de un programa de cirugía bariátrica sin ingreso hospitalario y seguimiento con plataforma de telemonitorización / Implementation of a same-day discharge bariatric surgery program and follow-up with a telemonitoring platform

Introducción: Existe experiencia previa en programas de cirugía bariátrica ambulatoria en pacientes seleccionados, que reportan buenos resultados tras gastrectomía vertical. Estudios recientes demuestran que la cirugía ambulatoria también es factible y segura en el bypass gástrico en Y de Roux. El objetivo del presente trabajo es describir y analizar los resultados de nuestra experiencia inicial tras la implementación de un programa de cirugía bariátrica sin ingreso hospitalario, con la utilización del sistema de telemonitorización. Métodos: Estudio observacional prospectivo con 14 pacientes consecutivos seleccionados, intervenidos de cirugía bariátrica primaria (gastrectomía vertical o bypass gástrico en Y de Roux) en un único centro, desde abril de 2021 hasta febrero 2023, con seguimiento en domicilio mediante la plataforma de telemonitorización REVITA® (HI Iberia, S.A.) y la unidad de hospitalización a domicilio. Resultados: Desde abril de 2021 a febrero 2023 fueron seleccionados para este programa 14 pacientes, lo cual significa el 7,3% del total de 191 pacientes intervenidos de cirugía bariátrica durante este periodo. Llegaron a completar el circuito 10 de los 14 pacientes seleccionados (71,4%). Cuatro de los 10 pacientes que completaron el circuito consultaron a urgencias en las primeras 24h (40%). No hubo complicaciones graves, reingresos, ni reintervenciones propias de la cirugía bariátrica. Se ha estimado un ahorro de 762€ por cada paciente que completa el circuito. Conclusiones: La cirugía bariátrica sin ingreso hospitalario es factible y segura en pacientes seleccionados usando una plataforma de telemonitorización y con el apoyo de una unidad de hospitalización a domicilio. (AU)

Introduction: Some groups have initiated outpatient bariatric surgery programs in selected patients, publishing good results after sleeve gastrectomy. Recent studies show that outpatient surgery is also feasible and safe in Roux-en-Y gastric bypass. The aim of this paper is to describe and analyze the results of our initial experience after the implementation of a same-day discharge bariatric surgery program using a telemonitoring system. Methods: We have completed a prospective, observational study with 14 consecutive, selected patients undergoing primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single center from April 2021 to February 2023, with home follow-up using the REVITA® telemonitoring platform (HI Iberia, S.A.) and the home hospitalization unit. Results: From April 2021 to February 2023, 14 patients were selected for this program, which meant 7.3% of the total of 191 patients who underwent bariatric surgery during this period. Ten out of the 14 patients selected completed the circuit (71.4%), 4 of whom consulted the emergency department within the first 24h (40%). There were no serious complications, readmissions or re-operations typical of bariatric surgery. The estimated savings per patient who completed the circuit was €762. Conclusion: Bariatric surgery without hospital admission is feasible and safe in selected patients using a telemonitoring platform and with the support of a home hospitalization unit. (AU)

Implementation of a same-day discharge bariatric surgery program and follow-up with a telemonitoring platform.

INTRODUCTION: Some groups have initiated outpatient bariatric surgery programs in selected patients, publishing good results after sleeve gastrectomy. Recent studies show that outpatient surgery is also feasible and safe in Roux-en-Y gastric bypass. The aim of this paper is to describe and analyze the results of our initial experience after the implementation of a same-day discharge bariatric surgery program using a telemonitoring system. METHODS: We have completed a prospective, observational study with 14 consecutive, selected patients undergoing primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single center from April 2021 to February 2023, with home follow-up using the REVITA® telemonitoring platform (HI Iberia, S.A.) and the Home Hospitalization Unit. RESULTS: From April 2021 to February 2023, 14 patients were selected for this program, which meant 7.3% of the total of 191 patients who underwent bariatric surgery during this period. Ten out of the 14 patients selected completed the circuit (71.4%), 4 of whom consulted the emergency department within the first 24 h (40%). There were no serious complications, readmissions or re-operations typical of bariatric surgery. The estimated savings per patient who completed the circuit was 762. CONCLUSION: Bariatric surgery without hospital admission is feasible and safe in selected patients using a telemonitoring platform and with the support of a home hospitalization unit.

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study.

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.

Fractal dimension analysis of malignant and benign endobronchial ultrasound nodes.

BACKGROUND: Endobronchial ultrasonography (EBUS) has been applied as a routine procedure for the diagnostic of hiliar and mediastinal nodes. The authors assessed the relationship between the echographic appearance of mediastinal nodes, based on endobronchial ultrasound images, and the likelihood of malignancy. METHODS: The images of twelve malignant and eleven benign nodes were evaluated. A previous processing method was applied to improve the quality of the images and to enhance the details. Texture and morphology parameters analyzed were: the image texture of the echographies and a fractal dimension that expressed the relationship between area and perimeter of the structures that appear in the image, and characterizes the convoluted inner structure of the hiliar and mediastinal nodes. RESULTS: Processed images showed that relationship between log perimeter and log area of hilar nodes was lineal (i.e. perimeter vs. area follow a power law). Fractal dimension was lower in the malignant nodes compared with non-malignant nodes (1.47(0.09), 1.53(0.10) mean(SD), Mann-Whitney U test p < 0.05)). CONCLUSION: Fractal dimension of ultrasonographic images of mediastinal nodes obtained through endobronchial ultrasound differ in malignant nodes from non-malignant. This parameter could differentiate malignat and non-malignat mediastinic and hiliar nodes.

[The usefulness of hospital at home in nephrology]. / Utilidad de la hospitalización a domicilio en nefrología.

BACKGROUND AND OBJECTIVE: The Hospital at Home Unit (HHU) is a medical care model effective in different fields of medical and surgical conditions. The objective of the study was to analyse the utility of moving acute nephrologic patients to a HHCU. PATIENTS AND METHOD: We review the Nephrology Service requests to move patients to the HHU the last 3 years. The results were compared with those obtained from the rest of patients admitted at the HHU during the same period. RESULTS: The requests number was 85 and 79 (93%) patients were included for the study. Patients had high comorbidity (Charlson index mean, 3.75) and acute medical problems. The length of stay at the HHU was 12.65 days. The total intervention rate was 1.23 interventions/day. In 71 cases (89.9%) the hospital discharge was at the patient's home. In 8 cases the readmission at the hospital was required to solve the medical process. Hospital readmissions after the HHCU discharge before 30 days was 6.3%. No statistical differences were found between nephrology patients and the rest of HHU patients when comparing the intervention rates, the percentage of home discharges and the hospital readmissions. CONCLUSIONS: The moving of nephrologic acute patients to a HHU is a save choice and well accepted by patients and their families.

Utilidad de la hospitalización a domicilio en nefrología / The usefulness of hospital at home in nephrology

Fundamento y objetivo: La hospitalización a domicilio (HAD) es una modalidad asistencial eficaz en distintos campos de la patología médica y quirúrgica. El objetivo del estudio fue analizar la utilidad de la HAD en pacientes nefrológicos con procesos agudos. Pacientes y método: Se revisa las solicitudes de traslado a la Unidad de Hospitalización a Domicilio (UHAD) desde el Servicio de Nefrología durante 3 años. Se compara estos resultados con los del resto de los pacientes atendidos en la UHAD. Resultados: Se registró 85 solicitudes, y se aceptó 79 (93%). Se trataba de pacientes con elevada comorbilidad (Charlson de 3,75) y con problemas clínicos activos. La estancia media en la UHAD fue de 12,65 días, la tasa de intervención global, de 1,23 intervenciones por paciente y día de estancia. Se procedió al alta hospitalaria en 71 casos (89,9%). Ocho pacientes (10,1%) reingresaron en nefrología y por empeoramiento clínico hubo 5 (6,3%) reingresos a los 30 días. No se apreció diferencias respecto al resto de los pacientes atendidos en la UHAD al comparar las tasas de intervención asistencial, las altas a domicilio y los reingresos. Conclusiones: El traslado a la UHAD de pacientes con enfermedades nefrológicas es una alternativa segura, eficaz y bien aceptada por el paciente y su familia

Background and objective: The Hospital at Home Unit (HHU) is a medical care model effective in different fields of medical and surgical conditions. The objective of the study was to analyse the utility of moving acute nephrologic patients to a HHCU. Patients and method: We review the Nephrology Service requests to move patients to the HHU the last 3 years. The results were compared with those obtained from the rest of patients admitted at the HHU during the same period. Results: The requests number was 85 and 79 (93%) patients were included for the study. Patients had high comorbility (Charlson index mean, 3.75) and acute medical problems. The length of stay at the HHU was 12.65 days. The total intervention rate was 1.23 interventions/day. In 71 cases (89.9%) the hospital discharge was at the patient's home. In 8 cases the readmission at the hospital was required to solve the medical process. Hospital readmissions after the HHCU discharge before 30 days was 6.3%. No statistical differences were found between nephrology patients and the rest of HHU patients when comparing the intervention rates, the percentage of home discharges and the hospital readmissions. Conclusions: The moving of nephrologic acute patients to a HHU is a save choice and well accepted by patients and their families

Tratamiento de las neumonías extrahospitalarias y hospitalización a domicilio / Treatment of extrahospital pneumonia and home hospitalization

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