Influence of Preoperative Frailty on Health-Related Quality of Life After Cardiac Surgery.

BACKGROUND: Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. METHODS: This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. RESULTS: The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. CONCLUSIONS: Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.

Formación en cirugía mamaria en España / Training in breast surgery in Spain

La cirugía de la mama forma parte fundamental en la formación y competencia de la cirugía general en España, constituyendo un «área frontera» asumida eficientemente por cirujanos y ginecólogos. El objetivo fundamental del proceso formativo está constituido por el tratamiento quirúrgico del cáncer de mama, que incluye la cirugía conservadora y las técnicas oncoplásticas y reconstructivas. En este artículo, se realiza un análisis de la situación actual de la formación en cirugía mamaria en nuestro país y se plantean esquemáticamente los posibles objetivos de los diversos programas formativos, para optimizar el acceso y la capacitación de los residentes y cirujanos en esta área teniendo en cuenta el RD 639/2014 y la normativa europea. Resulta prioritario concretar el nivel de formación que se pretende alcanzar, en relación con el grupo de profesionales a quien va dirigido, teniendo en cuenta su ámbito competencial: residente de cirugía, formación continuada y especial dedicación a esta área

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area

Training in breast surgery in Spain. / Formación en cirugía mamaria en España.

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area.

Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente / A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook

Introducción: No hay datos cuantificados de la actividad real conseguida durante los 5 años de formación en España de la especialidad de Cirugía General y del Aparato Digestivo (CGAD). Igualmente, hay escasos datos en los programas de otros países y especialidades quirúrgicas. El objetivo es estimar la actividad media quirúrgica global, por áreas de capacitación específica y grado de complejidad, del programa español de la especialidad. Participantes y método Estudio multicéntrico prospectivo observacional sobre la actividad de los residentes de CGAD en España a través del libro informático del residente de la Asociación Española de Cirujanos (LIR-AEC). Cada residente registra su propia actividad supervisado por su tutor. El periodo de muestra fue de 6 meses. A partir de los resultados se estimaron las medianas de actividad anual y del periodo de la residencia. Resultados Actividad quirúrgica: se ha estimado que durante la residencia asisten a 1.325 intervenciones, realizan como cirujano principal 654 (49%). Actividad asistencial: la media de guardias es de 5,2±1,8 al mes. La actividad en consultas externas es de 548 primeras visitas y casi el doble de segundas visitas. Actividad científica: el número total de cursos y congresos es de 34. La media estimada de comunicaciones a congresos es de 14 y de publicaciones de 3.ConclusionesEl LIR-AEC es una herramienta adecuada para verificar la actividad del programa español de CGAD. Estos resultados permitirán una evaluación comparativa con la formación de los programas de otros países y especialidades quirúrgicas (AU)

Introduction: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by (..) (AU)

[A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook]. / Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente.

INTRODUCTION: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by specific skill areas and by the level of complexity of the Spanish program in the specialty of GGS. PATIENTS AND METHOD: A prospective, observational, multicentre study was performed on the activity of GGS residents in Spain using the Resident Computerised Logbook of the Spanish Surgeons Association (LIR-AEC). Each of the residents registered their own activity supervised by their tutor. The sample period was 6 months. The medians of the annual activity and the period of residency were calculated from the results. RESULTS: Surgical activity: during the residency, it was estimated that that they attended 1,325 operations, 654 (49%) as lead surgeon. Health care activity: the mean number of times on-call was 5.2±1.8 per month. Activity in outpatient clinics was 548 first visits, and almost double for second visits. Scientific activity: the total number of courses and conferences attended was 34. The estimated mean number of presentations at conferences was 14, with 3 publications. CONCLUSIONS: LIR-AEC is a suitable tool to verify activity in the Spanish GGS Program. These results may be useful for comparing with training programs in other countries and in other surgical specialties.

Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents.

PURPOSE: To describe the use of self-expandable metallic stents to manage malignant colorectal obstructions and to compare the radiation dose between fluoroscopic guidance of stent placement and combined endoscopic and fluoroscopic guidance. MATERIALS AND METHODS: From January 1998 to December 2007, 467 oncology patients undergoing colorectal stent placement in a single center were included in the study. Informed consent was obtained in all cases. All procedures were performed with fluoroscopic or combined fluoroscopic and endoscopic guidance. Inclusion criteria were total or partial colorectal obstruction of neoplastic origin. Exclusion criteria were life expectancy shorter than 1 month, suspicion of perforation, and/or severe colonic neoplastic bleeding. Procedure time and radiation dose were recorded, and technical and clinical success were evaluated. Follow-up was performed by clinical examination and simple abdominal radiographs at 1 day and at 1, 3, 6, and 12 months. RESULTS: Of 467 procedures, technical success was achieved in 432 (92.5%). Thirty-five treatments (7.5%) were technical failures, and the patients were advised to undergo surgery. Significant differences in radiation dose and clinical success were found between the fluoroscopy and combined-technique groups (P < .001). Total decompression was achieved in 372 cases, 29 patients showed remarkable improvement, 11 showed slight improvement, and 20 showed clinical failure. Complications were recorded in 89 patients (19%); the most significant were perforation (2.3%) and stent migration (6.9%). Mean interventional time and radiation dose were 67 minutes and 3,378 dGy·cm(2), respectively. CONCLUSIONS: Treatment of colonic obstruction with stents requires a long time in the interventional room and considerable radiation dose. Nevertheless, the clinical benefits and improvement in quality of life justify the radiation risk.

Mediastinoscopia en el tratamiento del hiperparatiroidismo recidivado / Mediastinoscopy in the treatment of recurrent hyperparathyroidism

No disponible

Antibioticoterapia profiláctica de corta duración en la cirugía del quiste hidatídico hepático / Short-term prophylatic antibiotic therapy in surgery of hepatic hydatic cyst

Se presenta un estudio prospectivo randomizado de 2 grupos de pacientes sometidos a cirugía hepatobiliar por hidatidosis hepática, para valorar la efectividad de 2 dosis de la combinación clindamicina-tobramicina como antibioticoterapia profiláctica. No se encontraron complicaciones sépticas en el grupo con profilaxis, frente a 7 (58,3%) en el grupo control. La estancia hospitalaria se redujo de 29 a 9 días. No encontramos reacciones adversas debidas a los antibióticos. Se concluye que la combinación clindamicina-tobramicina es útil como pauta profiláctica en la cirugía de la hidatidosis hepática

Antibioticoterapia profiláctica de corta duración en la cirugía del quiste hidatídico hepático / Short-term prophylatic antibiotic therapy in surgery of hepatic hydatic cyst

Se presenta un estudio prospectivo randomizado de 2 grupos de pacientes sometidos a cirugía hepatobiliar por hidatidosis hepática, para valorar la efectividad de 2 dosis de la combinación clindamicina-tobramicina como antibioticoterapia profiláctica. No se encontraron complicaciones sépticas en el grupo con profilaxis, frente a 7 (58,3%) en el grupo control. La estancia hospitalaria se redujo de 29 a 9 días. No encontramos reacciones adversas debidas a los antibióticos. Se concluye que la combinación clindamicina-tobramicina es útil como pauta profiláctica en la cirugía de la hidatidosis hepática (AU)