Cancelación en CMA: Incidencia y causas / Cancellation in CMA: Incidence and causes

Introducción: Las Unidades de Cirugía Mayor Ambulatoria (UCMA) cada día cobran más relevancia precisando una correcta gestión. Uno de los principales parámetros a mejorar en la política de gestión hospitalaria es el índice de cancelaciones sobre procesos electivos. Material y método Diseñamos un estudio retrospectivo observacional, seleccionando todos los pacientes intervenidos en nuestra UCMA desde 1995 hasta 2009: un total de 16.934 pacientes. Analizamos las intervenciones quirúrgicas canceladas el día anterior a la intervención y las cancelaciones en el día de la intervención. Resultados Un total de 701 pacientes (4,1%) sufrieron la cancelación de la intervención quirúrgica programada. En 343 pacientes (2%) la cancelación se produjo el día anterior a la intervención y en 358 pacientes (2,1%) la cancelación se produjo el día de la intervención. Causas de la cancelación enfermedad aguda intercurrente 180 pacientes (25,7%), decisión personal del paciente 126 (18%), no comparecencia del paciente 28 (4%), preparación incorrecta del paciente 190 (27,1%), falta de recursos 177 (25,2%). Distribuyendo las causas de cancelación según la (..) (AU)

Introduction: Major Ambulatory Surgery (MAS) units are becoming increasingly important and require correct management. One of the principal improvement parameters in hospital management policy is the rate of cancellations of elective surgery. Material and method: We designed a retrospective, observational study by selecting all the patients operated on in our MAS unit from 1995 to 2009: 16.934 patients. We analysed the surgical procedures cancelled the day before the operation. Results: A total of 701 patients (4.1%) had a scheduled surgical intervention cancelled. This cancellation occurred the day before the operation in 343 patients (2%) and on the same day of the operation in 358 patients (2.1%). Reasons for the cancellation: acute intercurrent disease in 180 patients (25.7%), personal decision of the patient in 126 (18%), non-appearance of the patient in 28 (4%), incorrect preparation of the patient in 190 (27.1%), lack of resources (..) (AU)

[Cancellation in CMA: incidence and causes]. / Cancelación en CMA: incidencia y causas.

INTRODUCTION: Major Ambulatory Surgery (MAS) units are becoming increasingly important and require correct management. One of the principal improvement parameters in hospital management policy is the rate of cancellations of elective surgery. MATERIAL AND METHOD: We designed a retrospective, observational study by selecting all the patients operated on in our MAS unit from 1995 to 2009: 16.934 patients. We analysed the surgical procedures cancelled the day before the operation. RESULTS: A total of 701 patients (4.1%) had a scheduled surgical intervention cancelled. This cancellation occurred the day before the operation in 343 patients (2%) and on the same day of the operation in 358 patients (2.1%). Reasons for the cancellation: acute intercurrent disease in 180 patients (25.7%), personal decision of the patient in 126 (18%), non-appearance of the patient in 28 (4%), incorrect preparation of the patient in 190 (27.1%), lack of resources in 177 (25.2%). Distributing the reasons for cancellation according to the possibility of preventing them; 369 cancellations (52.6%) could be avoidable, 43 (6.2%) potentially avoidable, 177 (25.2%) difficult to avoid, and 112 (16%) unavoidable. CONCLUSIONS: More than half of the cancellations could have been avoided. We recommend improvements in the replacement of already scheduled patients. Information campaigns would be needed to increase the awareness of the population on the real cost of health services. Improvement measures would also be needed to improve the selection-evaluation of patients with pre-operative protocols/assessment units.

Results of biliopancreatic diversion after five years.

BACKGROUND: Gastric restrictive procedures, currently the most popular surgical operations for morbid obesity, have proved to be effective in initiating weight loss, but questions regarding their long-term efficacy in weight maintenance have arisen. Biliopancreatic diversion (BPD) is a mixed and complex technique that has shown good long-term results. There are no series with long-term follow-up of BPD in Spain. We present >5 year results (average 67.9 +/- 15 SD mons, range 48-96), evaluating weight loss, morbidity and mortality after BPD. METHODS: 74 patients who underwent BPD and completed 5 or more years of follow-up were studied. The results have been analyzed in terms of weight loss (classification of Reinhold), improvement in morbidity, and improvement in quality of life (BAROS). RESULTS: 78.6% were women. Mean age was 38 +/- 11 years (18-61). Mean preoperative body mass index (BMI) was 54 +/- 8 kg/m(2). Progression of BMI: 1 year 34 +/- 6, 2 years 31 +/- 6, 5 years 33 +/- 7 and 7 years 31 +/- 3 kg/m(2). Excess weight loss at 1 year follow-up was 67%, at 2 years 75%, at 5 years 70% and at 7 years 71%. There were significant differences between morbidly obese (BMI <50 kg/m(2)) and super-obese (BMI >50 kg/m(2) ), with better results in the morbidly obese group. CONCLUSION: BPD shows long-term effectiveness in weight loss, co-morbidity improvement and quality of life. Protein, vitamin and oligoelement deficits may appear in the long-term, so that strict follow-up and supplementation of deficiencies are necessary.

Vertical banded gastroplasty: is it a durable operation for morbid obesity?

BACKGROUND: Long-term follow-up is important in the evaluation of results of bariatric operations. The authors followed vertical banded gastroplasty (VBG) in an ongoing database. METHODS: From 1986 to 1999, 123 VBGs were performed in one surgical ward. The series comprises 105 females and 18 males, with mean age 37 years and mean preoperative BMI 48.39 kg/m(2). The authors evaluated long-term results (patients followed, patients who underwent revisional surgery, success rate and complications), analyzed in 2000 and again in 2002. RESULTS: With time, the percentage of patients in the follow-up decreased from 65 to 53%, the success-rate decreased from 46.16 to 32.79%, and revisional surgery for inadequate weight loss or complications increased from 9.61 to 29.51% in only 2 years. CONCLUSION: The weight loss of VBG was frequently not maintained in the long-term. However, we have previously found maintained improvements in comorbidities.