Surgical complications in a population-based colorectal cancer screening program: Incidence and associated factors. / Complicaciones posquirúrgicas en un programa de cribado poblacional de cáncer colorrectal: incidencia y factores asociados.

INTRODUCTION: Colorectal cancer (CRC) screening programs produce risks, including those derived from colorectal surgeries. The objective of this analysis is to evaluate the complications associated with the surgery. PATIENTS AND METHODS: Retrospective analysis including patients who required colorectal surgery within the population-based CRC screening program in Galicia (May 2013-June 2019). We analyzed the indication for surgery and the rate of in-hospital (mildI-II, severeIII-V, Clavien-Dindo classification) and at discharge complications. We performed a multivariate analysis to determine the variables independently associated. RESULTS: In the analyzed period, 1092 patients underwent surgery (benign lesion 16.5%, pT1 CRC 18.2%, rest of CRC 64.6%) laparoscopic approach in 69.8% of the cases. In-hospital complications were detected in 19.2% of patients (mild: 13.4%; severe: 5.9%; deaths: 0.2%) and at discharge in 159 (14.6%) patients. Male sex was associated with in-hospital complications (OR: 2.0; 95%CI: 1.3-3.0). The variables associated with severe complications were: male sex (OR: 2.6; 95%CI: 1.2-5.5), tertiary hospital (OR: 0.5; 95%CI: 0.2-0.9) and ECOGI (OR: 0.2; 95%CI: 0.05-0.6). The factors associated with complications after discharge were age ≥60years (OR: 1.5; 95%CI: 1.0-2.3), rectal location (OR: 1.6; 95%CI: 1.1-2.3) and in-hospital complications (OR: 2.2; 95%CI: 1.5-3.2). CONCLUSIONS: Surgery is the main cause of morbidity and mortality associated with a CRC screening program. These results must be taken into account in the decision making of lesions that are candidates for endoscopic resection.

Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study.

BACKGROUND: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. METHODS: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist's adenoma detection rate (ADR) classified into quartiles and the hospital's complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). RESULTS: We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87-1.19), due to colonoscopy complications (0.02, 95% CI 0.00-0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85-1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11-2.23), sex (female = 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87-185.59; intermediate risk = 5.63, 95% CI 1.89-16.80; low risk = 1.43; 95% CI 0.36-5.75), the endoscopist's ADR (Q4 = 0.44, 95% CI 0.28-0.68; Q3 = 0.44, 95% CI 0.27-0.71; Q2 = 0.71, 95% CI 0.44-1.14) and the hospital (tertiary = 0.54, 95% CI 0.38-0.79). CONCLUSIONS: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist's ADR and the hospital's complexity.

Epidemiología de la varicela en España en los períodos pre y post vacunación / Epidemiology of varicella in Spain pre-and post-vaccination periods

Fundamento: El virus varicela zoster puede causar dosenfermedades, la varicela y el herpes zóster. La vacuna frentea la varicela se incorporó en España en 2005 para personassusceptibles de entre 10 y 14 años. En 2007 se aprobó una propuestade vigilancia de la varicela y herpes zóster que permitieradetectar posibles cambios en los patrones de distribuciónpor edad, en la gravedad y complicaciones. El objetivo de estetrabajo es conocer la carga de enfermedad por varicela antes ydespués de la vacunación.Método: Se analizan los datos agregados (casos e incidencia)de varicela y herpes zóster en España en el sistema CMBDpara 1997-2003 y 2005-2007, así como la mortalidad por estaenfermedad a nivel nacional para e período1999-2006.Resultados: El 88,1% de los casos de varicela se da enpersonas menores de 15 años. En el CMBD se registró un promedioanual de 1.311 ingresos. No se observaron cambios significativosen la distribución por edad, sexo ni complicacionesdurante los ingresos en ninguno de los períodos estudiados. El32-36% anual ingresó por un motivo diferente a varicela. Lamortalidad osciló entre 4 y 14 individuos/año, el 80% mayoresde 14 años. El 64% de los casos notificados de herpes zósterfueron mayores de 50 años. La tasa media anual de ingresospor fue de 2,5 por 100.000 habitantes sin diferencias por sexo.La tasa media anual de defunciones fue 0,31 por millón dehabitantes.Conclusiones: En España la varicela tuvo una disminucióngeneralizada durante 2005-2007, pero es difícil valorar elimpacto de la vacunación por la falta de cifras de coberturavacunal y porque este período coincide con el inmediato a laúltima onda epidémica, cuyo máximo se registró en 2004(AU)

Background. Varicella virus can cause two differentdiseases: chickenpox and herpes zoster. In 2005 varicellavaccine has been introduced in the Spanish nationalvaccination schedule for 10-14 years old non-immune people,in order to reduce the severity of the disease. In 2007 a newsurveillance protocol with aggregate data for chickenpox andherpes zoster was approved in order to detect any change inage distribution, severity and complications of the chickenpoxand herpes zoster cases. The aim of this study is to know theburden of diseases (in the last ten years).Methods. Number of cases, hospitalization and incidencefor chickenpox and herpes zoster were study for two periods1997-2003 and 2005-2007. Analysis for 1996-2007 fatal caseswas done too. We decided to remove year 2004 because theextremely high chickenpox incidence registered. Sources ofdata: RENAVE (Spanish Surveillance Network), Spanishhospital surveillance system (CMBD), and mortality registries.Results. Chickenpox incidence decreased since 2005, butan increasing trend was detected in hospitalisation with anaverage of 1,311 hospitalizations every year. For the 32%-36%of hospitalized cases, the main diagnosis was not chickenpox.4-14 deaths per year have been detected; 80% of them wereolder than 14 years. Annual rate of herpes zosterhospitalization was 2.5 per 100,000 inhabitants, similar in bothsexes. Case fatality rate per year was 0.31 per millioninhabitants. No significant changes were detected in age andsex in complicated cases between the two periods. 88% ofchickenpox cases were younger than 15 years old and 64% ofherpes zoster older than 50 years in 2007.Conclusions. Chickenpox has been decreasing during2005-2007 in Spain...(AU)

[Burden of disease in Spanish population under 15 years old in 1999]. / Carga de enfermedad de la población española menor de 15 años para el año 1999.

BACKGROUND AND OBJECTIVE: Burden of disease (DALYs) can help define health priorities. Our objective was to assess DALYs of those illnesses most important in Spanish children and teenagers. MATERIAL AND METHOD: We calculated DALYs components (YLL, YLD) by age groups and sex. Sources used were Spanish mortality data and WHO DALY's estimates. RESULTS: Total DALYs was 46.57/1000 habitants and it was highest in children aged less than 1 year. The first cause was represented by non-communicable diseases and the second by communicable-perinatal diseases in less than 1 year and 1-4 years and injuries in 5-14 years. CONCLUSIONS: DALYs is a good indicator to define health's population.