Utilization of Antibiotic Bone Cement in Spine Surgery: Pearls, Techniques, and Case Review.

Vertebral osteomyelitis (VO) encompasses a spectrum of spinal infections ranging from isolated mild vertebral osteomyelitis to severe diffuse infection with associated epidural abscess and fracture. Although patients can often be treated with an initial course of intravenous antibiotics, surgery is sometimes required in patients with sepsis, spinal instability, neurological compromise, or failed medical treatment. Antibiotic bone cement (ABC) has been widely used in orthopedic extremity surgery for more than 150 years, both for prophylaxis and treatment of bacterial infection. However, relatively little literature exists regarding its utilization in spine surgery. This article describes ABC utilization in orthopedic surgery and explains the technique of ABC utilization in spine surgery. Surgeons can choose from multiple premixed ABCs with variable viscosities, setting times, and antibiotics or can mix in antibiotics to bone cements themselves. ABC can be used to fill large defects in the vertebral body or disc space or in some cases to coat instrumentation. Surgeons should be wary of complications such as ABC extravasation as well as an increased difficulty with revision. With a thorough understanding of the properties of the cement and the methods of delivery, ABC is a powerful adjunct in the treatment of spinal infections.

Complications of Lateral Decubitus Positioning During Orthopaedic Surgery.

¼ Lateral decubitus positioning is a nonanatomical position used for multiple orthopaedic procedures to obtain adequate surgical exposure.¼ Unique ophthalmologic, musculoskeletal, neurovascular, and hemodynamic complications may arise inadvertently from positioning.¼ Orthopaedic surgeons should be aware of the possible complications that may manifest from placing patients in the lateral decubitus position to adequately prevent and to properly manage them.

Adjacent Segment Disease After Spinal Fusion.

¼ Adjacent segment disease is characterized by a degenerative process adjacent to a previously fused spine segment, with new onset of clinical symptoms such as radiculopathy, myelopathy, or instability.¼ Etiology is related to the natural history of the disease process, increased biomechanical stress at adjacent segments, clinical factors specific to the individual patient, intraoperative factors, and malalignment.¼ Treatment is usually nonoperative, but surgical intervention can be indicated. Decompression and fusion remain the mainstay of operative treatment, and isolated decompression should be considered in specific cases.¼ Further randomized controlled trials are needed to establish how the treatment should progress, particularly with the development of minimally invasive and endoscopic surgery.

Robotic Spine Surgery in Rhode Island.

Surgical robots were first proposed in the 1960s with subsequent development and clinical implementation in the 1980s and 1990s. Recent advances in technology have led to widespread utilization of robots in many surgical subspecialties. In spine surgery, robots are primarily utilized for pedicle screw placement, with several studies highlighting the potential benefits of improved accuracy and reduction in radiation exposure. Once streamlined, robotic spine surgery (RSS) can provide financial renumeration through potential cost savings and marketing benefits, and in the future will likely aid in more complex surgeries. In Rhode Island, this technology has been implemented and has the potential to deliver optimized outcomes for patients. Robotic spine surgery is not a substitute for a skilled spine surgeon however, and careful diagnosis, care planning, and surgical execution are still mandatory to deliver the best possible patient outcomes. In this review, we chronicle the history of RSS, outline currently available RSS platforms, describe the efficacy, risks, and complications of RSS procedures, and explain the current and future utilization of RSS in Rhode Island.

Development of a Robotic Spine Surgery Program: Rationale, Strategy, Challenges, and Monitoring of Outcomes After Implementation.

ABSTRACT: Surgical robots were invented in the 1980s, and since then, robotic-assisted surgery has become commonplace. In the field of spine surgery, robotic assistance is utilized mainly to place pedicle screws, and multiple studies have demonstrated that robots can increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. However, this may be at the cost of longer operative times, complications, and the risk of errors in mapping the patient's anatomy.

Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use.

Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens. VO can be devastating, as infection can result in pathogenic biofilms on instrumentation that is dangerous to remove. New techniques, such as kyphoplasty and novel vertebroplasty methods, could amplify the potential of ABC in spine surgery. However, caution should be exercised when using ABC as there is some evidence of toxicity to patients and surgeons, antibiotic allergies, bone cement structural impairment, and possible development of antibiotic resistance. The purpose of this article is to describe the basic science of antibiotic cement utilization and review its usage in spine surgery.

Bowel and Bladder Care in Patients With Spinal Cord Injury.

Complete and incomplete spinal cord injuries affect between 250,000 and 500,000 people on an annual basis worldwide. In addition to sensory and motor dysfunction, spinal cord injury patients also suffer from associated conditions such as neurogenic bowel and bladder dysfunction. The degree of dysfunction varies on the level, degree, and type of spinal cord injury that occurs. In addition to the acute surgical treatment of these patients, spine surgeons should understand how to manage neurogenic bowel and bladder care on both a short- and long-term basis to minimize the risk for complications and optimize potential for rehabilitation.

Nosocomial COVID-19 infection mortality following surgery for severe progressive cervical myelopathy: a case report.

INTRODUCTION: We present the unique case of a nosocomial COVID infection acquired after urgent surgical intervention for cervical myelopathy, as well as the sequelae that followed in the postoperative period. CASE PRESENTATION: An initially COVID-negative patient underwent urgent surgical intervention for cervical myelopathy with significant neurological deterioration. She underwent an uncomplicated staged anterior cervical discectomy and fusion with corpectomy, as well as a subsequent posterior cervical instrumented fusion within the same hospitalization. The patient would refuse to adhere to standard COVID precautions during her admission and demonstrated rapid decompensation following her particularly uneventful surgeries, ultimately leading to her expiration. A laboratory test confirmed that she had contracted COVID at the time of the patient's death. DISCUSSION: This report highlights the repercussions of COVID-19 infection during the perioperative period and its implications on surgical outcomes. The stresses of surgery and the body's immunosuppressive responses during this time place patients at particular risk for the contraction of this virus. The standard precautions should be followed and vaccination should be considered for surgical candidates prior to their operations, as they become more readily accessible.

Temperature Prediction Using Multivariate Time Series Deep Learning in the Lining of an Electric Arc Furnace for Ferronickel Production.

The analysis of data from sensors in structures subjected to extreme conditions such as the ones used in smelting processes is a great decision tool that allows knowing the behavior of the structure under different operational conditions. In this industry, the furnaces and the different elements are fully instrumented, including sensors to measure variables such as temperature, pressure, level, flow, power, electrode positions, among others. From the point of view of engineering and data analytics, this quantity of data presents an opportunity to understand the operation of the system under normal conditions or to explore new ways of operation by using information from models provided by using deep learning approaches. Although some approaches have been developed with application to this industry, it is still an open research area. As a contribution, this paper presents an applied deep learning temperature prediction model for a 75 MW electric arc furnace, which is used for ferronickel production. In general, the methodology proposed considers two steps: first, a data cleaning process to increase the quality of the data, eliminating both redundant information as well as atypical and unusual data, and second, a multivariate time series deep learning model to predict the temperatures in the furnace lining. The developed deep learning model is a sequential one based on GRU (gated recurrent unit) layer plus a dense layer. The GRU + Dense model achieved an average root mean square error (RMSE) of 1.19 °C in the test set of 16 different thermocouples radially distributed on the furnace.

Recomendaciones basadas en la evidencia para el manejo del dolor neuropático (revisión de la literatura) / Evidence-based recommendations for the management of neuropathic pain (review of the literature)

Objetivo: Sintetizar, mediante una revisión de la literatura, las recomendaciones actuales en el manejo del dolor neuropático. Metodología: Revisión temática basada en una búsqueda de literatura altamente sensible para la identificación de guías de práctica clínica y revisiones sistémicas de la literatura enfocadas en diagnóstico y manejo del dolor neuropático, desde 2012 a 2017. De las referencias incluidas, se obtuvo información relacionada con definiciones, consideraciones relevantes, indicaciones y objetivos del tratamiento, tanto farmacológico como no farmacológico y criterios de remisión. Resultados: Se incluyeron 34 guías de práctica clínica relevantes para el manejo del dolor neuropático. Se realizó una síntesis de aspectos relevantes enfocados en: 1) las herramientas de tamización disponibles para la identificación y clasificación del dolor neuropático; 2) el diagnóstico y seguimiento de las pruebas de confirmación; 3) principios del manejo del dolor, así como el manejo farmacológico y no farmacológico de primera, segunda y tercera línea, de acuerdo con la localización de las lesiones; y 4) seguimiento. Los tratamientos de primera línea más comúnmente recomendados influyen los antidepresivos tricíclicos, α2δ-ligandos (pregabalina y gabapentina) y los inhibidores selectivos de la recaptación de serotonina/noradrenalina. Conclusión: El dolor neuropático es una condición común en la práctica clínica, donde el médico no especialista en dolor realizará el diagnóstico basado en una historia clínica detallada y examen físico dirigido. El tratamiento debe ser multidisciplinario e iniciarse precozmente con fármacos de primera línea

Objective: To synthesize, through a literature review, the current recommendations in the management of neuropathic pain. Methodology: Thematic review based on a highly sensitive literature search for the identification of clinical practice guidelines and systematic reviews, focused on diagnosis and management of neuropathic pain, from 2012 to 2017. From the included references, it was obtained information related to definitions, relevant considerations, indications and objectives of treatment, both pharmacological and non-pharmacological, as well as remission criteria. Results: We included 34 relevant clinical practice guidelines for the management of neuropathic pain. The synthesis of relevant aspects focused on: 1) the screening tools available for identification and classification of neuropathic pain; 2) diagnosis and follow-up of confirmation tests; 3) pain management principles, as well as pharmacological and non-pharmacological management as first, second and third line, according to the location of lesions; and 4) follow-up. The most commonly recommended first-line treatments include tricyclic antidepressants, α2δ-ligands (pregabalin and gabapentin), and selective serotonin / noradrenaline reuptake inhibitors. Conclusion: Neuropathic pain is a common condition in clinical practice, where the non-pain specialist will perform the diagnosis based on a detailed clinical history and directed physical exam. The treatment must be multidisciplinary and begin early with first-line drugs

Autonomía y supervisión del residente de cirugía: ¿se cumplen las expectativas en el quirófano? / Autonomy and supervision of the surgical resident: Are the expectations met in the operating room?

INTRODUCCIÓN: La supervisión efectiva y la autonomía gradual del residente de cirugía son importantes recursos educativos para su futura práctica independiente y segura. El objetivo de este estudio es el de comparar las percepciones sobre la supervisión y autonomía que tienen los residentes y profesores en el quirófano, con referencia a los estándares definidos en el currículo. MÉTODOS: Se realizó una medición de las percepciones de residentes y profesores mediante la Escala de Zwisch. Se identificaron los 10 procedimientos más frecuentemente realizados. Para cada uno de los procedimientos se calculó la media y la desviación estándar de la escala. Se comparó la percepción de los residentes, profesores con respecto a los niveles de competencia descritos en el currículo mediante el cálculo de ANOVA independiente (p < 0,05). RESULTADOS: Los principales procedimientos realizados fueron: colecistectomía, apendicectomía, cirugía de hernias de la pared abdominal, lavado peritoneal terapéutico, cirugía de tejidos blandos, laparotomía exploratoria, inserción de catéter central, toracostomía drenaje cerrado, laparoscopia diagnóstica y colectomía abierta. Las principales diferencias en las puntuaciones de la escala de Zwisch se encontraron en niveles avanzados de la residencia en procedimientos como colecistectomía, apendicectomía y en la intervención de hernias de la pared abdominal. CONCLUSIÓN: Existe congruencia entre las percepciones de autonomía y supervisión de los residentes de cirugía y sus profesores con respecto al currículo en la mayoría de procedimientos. Se requieren ajustes en los niveles de autonomía en niveles avanzados de la residencia, los cuales deberán evaluarse en nuevos estudios

INTRODUCTION: Effective supervision and gradual autonomy for surgical residents are important educational resources related to their future independent and safe practice. The aim of this study is to compare the perceptions about the supervision and autonomy that residents and the faculty have in the operating room, with reference to the standards defined in the curriculum. METHODS: The perceptions of residents and faculty were measured by using the Zwisch Scale. The 10 most frequently performed procedures were identified. The mean and standard deviations of the scale were calculated for each procedure. Resident and faculty perceptions were compared against the competency levels described in the curriculum by using independent ANOVAs (P<.05). RESULTS: The main procedures were: cholecystectomy, appendectomy, abdominal wall hernia surgery, therapeutic peritoneal lavage, soft tissue surgery, exploratory laparotomy, central catheter insertion, chest tube insertion, diagnostic laparoscopy, and open colectomy. The main differences in the Zwisch Scale scores were found in advanced levels of residence training in procedures such as, cholecystectomy, appendectomy, and repair of abdominal wall hernias. CONCLUSION: There is congruence between the perceptions of autonomy and supervision of surgical residents and faculty with regards to the curriculum in most procedures. Further adjustments are required in order to determine autonomy at advanced levels of the residency, which requires future research

Development of a group contribution method for estimating free energy of peptides in a dodecane-water system via molecular dynamic simulations.

BACKGROUND: Calculation of the Gibbs free energy changes of biological molecules at the oil-water interface is commonly performed with Molecular Dynamics simulations (MD). It is a process that could be performed repeatedly in order to find some molecules of high stability in this medium. Here, an alternative method of calculation has been proposed: a group contribution method (GCM) for peptides based on MD of the twenty classic amino acids to obtain free energy change during the insertion of any peptide chain in water-dodecane interfaces. Multiple MD of the twenty classic amino acids located at the interface of rectangular simulation boxes with a dodecane-water medium were performed. RESULTS: A GCM to calculate the free energy of entire peptides is then proposed. The method uses the summation of the Gibbs free energy of each amino acid adjusted in function of its presence or absence in the chain as well as its hydrophobic characteristics. CONCLUSION: Validation of the equation was performed with twenty-one peptides all simulated using MD in dodecane-water rectangular boxes in previous work, obtaining an average relative error of 16%.

Evaluación de la satisfacción con el resultado clínico después de 10 años de simpatectomía videotoracoscópica bilateral para el manejo de la hiperhidrosis primaria / Assessing levels of satisfaction of clinical results at 10 years following bilateral videothoracoscopic sympathectomy in the management of primary hyperhydrosis

Introducción. La hiperhidrosis primaria localizada y el rubor facial patológico son manifestaciones de hiperfunción del sistema autónomo simpático, que se presentan en casi el 3 % de la población y afectan en forma importante la vida cotidiana de muchas de estas personas. La simpatectomía videotoracoscópica es actualmente el tratamiento de elección. Materiales y métodos. Estudio descriptivo de una serie de 44 pacientes con síntomas de hiperhidrosis a quienes se les practicó simpatectomía videotoracoscópica bilateral, entre los años 2000 y 2003, para evaluar el nivel de satisfacción con los resultados clínicos. Resultados. Se pudieron localizar 18 pacientes en el 2014, con más de 10 años de evolución desde la cirugía (41 %). La satisfacción inicial, evaluada una semana después de la cirugía, fue excelente (90 %) en 42 de 44 pacientes, moderada, en uno, y solo en uno, inferior a 50 %. Diez años después de la cirugía, el promedio de satisfacción fue de 81,7 %. De 18 pacientes, 15 continuaban estando muy satisfechos o satisfechos (71-100 %) y 2 estaban insatisfechos (50 % o menos): uno por sudoración compensatoria grave y otro por recidiva de los síntomas. Conclusiones. Se encontró que la satisfacción de los pacientes con los resultados a largo plazo no parece depender de la gravedad de la hiperhidrosis compensatoria. Parece, entonces, que la hiperhidrosis compensatoria puede ser mejor tolerada con el paso del tiempo, ya que el paciente se acostumbra a esta situación y ya no lo afecta tanto en su vida cotidiana.

Introducción. La hiperhidrosis primaria localizada y el rubor facial patológico son manifestaciones de hiperfunción del sistema autónomo simpático, que se presentan en casi el 3 % de la población y afectan en forma importante la vida cotidiana de muchas de estas personas. La simpatectomía videotoracoscópica es actualmente el tratamiento de elección. Materiales y métodos. Estudio descriptivo de una serie de 44 pacientes con síntomas de hiperhidrosis a quienes se les practicó simpatectomía videotoracoscópica bilateral, entre los años 2000 y 2003, para evaluar el nivel de satisfacción con los resultados clínicos. Resultados. Se pudieron localizar 18 pacientes en el 2014, con más de 10 años de evolución desde la cirugía (41 %). La satisfacción inicial, evaluada una semana después de la cirugía, fue excelente (90 %) en 42 de 44 pacientes, moderada, en uno, y solo en uno, inferior a 50 %. Diez años después de la cirugía, el promedio de satisfacción fue de 81,7 %. De 18 pacientes, 15 continuaban estando muy satisfechos o satisfechos (71-100 %) y 2 estaban insatisfechos (50 % o menos): uno por sudoración compensatoria grave y otro por recidiva de los síntomas. Conclusiones. Se encontró que la satisfacción de los pacientes con los resultados a largo plazo no parece depender de la gravedad de la hiperhidrosis compensatoria. Parece, entonces, que la hiperhidrosis compensatoria puede ser mejor tolerada con el paso del tiempo, ya que el paciente se acostumbra a esta situación y ya no lo afecta tanto en su vida cotidiana.

Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral / Impact of the flipped classroom strategy in the learning environment in surgery: A comparison with the lectures

Introducción. La Facultad de Medicina de la Universidad de La Sabana utiliza rutinariamente la clase magistral como una de las principales estrategias educativas en áreas clínicas. Desde 2012, se introdujo un "currículo en contexto" y la estrategia del aula invertida en el curso de cirugía. Objetivo. Comparar el impacto de la clase magistral con el del aula invertida en el ambiente de aprendizaje en cirugía. Materiales y métodos. Se utilizó el cuestionario Dundee Ready Education Environment Measure (DREEM) en cuatro cohortes de estudiantes. Se analizaron los cinco dominios y la puntuación global del instrumento con ambas estrategias y se determinó el ANOVA (p<0,05). La consistencia interna se evaluó con el coeficiente alfa de Cronbach. Resultados. El cuestionario fue respondido por 207 participantes (hombres: 36 %; edad: 21,9 ± 1,49 años). La puntuación global del DREEM y la de sus dominios fueron mayores con la estrategia del aula invertida, lo que la situaría en un nivel de excelencia. No hubo diferencias entre el ANOVA de cada dominio y el de la puntuación global del cuestionario con el modelo de aula invertida, pero sí las hubo con la estrategia de clase magistral (p<0,01). Se encontraron elevados niveles de confiabilidad (Cronbach>0,90) para todas las mediciones en ambos ambientes y coherencia en todas las cohortes. Conclusiones. La puntuación de la estrategia de aula invertida en el cuestionario DREEM, se situó en un nivel de excelencia en comparación con la de la clase magistral. Es crucial determinar los factores que obtuvieron una puntuación negativa para promover el mejoramiento del entorno de aprendizaje, así como hacer mediciones en el tiempo para garantizar la calidad y el éxito de la estrategia.

Introduction: The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. Objective: To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. Materials and methods: The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. Results: There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. Conclusions: The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video).

BACKGROUND: Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at major Japanese institutions have reported en bloc resection, en bloc tumor-free margin resection, and curative resection rates of 92.7% to 96.1%, 82.6% to 94.5%, and 73.6% to 85.4%, respectively, with delayed bleeding and perforation rates of 0.6% to 6.0% and 3.6% to 4.7%, respectively. Although ESD is currently an alternative treatment in some countries, particularly in Asia, it remains uncertain whether ESD therapeutic outcomes in Western endoscopy settings can be comparable to those achieved in Japan. OBJECTIVE: To evaluate the ESD therapeutic outcomes for differentiated early gastric cancer (EGC) in a Western endoscopy setting. DESIGN/SETTING: Consecutive case series performed by an expertly trained Western endoscopist. PATIENTS: Fifty-three patients with 54 lesions. INTERVENTIONS: ESD for early gastric cancers (T1) satisfying expanded inclusion criteria. MAIN OUTCOME MEASUREMENTS: En bloc resection, en bloc tumor-free margin resection, and curative resection rates were 98%, 93%, and 83%, respectively. The delayed bleeding rate was 7%, and the perforation rate was 4%. RESULTS: The mean patient age was 67 years, and the mean tumor size was 19.8 mm, with 54% of the lesions located in the lesser curvature. The median procedure time was 61 minutes, with ESD procedures 60 minutes or longer associated with submucosal fibrosis (P < .001) and tumor size 25 mm or larger (P = .03). In every ESD procedure, both circumferential incision and submucosal dissection were performed by using a single knife. Two of the 4 delayed bleeding cases required surgery, and all perforations were successfully managed by using endoscopic clips. LIMITATION: Long-term outcome data are currently unavailable. CONCLUSION: ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western endoscopy setting comparable to those achieved at major Japanese institutions.

[Impact of the flipped classroom strategy in the learning environment in surgery: A comparison with the lectures]. / Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral.

INTRODUCTION: The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. OBJECTIVE: To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. MATERIALS AND METHODS: The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. RESULTS: There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. CONCLUSIONS: The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

The evolution of laparoscopy in abdominal surgery: a meta-analysis of the effect on infectious outcomes.

BACKGROUND: Laparoscopic surgery has been recommended as an effective strategy because of its advantages in decreasing abdominal surgical site infections (SSIs). The aim of this study was to assess the effect of laparoscopy on superficial and organ/space SSIs compared with open surgery in hollow-viscus procedures over time. STUDY DESIGN: Data on SSIs from randomized-controlled trials (RCTs) evaluating open versus laparoscopic abdominal surgeries were extracted from the Cochrane Database Reviews. Re-analysis of these data was performed to assess infections. Heterogeneity was also explored. A subgroup analysis was performed according to elective/emergency surgery status. RESULTS: Data from 72 RCTs including 8218 patients were collected (4116 patients in the laparoscopic group and 4102 patients in the open group). For superficial SSI, the pooled RD was -4.4% (95% CI: -5.4% to -3.3%), which indicated a lower risk in the laparoscopic group. For organ/space SSI, the pooled RD was 0.5% (95% CI: -0.1% to 1%), which indicated similar rates between the groups. Changes in SSI frequency had occurred over time. CONCLUSION: Laparoscopic surgery significantly decreases the risk of superficial SSI but does not affect the risk of organ/space SSI. Experience with technique improves outcomes.

Factores que influencian la elección de una carrera quirúrgica: análisis multiinstitucional global desde una perspectiva académica en Bogotá / Factors influencing a surgical career: multi-institutional analysis from an academic perspective in Bogotá

Introducción. Existen preferencias positivas y negativas que se relacionan con la decisión de seguir una carrera quirúrgica. No existe información al respecto en Colombia. El objetivo de este estudio fue analizar las preferencias que favorecen la elección basado en una evaluación global. Métodos. Se hizo una encuesta anónima entre internos, aspirantes, residentes y profesores. Se evaluaron seis categorías: oportunidades económicas, laborales, estilo de vida, modelos, estatus social y profesional. En los profesores y residentes, se evaluó la opinión de las preferencias que tienen los internos y aspirantes actualmente, no sus propias preferencias. Se evaluó el peso que la población da a las variables relacionadas con la elección y el cambio que sufren las preferencias, desde la posición de interno hasta profesor. Resultados. Se realizaron 176 encuestas. Las categorías que ofrecieron una poderosa influencia positiva o influencia positiva se relacionaron con la tutoría, la personalidad, y la situación social y económica del cirujano. En el segundo análisis, existe una tendencia al crecimiento para cada categoría de preferencias a partir de la posición de interno a aspirante, seguido por un decrecimiento en las preferencias cuando se alcanza la de residente y la de profesor. Conclusiones. Las preferencias para optar por una carrera quirúrgica en Bogotá, varían de acuerdo con la posición ocupada dentro de la carrera profesional. Varias preferencias exhiben una menor influencia desde la perspectiva de los profesores. Este hallazgo puede relacionarse hipotéticamente con el influjo del sistema sanitario en la práctica y requiere profundización en nuevos estudios.

Introduction. There are positive and negative preferences related to the decision to pursue a surgical career. There is no pertaining information In Colombia. The aim of the present study was to analyze the preferences that favor this choice under a global approach. Methods. An anonymous survey was conducted among interns, applicants, residents and faculty (attending). Six categories were evaluated: economic opportunities, employment, life style, role modeling, social and professional status. Among the faculty and the residents, we assessed the preferences opinion manifested by interns and applicants, but not their own preferences. The weight that the study population gives to the variables related to the choice and the change that undergo the preferences from the intern to the attending perspectives were evaluated. Results. 176 surveys were conducted. Those categories offering a powerful positive influence or a positive influence were related to mentoring, personality, and social and economic status of the surgeon. In the second analysis there appears a growing trend for each category of preference starting from the internship position or applicant, followed by a decrease in the preferences when reaching the resident or faculty position. Conclusions. Preferences to opt for a surgical career in Bogotá, Colombia, vary according to the position occupied within the surgical career. Several preferences exhibit less influence from the perspective of the attending surgeon. This finding may be hypothetically related to the influx of the health system on the surgical practice and it requires deepening through further studies.