[Single preoperative dose of metronidazole plus gentamicin for antimicrobial prophylaxis in colorectal surgery]. / Dosis única preoperatoria de metronidazol más gentamicina para profilaxis antibiótica en cirugía colorrectal.

BACKGROUND AND OBJECTIVE: To prove that a single-preoperative dose (SD) of metronidazole plus gentamicin guarantees the same clinical effectiveness than the same dose administered in a multiple-perioperative schedule (MD), with a reduction of the direct costs. PATIENTS AND METHOD: A retrospective cohort study with patients undergoing elective colorectal surgery between 1995 and 2003 was designed. Patients in the cohort of cases received a SD of metronidazole 1500 mg plus gentamicin 240 mg between 1999 and 2003. Patients included in the cohort of controls received the same dose of antibiotics in a MD schedule between 1995 and 1997. Clinical effectiveness was evaluated as length of stay, mortality and rate of surgical-related infections. Economic analysis was performed using direct costs of therapy exclusively. RESULTS: 414 patients were included in the cohort of MD and 978 were included in the cohort of SD. Total length of stay (standard deviation) was 15.1 (16.2 days), with a significant reduction in the SD cohort versus the MD cohort: 14.0 (15.4) days versus 17.5 (17.8) days (p < 0.001). No differences in mortality (overall rate 3.2%) or surgical infection rate (overall rate 8.6%) between cohorts were found. SD schedule produces a 35% cost-reduction per procedure. CONCLUSIONS: Attending the clinical effectiveness, no differences between SD and MD cohorts were found. Therefore, according to logistics advantages and costs reduction, the SD of antibiotic is considered the most efficient option.

Dosis única preoperatoria de metronidazol más gentamicina para profilaxis antibiótica en cirugía colorrectal / Single preoperative dose of metronidazole plus gentamicin for antimicrobial prophylaxis in colorectal surgery

Fundamento y objetivo: El propósito del estudio ha sido demostrar que una dosis única (DU) preoperatoria de la mezcla metronidazol-gentamicina garantiza una efectividad similar a la obtenida por los mismos antibióticos en dosis múltiple (DM) perioperatoria, acompañada de una reducción de costes directos. Pacientes y método: Se ha realizado un estudio retrospectivo de cohortes en pacientes a quienes se practicó cirugía colorrectal programada entre 1995 y 2003. Los pacientes de la cohorte objeto de estudio recibieron como pauta profiláctica una mezcla de 1.500 mg de metronidazol y 240 mg de gentamicina en DU preoperatoria entre 1999 y 2003. Los controles recibieron los mismo antibióticos en un esquema de DM perioperatoria entre 1995 y 1997. La efectividad clínica se evaluó mediante el análisis de la estancia hospitalaria, la mortalidad y las complicaciones infecciosas. El análisis económico contempló exclusivamente los costes directos del tratamiento. Resultados: Se incluyó a 414 pacientes en la cohorte de DM y a 978 en la de DU. La estancia media (desviación estándar) total fue de 15,1 (16,2) días, con una reducción significativa de la estancia en la cohorte de DU respecto a la de DM: 14,0 (15,4) frente a 17,5 (17,8) días (p < 0,001). No se observaron diferencias en la mortalidad de ambas cohortes (mortalidad global del 3,2%) ni en la incidencia acumulada de infección posquirúrgica (incidencia global del 8,6%). El esquema en DU supuso una reducción del coste por procedimiento del 35%. Conclusiones: Desde el punto de vista clínico no se aprecian diferencias entre las cohortes de DU y DM. Por tanto, las ventajas logísticas y la reducción de costes hacen de la profilaxis en DU la opción más eficiente

Background and objective: To prove that a single-preoperative dose (SD) of metronidazole plus gentamicin guarantees the same clinical effectiveness than the same dose administered in a multiple-perioperative schedule (MD), with a reduction of the direct costs. Patients and method: A retrospective cohort study with patients undergoing elective colorectal surgery between 1995 and 2003 was designed. Patients in the cohort of cases received a SD of metronidazole 1500 mg plus gentamicin 240 mg between 1999 and 2003. Patients included in the cohort of controls received the same dose of antibiotics in a MD schedule between 1995 and 1997. Clinical effectiveness was evaluated as length of stay, mortality and rate of surgical-related infections. Economic analysis was performed using direct costs of therapy exclusively. Results: 414 patients were included in the cohort of MD and 978 were included in the cohort of SD. Total length of stay (standard deviation) was 15.1 (16.2 days), with a significant reduction in the SD cohort versus the MD cohort: 14.0 (15.4) days versus 17.5 (17.8) days (p < 0.001). No differences in mortality (overall rate 3.2%) or surgical infection rate (overall rate 8.6%) between cohorts were found. SD schedule produces a 35% cost-reduction per procedure. Conclusions: Attending the clinical effectiveness, no differences between SD and MD cohorts were found. Therefore, according to logistics advantages and costs reduction, the SD of antibiotic is considered the most efficient option

Técnica de Serra-Dória. Un buen recurso para el tratamiento de la acalasia esofágica recidivada / The Serra-Dória technique. A good resource for the treatment of recurrent achalasia

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