[Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report.] / Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura.

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar.

Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura / Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases

Aneurismas venosos yuxtaanastomóticos en fístulas arteriovenosas para hemodiálisis / Juxtaanastomotic venous aneurysms in arteriovenous fistulas for hemodialysis

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Reparación quirúrgica urgente de las fístulas arteriovenosas para hemodiálisis trombosadas. Repercusión económica de la implantación de un protocolo de actuación en un área sanitaria / Economic repercussions of implementing a protocol for urgent surgical repair of thrombosed arteriovenous fistulae

Introducción: Cuando un paciente en hemodiálisis sufre la trombosis de su fístula arteriovenosa (FAV), necesita algún procedimiento urgente para su próxima sesión de diálisis. Existen dos opciones terapéuticas: la colocación de un catéter venoso central (CVC) o la reparación de su FAV. El objetivo de este trabajo es valorar la posibilidad de reparación urgente de las FAV trombosadas dentro de la actividad de urgencias de un servicio de cirugía general y determinar la posible repercusión económica de la implantación de este protocolo de trabajo en un área sanitaria. Método: Se realizó la recogida prospectiva de todas las intervenciones quirúrgicas urgentes realizadas para la reparación de las FAV trombosadas en el período 2000-2011 en nuestro centro. Se analizaron los resultados clínicos mediante dos variables: tasa de trombosis (episodios/paciente/año) y porcentaje de rescate. Se consideró un rescate eficaz si tras la intervención el paciente se pudo dializar con su FAV evitando la colocación de un CVC. Se definió e implantó el proceso clínico «FAV trombosada» y se estudió su coste económico mediante un análisis detallado realizado por el departamento económico financiero de nuestro centro. También se realizó este análisis para el proceso clínico alternativo (nueva FAV) utilizando los datos publicados por el Ministerio de Sanidad (peso del Grupo Relacionado con el Diagnóstico: accesos vasculares para hemodiálisis, unidad de complejidad hospitalaria, precio público de procesos ambulatorios y porcentaje de cirugía ambulatoria). Finalmente se realizó una estimación de la repercusión económica de la implantación de este proceso comparando los costes de ambos procedimientos. Resultados: Durante el período de estudio se produjeron 268 episodios de trombosis, lo que supone una tasa de 0,10 episodios/paciente/año (0,05 en FAV autólogas y 0,43 en injertos). Se atendieron de forma urgente por el servicio de cirugía 203 (75 %), consiguiendo rescatar 168 FAV (82 %). El coste de una reparación urgente de una FAV se estimó en 999 Euro. El precio promedio de una FAV programada más el precio de la colocación y mantenimiento de un CVC se estimó en 6397 Euro. El ahorro producido por la reparación urgente de las FAV en nuestra área de salud es de 107 940 Euros/año. La extrapolación al conjunto del país para una población de 23 000 pacientes en hemodiálisis sería de 9 930 480 Euros/año. Conclusiones: Es posible realizar el rescate quirúrgico urgente de la mayoría de las FAV para hemodiálisis. La implantación de un protocolo multidisciplinar evita la colocación de catéteres en estos pacientes, disminuyendo el gasto asociado a ellos (AU)

Introduction: When a patient undergoing haemodialysis suffers from arteriovenous fistula (AVF) thrombosis, (s)he needs an urgent procedure before the next dialysis session. Two different treatment options are available: placing a central venous catheter (CVC) or repairing the AVF. The objective of this study is to assess the possibility of urgent repair of thrombosed AVFs within the emergency care activity of a general surgery department and to determine the possible economic repercussions of implementing this working protocol in an area of healthcare. Method: We completed the prospective collection of all the urgent surgical interventions made to repair thrombosed AVFs for the period 2000-2011 at our centre. The clinical results were analysed using two variables: rate of thrombosis (episodes/patient/year) and percentage of recovery. Recovery was deemed effective if after the surgery the patient was able to undergo dialysis of his/her AVF without the need to place a CVC. The "thrombosed AVF" clinical process was defined and implemented, and its economic cost was analysed via a detailed analysis conducted by our centre's Financial Department. This analysis was also conducted for the alternative clinical process (new AVF), using the data published by the Ministry of Health (weight of the Diagnosis-Related Group: vascular accesses for haemodialysis, hospital complexity unit, public cost of outpatient procedures and percentage of economic repercussions of the implementation of this process, comparing the costs of both procedures). Results: During the study period 268 episodes of thrombosis occurred, a rate of 0.1 episodes/patient/year (0.05 on autologous AVFs and 0.43 on grafts). 203 (75%) were treated urgently by the surgery department, of which 168 AVFs (82%) were recovered. The cost of urgently repairing an AVF was estimated at Euros999. The average cost of a scheduled AVF intervention, plus the cost of placing and maintaining a CVC, was estimated at Euros6,397. The saving made by urgent repair of AVFs in our area of healthcare is Euros107,940/year. Extrapolating this to the entire country for a population of 23,000 patients on haemodialysis, the total would be Euros9,930,480/year. Conclusions: It is possible to perform urgent surgical recovery on the majority of AVFs for haemodialysis. Implementing multidisciplinary protocol avoids fitting these patients with catheters, reducing the cost this entails (AU)

Economic repercussions of implementing a protocol for urgent surgical repair of thrombosed arteriovenous fistulae.

INTRODUCTION: When a patient undergoing haemodialysis suffers from arteriovenous fistula (AVF) thrombosis, (s)he needs an urgent procedure before the next dialysis session. Two different treatment options are available: placing a central venous catheter (CVC) or repairing the AVF. The objective of this study is to assess the possibility of urgent repair of thrombosed AVFs within the emergency care activity of a general surgery department and to determine the possible economic repercussions of implementing this working protocol in an area of healthcare. METHOD: We completed the prospective collection of all the urgent surgical interventions made to repair thrombosed AVFs for the period 2000-2011 at our centre. The clinical results were analysed using two variables: rate of thrombosis (episodes/patient/year) and percentage of recovery. Recovery was deemed effective if after the surgery the patient was able to undergo dialysis of his/her AVF without the need to place a CVC. The "thrombosed AVF" clinical process was defined and implemented, and its economic cost was analysed via a detailed analysis conducted by our centre's Financial Department. This analysis was also conducted for the alternative clinical process (new AVF), using the data published by the Ministry of Health (weight of the Diagnosis-Related Group: vascular accesses for haemodialysis, hospital complexity unit, public cost of outpatient procedures and percentage of economic repercussions of the implementation of this process, comparing the costs of both procedures). RESULTS: During the study period 268 episodes of thrombosis occurred, a rate of 0.1 episodes/patient/year (0.05 on autologous AVFs and 0.43 on grafts). 203 (75%) were treated urgently by the surgery department, of which 168 AVFs (82%) were recovered. The cost of urgently repairing an AVF was estimated at €999. The average cost of a scheduled AVF intervention, plus the cost of placing and maintaining a CVC, was estimated at €6,397. The saving made by urgent repair of AVFs in our area of healthcare is €107,940/year. Extrapolating this to the entire country for a population of 23,000 patients on haemodialysis, the total would be €9,930,480/year. CONCLUSIONS: It is possible to perform urgent surgical recovery on the majority of AVFs for haemodialysis. Implementing multidisciplinary protocol avoids fitting these patients with catheters, reducing the cost this entails.