Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study.

PURPOSE: Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. METHODS: Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). RESULTS: Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). CONCLUSION: FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.

Usefulness of histological superstudy of sentinel lymph nodes detected with radioisotopes in colon cancer.

INTRODUCTION: Adjuvant chemotherapy (CT) significally reduces the rate of relapse in +pN (stage III) colon cancer (CC) and in some pN0 (stage II) with risk factors such as pT4, vascular invasion V1, perineural invasion Pn1, and complicated tumors. However, unexpectedly, 20%-30% of pN0 present a relapse in the follow-up, which may suggest that the lymph node involvement was not discovered in the conventional histological study (CS), and its finding with a superstudy (SS) could increase the number of patients who would benefit from neoadjuvant CT. It is not possible to perform this SS in every lymph node (LN) from the specimen, but it is possible in a small group of LN which are representative of the N status (definition of sentinel node SN). The aim of our work is to state the representativeness of the SN and to analyze de number of patients who are suprastaged after the SS of the SN. MATERIAL AND METHODS: Prospective study of a series of patients who have undergone curative surgery for CC, to whom we perform selective biopsy of sentinel node (SBDN). Identification of SN was carried out with in vivo injection of the radiotracer, with ex vivo isolation of SN. Once the specimen is out, we take pictures of the surgical bed to rule out the presence of aberrant drainage routes, out of the routine oncological resection area. We performed the histological CS (Hematoxilin-Eosin stain (H-E) in conventional sections) in the rest of the LN from the mesocolon. In the SN we performed the CS and a SS with H-E in serial sections, immunohistochemistry (IHC) and molecular study with OSNA® (One Step Nucleic Acid Amplification). Diagnostic validity study od SBSN was carried out, defining the false negative (FN) as the negativity of the SN while other LN are positive (N+), as well as a valuation of the suprastaging due to the SS of the SN. RESULTS: We performed lymphatic map in 72 patients, finding the SN in 62 of them (87.3%). The 9 identification failures happened in the first 17 cases. We have not found aberrant drainage routes. A total of 1.164 LN were studied in the 62 patients (18.8 LN/patient), from which 145 are SN (2,34 SN/patient), having found 103 positive LN with the CS and 112 positive with the SS of SN (9+ LN more in 8 patients than detected with the CS). Positivity after CS in the SN group is 17.24% (25/145), while it is 8.53% in the rest (87/1.019) (P < .001). With the CS, 50% of the patients (31/62) were pN+ (4 are N+ exclusively in the SN), and after the SS of the SN, only 1 of the 31 pN0 patients (3.2%) becomes pN1a, with a definitive 51.6% of N+ in the whole series (32 N+ in the 62 patients) (5 are N+ exclusively in the SN). Exclusively with the SS of the SN, FN rate ("-SN, +others", meaning patients who are N+ having -SN) is 54.8% (17/31). With the SS of the SN, 8 of the 62 patients (12.9%) increase their total number of +LN: apart from the patient who turns from pN0 to pN1a, suprastaging from IIA to IIIB (and therefore increasing the total number of pN+ to 32), 5 of the 17 FN in the CS turns into positive (2 change the pN subindex and one is suprastaged from IIIB to IIIC), decreasing FN to 37.5% (12/32 cases). Besides, 2 patients whose SN is already positive in the CS increase the number of +SN after the SS of the SN, therefore both changing their pN subindex and one of them suprastaging from IIIB to IIIC. In summary, 8 patients increase the total number of positive SN after the SS (8/62, 12.9%), 5 of them changing the pN subindex (5/62, 12.9%), even if only 3 of them get suprastaged (3/62, 4.8%), among them the one who turns from pN0 to pN1a. CONCLUSION: Technique is valid and reproducible, with a high detection rate even with a high learning curve. It globally increases the number of affected LN in 12.9% of patients, having prognostic implications in 4.8% (suprastaging rate). Only 3.2% of pN0 patients in the CS turn to be +pN after the SS of the SN, with its therapeutic implications (prescription of adjuvant CT), which could be relevant when extrapolated to a big number of patients. The high FN rate (37.5%) prevents us from accepting the representativeness of SN as the global N status, but it is not clinically relevant in CC, as its aim is not to avoid lymphadenectomy, which remains mandatory (opposite to breast cancer or melanoma in which SN detection decides upon whether to perform or not the lymphadenectomy), but to decide which patients would benefit from adjuvant CT.

Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery.

Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.

Usefulness of histological superstudy of sentinel node detected with radioisotope in colon cancer. / Utilidad del superestudio anatomopatológico de ganglio centinela detectado con radioisótopos en el cáncer de colon.

INTRODUCTION: Adjuvant chemotherapy (CT) significally reduces the rate of relapse in +pN (stage III) colon cancer and in some pN0 (stage II) with risk factors such as pT4, vascular invasion V1, perineural invasion Pn1, and complicated tumors. However, unexpectedly, 20-30% of pN0 present a relapse in the follow-up, which may suggest that the lymph node involvement was not discovered in the conventional histological study (CS), and its finding with a superstudy (SS) could increase the number of patients who would benefit from neoadjuvant CT. It is not possible to perform this SS in every lymph node (LN) from the specimen, but it is possible in a small group of LN which are representative of the N status (definition of sentinel node SN). The aim of our work is to state the representativeness of the SN and to analyze de number of patients who are suprastaged after the SS of the SN. MATERIAL AND METHODS: Prospective study of a series of patients who have undergone curative surgery for colon cancer, to whom we perform selective biopsy of sentinel node. Identification of SN was carried out with in vivo injection of the radiotracer, with ex vivo isolation of SN. Once the specimen is out, we take pictures of the surgical bed to rule out the presence of aberrant drainage routes, out of the routine oncological resection area. We performed the histological CS (hematoxilin-eosin stain in conventional sections) in the rest of the LN from the mesocolon. In the SN we performed the CS and a SS with hematoxilin-eosin in serial sections, immunohistochemistry (IHC) and molecular study with One Step Nucleic Acid Amplification (OSNA®). Diagnostic validity study od selective biopsy of sentinel node was carried out, defining the false negative (FN) as the negativity of the SN while other LN are positive (N+), as well as a valuation of the suprastaging due to the SS of the SN. RESULTS: We performed lymphatic map in 72 patients, finding the SN in 62 of them (87.3%). The 9 identification failures happened in the first 17 cases. We have not found aberrant drainage routes. A total of 1.164 LN were studied in the 62 patients (18.8 LN/ patient), from which 145 are SN (2,34 SN/ patient), having found 103 positive LN with the CS and 112 positive with the SS of SN (9 +LN more in 8 patients than detected with the CS). Positivity after CS in the SN group is 17.24% (25/145), while it is 8.53% in the rest (87/1.019) (p<.001). With the CS, 50% of the patients (31/62) were pN+ (4 are N+ exclusively in the SN), and after the SS of the SN, only 1 of the 31 pN0 patients (3.2%) becomes pN1a, with a definitive 51.6% of N+ in the whole series (32 N+ in the 62 patients) (5 are N+ exclusively in the SN). Exclusively with the SS of the SN, FN rate ("-SN, +others", meaning patients who are N+ having -SN) is 54.8% (17/31). With the SS of the SN, 8 of the 62 patients (12.9%) increase their total number of +LN: apart from the patient who turns from pN0 to pN1a, suprastaging from IIA to IIIB (and therefore increasing the total number of pN+ to 32), 5 of the 17 FN in the CS turns into positive (2 change the pN subindex and one is suprastaged from IIIB to IIIC), decreasing FN to 37.5% (12/32 cases). Besides, 2 patients whose SN is already positive in the CS increase the number of +SN after the SS of the SN, therefore both changing their pN subindex and one of them suprastaging from IIIB to IIIC. In summary, 8 patients increase the total number of positive SN after the SS (8/62, 12.9%), 5 of them changing the pN subindex (5/62, 12.9%), even if only 3 of them get suprastaged (3/62, 4.8%), among them the one who turns from pN0 to pN1a. CONCLUSION: Technique is valid and reproducible, with a high detection rate even with a high learning curve. It globally increases the number of affected LN in 12.9% of patients, having prognostic implications in 4.8% (suprastaging rate). Only 3.2% of pN0 patients in the CS turn to be +pN after the SS of the SN, with its therapeutic implications (prescription of adjuvant CT), which could be relevant when extrapolated to a big number of patients. The high FN rate (37.5%) prevents us from accepting the representativeness of SN as the global N status, but it is not clinically relevant in colon cancer, as its aim is not to avoid lymphadenectomy, which remains mandatory (opposite to breast cancer or melanoma in which SN detection decides upon whether to perform or not the lymphadenectomy), but to decide which patients would benefit from adjuvant CT.

[Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study]. / Evaluación de la adecuación al protocolo de profilaxis antibiótica en histerectomías. Estudio de cohortes prospectivo.

OBJECTIVE: Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. METHODS: A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. RESULTS: A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. CONCLUSIONS: The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

Evaluación de la adecuación al protocolo de profilaxis antibiótica en cirugía de mama y su efecto sobre la incidencia de infección quirúrgica / Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection

Fundamento: La profilaxis antibiótica es una de las formas más eficaces de evitar la infección de sitio quirúrgico (ISQ). En este estudio se evalúan el cumplimiento del protocolo de profilaxis antibiótica y el efecto de su inadecuación en la incidencia de ISQ en cirugía de mama. Material y métodos: Estudio prospectivo de cohortes realizado entre julio de 2008 y julio de 2018. Se evaluaron el grado de cumplimiento de la profilaxis antibiótica en cirugía de mama y las causas de no cumplimiento: elección del antibiótico, vía de administración, tiempo de inicio, dosis y duración. Se estudió la incidencia de ISQ durante los 30 días posteriores a la intervención (90 en caso de implantes o prótesis). Para evaluar el efecto de la inadecuación de la profilaxis se utilizó el riesgo relativo (RR). Resultados: Se estudiaron 1.328 intervenciones en 1.212 mujeres. La incidencia acumulada de ISQ fue del 1,7% (n=22) y la etiología más frecuente Staphylococcus aureus (47,1%). El cumplimiento global del protocolo de profilaxis antibiótica fue del 95,3% (incluyendo las 568 cirugías donde no estaba indicada). Las causas principales de no cumplimiento fueron el tiempo de inicio (46,8%) y la elección del antibiótico (40,3%). La inadecuación aumentó significativamente la incidencia de ISQ (8,1 vs 1,3%, p=0,003) y el riesgo de sufrirla (RR=6,5; IC95% 2,3-18,1). Conclusiones: La tasa global de adecuación al protocolo fue muy alta. La inadecuación de la profilaxis antibiótica duplicó, al menos, el riesgo de sufrir ISQ en cirugía de mama

Background: Antibiotic prophylaxis is one of the most effective ways to avoid surgical site infection (SSI). The present study evaluates compliance with the antibiotic prophylaxis protocol and the effect of non-compliance on the incidence of SSI in breast surgery. Methods: A prospective cohort study was carried out from July 2008 to July 2018. It assessed the degree of compliance with antibiotic prophylaxis in breast surgery and the causes of non-compliance: choice of antibiotic, route of administration, time of onset, dose and duration. The incidence of SSI was studied during the 30 days after intervention (90 in the case of implants or prostheses). Relative risk (RR) was used to assess the effect of inadequate prophylaxis. Results: We studied 1,328 interventions in 1,212 women. The cumulative incidence of SSI was 1.7% (n=22) and the most common etiology was Staphylococcus aureus (47.1%). Overall antibiotic prophylaxis protocol compliance was 95.3%, (including the 568 interventions where it was not indicated). The principle causes of non-compliance were the time of onset (46.8%) and choice of antibiotic (40.3%). Non-compliance significantly increased both incidence of SSI (8.1 vs 1.3%, p=0,003) and its risk (RR=6.5, CI95% 2.3-18.1). Conclusions: The overall protocol compliance rate was very high. Non-compliance with prophylaxis protocol at least doubled the risk of SSI in breast surgery

[Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection]. / Evaluación de la adecuación al protocolo de profilaxis antibiótica en cirugía de mama y su efecto sobre la incidencia de infección quirúrgica.

BACKGROUND: Antibiotic prophylaxis is one of the most effective ways to avoid surgical site infection (SSI). The present study evaluates compliance with the antibiotic prophylaxis protocol and the effect of non-compliance on the incidence of SSI in breast surgery. METHODS: A prospective cohort study was carried out from July 2008 to July 2018. It assessed the degree of compliance with antibiotic prophylaxis in breast surgery and the causes of non-compliance: choice of antibiotic, route of administration, time of onset, dose and duration. The incidence of SSI was studied during the 30 days after intervention (90 in the case of implants or prostheses). Relative risk (RR) was used to assess the effect of inadequate prophylaxis. RESULTS: We studied 1,328 interventions in 1,212 women. The cumulative incidence of SSI was 1.7% (n=22) and the most common etiology was Staphylococcus aureus (47.1%). Overall antibiotic prophylaxis protocol compliance was 95.3%, (including the 568 interventions where it was not indicated). The principle causes of non-compliance were the time of onset (46.8%) and choice of antibiotic (40.3%). Non-compliance significantly increased both incidence of SSI (8.1 vs 1.3%, p=0,003) and its risk (RR=6.5, CI95% 2.3-18.1). CONCLUSIONS: The overall protocol compliance rate was very high. Non-compliance with prophylaxis protocol at least doubled the risk of SSI in breast surgery.

[Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study]. / Adherencia a la higiene de manos con soluciones hidroalcohólicas en estudiantes de medicina. Estudio descriptivo transversal.

OBJECTIVE: To assess hand hygiene compliance covertly in medical students in a university teaching hospital. METHODS: Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS: We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS: Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.

[Presurgical preparation and surgical site infection in neck surgery. The effect of the protocol adequacy in the improvement of the health care quality]. / Impacto de la adecuación del protocolo de preparación prequirúrgica en la incidencia de infección de localización quirúrgica en cirugía cervical.

BACKGROUND: Surgical wound infection is one of the leading causes of healthcare-associated infections. One of the most common measures for its reduction is the pre-surgical preparation. The aim of this study was to evaluate the adequacy to the pre-surgical protocol in patients undergoing neck surgery and the relationship with the incidence of surgical wound infection. MATERIAL AND METHODS: Observational cohort study, conducted from January 2011 to December 2017. Variables related to patient, pre-surgical preparation and infection were collected. Infection rate was calculated after a maximum period of 30days after surgery. The effect of the pre-surgical preparation's adequacy and infection was evaluated. RESULTS: The study included 131 patients. The global adequacy of the pre-surgical protocol was 84.7%, being the main cause of inadequacy the application of the mouthwash (7.6% of the interventions). The overall incidence of surgical wound infection during the follow-up period was 4.6% (95%CI: 1.0%-8.2%). No relationship between the adequacy to the protocol and the presence of infection was found (P=.59). CONCLUSIONS: Adequacy of the pre-surgical preparation in our hospital was high and the incidence of surgical wound infection was low, and no relationship was found between the two. The results show a high safety culture in this surgery. However, there is still room for improvement in the quality of care of our patients.

Integral nutritional approach to the care of cancer patients: results from a Delphi panel

Introduction: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. Methods: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. Results: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. Conclusions: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan

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Integral nutritional approach to the care of cancer patients: results from a Delphi panel.

INTRODUCTION: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. METHODS: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. RESULTS: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. CONCLUSIONS: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.

Incidencia de infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio de cohortes prospectivo / Incidence of surgical site infection in colon surgery and antibiotic prophylaxis adequacy: prospective cohort study

Fundamento: La infección de localización quirúrgica (ILQ) tiene un considerable impacto clínico y económico a nivel hospitalario, por lo que se consideran prioritarios su prevención y seguimiento. El objetivo de este estudio fue la evaluación del cumplimiento del protocolo de profilaxis antibiótica en la cirugía de colon y el efecto de su inadecuación en la incidencia de ILQ. Material y métodos: Se realizó un estudio de cohortes prospectivo desde julio de 2008 a julio de 2016. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y las causas de incumplimiento en cirugía de colon: duración e inicio, elección, vía de administración y dosis de antibiótico. Se estudió la incidencia de ILQ después de un período máximo de incubación de 30 días. Para evaluar el efecto del incumplimiento de la profilaxis en la ILQ se usó el riesgo relativo (RR). Resultados: El estudio incluyó 771 pacientes. La incidencia acumulada de ILQ fue del 5,8%, la mayoría (67%) infecciones incisionales superficiales. La etiología más frecuente de ILQ fue Escherichia coli (28%). La profilaxis antibiótica se administró en el 97,8% de los pacientes, con un cumplimiento global del protocolo del 91,9%. La causa principal de incumplimiento fue la elección del antibiótico (58,2%). No se encontró relación entre inadecuación de la profilaxis e incidencia de infección de localización quirúrgica (RR=0,5; IC95% 0,1-1,8). Conclusiones: La tasa global de adecuación al protocolo de profilaxis antibiótica fue alta. No se encontró asociación significativa entre adecuación de la profilaxis e incidencia de ILQ en cirugía de colo (AU)

Background: Surgical site infection (SSI) has a considerable clinical and economic impact at the hospital level, so prevention and monitoring are considered a high priority. The objective of this study was to assess compliance with the protocol of antibiotic prophylaxis in colon surgery and the effect of its inadequacy for the incidence of SSI. Methods: Prospective cohort study from July 2008 to July 2016. Compliance with antibiotic prophylaxis protocol and the causes of non-compliance were evaluated in colon surgery: duration and starting, choice, route of administration and dose of the antibiotic. The incidence of SSI was studied after a maximum incubation period of 30 days. Relative risk (RR) was used to evaluate the non-compliance causes of prophylaxis. Results: The study included 771 patients. The cumulative incidence of SSI was 5.8% (n=45), of which 2/3 were superficial incisional infections. The most common cause of SSI was Escherichia coli (28%). Antibiotic prophylaxis was administered in 97.8% of patients, with an overall protocol compliance of 91.9%. The principle cause of non-compliance was the choice of antibiotic (58.2%). No relationship between the inadequacy of prophylaxis and incidence of surgical site infection was found (RR=0.5; CI95% 0.1-1.8). Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol was high. No significant association between the adequacy of prophylaxis and incidence of surgical site infection in colon surgery was foun (AU)

[Incidence of surgical site infection in colon surgery and antibiotic prophylaxis adequacy: prospective cohort study]. / Incidencia de infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio de cohortes prospectivo.

BACKGROUND: Surgical site infection (SSI) has a considerable clinical and economic impact at the hospital level, so prevention and monitoring are considered a high priority. The objective of this study was to assess compliance with the protocol of antibiotic prophylaxis in colon surgery and the effect of its inadequacy for the incidence of SSI. METHODS: Prospective cohort study from July 2008 to July 2016. Compliance with antibiotic prophylaxis protocol and the causes of non-compliance were evaluated in colon surgery: duration and starting, choice, route of administration and dose of the antibiotic. The incidence of SSI was studied after a maximum incubation period of 30 days. Relative risk (RR) was used to evaluate the non-compliance causes of prophylaxis. RESULTS: The study included 771 patients. The cumulative incidence of SSI was 5.8% (n=45), of which 2/3 were superficial incisional infections. The most common cause of SSI was Escherichia coli (28%). Antibiotic prophylaxis was administered in 97.8% of patients, with an overall protocol compliance of 91.9%. The principle cause of non-compliance was the choice of antibiotic (58.2%). No relationship between the inadequacy of prophylaxis and incidence of surgical site infection was found (RR=0.5; CI95% 0.1-1.8). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol was high. No significant association between the adequacy of prophylaxis and incidence of surgical site infection in colon surgery was found.

Cirugía suprarrenal en España: resultados finales de una encuesta nacional / Adrenal Surgery in Spain: Final Results of a National Survey

Introducción Dada la disponibilidad del abordaje laparoscópico y la creciente detección de incidentalomas, las indicaciones de suprarrenalectomía pueden estar cambiando. La Sección de Cirugía Endocrina de la Asociación Española de Cirujanos diseñó una encuesta para analizar las indicaciones actuales de la suprarrenalectomía y sus resultados en los servicios de cirugía españoles. Material y métodos Se recogieron datos respecto al tipo de hospital y servicio, volumen de procedimientos, estudios de localización y preparación preoperatoria, indicaciones, técnica quirúrgica, instrumental utilizado, y resultados en términos de morbilidad y estancia hospitalaria. Se compararon los resultados de los centros en función de su volumen de actividad, utilizando las pruebas de Mann-Whitney para variables cuantitativas y de la chi al cuadrado para las cualitativas. Resultados Treinta y seis centros cumplimentaron el cuestionario e incluyeron 301 suprarrenalectomías realizadas en 2008. Las lesiones extirpadas más frecuentes fueron feocromocitoma (25,2%), adenoma no funcionante (16,2%), aldosteronoma (15,9%), adenoma de Cushing (11,2%), metástasis (10,3%), mielolipoma (5,6%) y carcinoma (4,9%) (..) (AU)

Introduction The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments.Material and methods Data were gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann–Whitney Test for the quantitative variables and chi squared for the qualitative ones. Results Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%).Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach (P=.019), and had a shorter overall hospital stay (P<.0001. Laparoscopic adrenalectomy was also associated with a shorter hospital stay (P<.0001).Conclusions Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay (..) (AU)

[Prognostic factors of spontaneous expulsion in ureteral lithiasis]. / Factores predictivos para la expulsión de la litiasis ureteral.

UNLABELLED: Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. OBJECTIVES: To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. MATERIAL AND METHODS: A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. RESULTS: 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR=1.823, p=0.013), size (>5 mm, OR=3.37, p>0.02), and medication (combination of alpha blockers and NSAIDs, OR=8.70, >0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0.006) and medication (p>0.001) as independent predictive factors.The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8.21 (95%CI 3.37-20.01) the possibilities of spontaneous expulsion. CONCLUSIONS: Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.

Factores predictivos para la expulsión de la litiasis ureteral / Prognostic factors of spontaneous expulsion in ureteral lithiasis

El tratamiento médico, la litotricia y la ureteroscopia son opciones terapéuticas para el tratamiento de la litiasis ureteral. La ureteroscopia y la litotricia son altamente resolutivas, si bien no están exentas de riesgos quirúrgicos y anestésicos. El tratamiento médico expulsivo es menos efectivo pero carece de esos riesgos. La selección de enfermos para el tratamiento médico debe ser cuidadosa, atendiendo a factores como el tamaño, la composición y la localización de la litiasis. Objetivos: Analizar retrospectivamente el papel de las características litiásicas y de la medicación (alfabloqueantes, antiinflamatorios no esteroideos [AINE] o la combinación de ambos) como factores predictivos de la expulsión de cálculos ureterales. Material y métodos: Para el estudio se encontraron disponibles 278 litiasis ureterales correspondientes a 260 enfermos. La variable principal del estudio fue el «resultado clínico» (expulsión o persistencia de la litiasis). Se analizaron la influencia de la localización, el tamaño, la composición y la medicación administrada (alfabloqueantes, AINE o la combinación de ambos) con el test de la chi cuadrado. A continuación, se llevó a cabo un análisis multivariante con un modelo de regresión logística para estudiar la influencia de cada una de las variables en presencia del resto de las covariables. Resultados: Se produjo la expulsión del 34,2% de las litiasis. La localización (uréter pelviano, odds ratio [OR]= 1,823; p=0,02), el tamaño (<5mm, OR=3,37; p<0,001) y la medicación administrada (combinación de alfabloqueantes y AINE, OR=8,70; p<0,001) resultaron factores predictivos para la expulsión. El análisis multivariante confirmó al tamaño (p=0,006) y a la medicación (p<0,001) como factores predictivos independientes. El tratamiento con una combinación de AINE y alfabloqueantes multiplica por 8,21 (intervalo de confianza del 95%: 3,37–20,01) las posibilidades de expulsión en comparación con la mera actitud expectante. Conclusiones: El tamaño del cálculo y la medicación son factores predictivos independientes para la expulsión de la litiasis ureteral (AU)

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. Objectives: To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methods: A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results: 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR= 1,823, p=0,013), size (<5mm, OR=3,37, p<0,02), and medication (combination of alpha blockers and NSAIDs, OR= 8,70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0,006) and medication (p<0,001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8,21 (95% CI 3.37–20,01) the possibilities of spontaneous expulsion. Conclusions: Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones (AU)

[Relational database for urinary stone ambulatory consultation. Assessment of initial outcomes]. / Una base de datos relacional para consulta de litiasis urinaria. Evaluación inicial de resultados.

OBJECTIVES: To create a relational database for monitoring lithiasic patients. We describe the architectural details and the initial results of the statistical analysis. METHODS AND MATERIALS: Microsoft Access 2002 was used as template. Four different tables were constructed to gather demographic data (table 1), clinical and laboratory findings (table 2), stone features (table 3) and therapeutic approach (table 4). For a reliability analysis of the database the number of correctly stored data was gathered. To evaluate the performance of the database, a prospective analysis was conducted, from May 2004 to August 2009, on 171 stone free patients after treatment (EWSL, surgery or medical) from a total of 511 patients stored in the database. Lithiasic status (stone free or stone relapse) was used as primary end point, while demographic factors (age, gender), lithiasic history, upper urinary tract alterations and characteristics of the stone (side, location, composition and size) were considered as predictive factors. An univariate analysis was conducted initially by chi square test and supplemented by Kaplan Meier estimates for time to stone recurrence. A multiple Cox proportional hazards regression model was generated to jointly assess the prognostic value of the demographic factors and the predictive value of stones characteristics. RESULTS: For the reliability analysis 22,084 data were available corresponding to 702 consultations on 511 patients. Analysis of data showed a recurrence rate of 85.4% (146/171, median time to recurrence 608 days, range 70-1758). In the univariate and multivariate analysis, none of the factors under consideration had a significant effect on recurrence rate (p=ns). CONCLUSIONS: The relational database is useful for monitoring patients with urolithiasis. It allows easy control and update, as well as data storage for later use. The analysis conducted for its evaluation showed no influence of demographic factors and stone features on stone recurrence.

Una base de datos relacional para consulta de litiasis urinaria. Evaluación inicial de resultados / Relational database for urinary stone ambulatory consultation. Assessment of initial outcomes

Objetivos: Crear una base de datos relacional orientada al seguimiento de la litiasis urinaria. Se presentan los detalles del diseño y los resultados iniciales de su explotación. Material y métodos: Se realiza base de datos desarrollada en el entorno de Microsoft Access® 2002, cuya información se ha distribuido en 4 tablas interrelacionadas: una tabla inicial donde se recogen los datos demográficos, una tabla de consulta, una tabla litiasis y una tabla procedimientos. Para la evaluación de la base de datos se realiza estudio observacional prospectivo desde mayo de 2004 hasta agosto de 2009 sobre 171 enfermos libres de litiasis tras tratamiento (médico, quirúrgico o LEOC), de un total de 511 introducidos en la base de datos. Se utilizó como variable indicadora la presencia o ausencia de recidiva litiasica. Se realizó análisis univariante para el estudio de la influencia de los factores demográficos (edad y sexo), aspectos relativos a la historia personal (antecedentes personales de litiasis o alteraciones de la vía urinaria) y características del cálculo (lateralidad, localización, tamaño y composición), mediante el test de la chi cuadrado, completándose con el cálculo de la probabilidad de recidiva litiásica en función del tiempo, mediante el método de Kaplan Meier. Posteriormente se realizó análisis multivariante mediante la regresión de Cox para estudiar la influencia cada una de las variables en presencia del resto de covariables. Resultados: Desde la puesta en marcha de la aplicación informática (septiembre de 2007), se han recogido datos de 702 consultas correspondientes a 511 enfermos. El análisis de los 171 enfermos disponibles para el análisis de supervivencia demostró una probabilidad de recidiva litiásica del 85,38% (146/171) con una mediana de tiempo a la recidiva de 608 días (rango 70–1.758). En el análisis univariante ningún factor estudiado resultó ser predictivo. El análisis multivariante tampoco confirmó ningún factor predictivo independiente para la recidiva litiásica. Conclusiones: La base de datos relacional es útil para el seguimiento de los enfermos con litiasis urinaria. Permite un control fácil y actualizado de los enfermos, así como un almacenamiento de datos para su posterior explotación. El estudio realizado para la evaluación de la misma no demostró influencia estadísticamente significativa de ninguno de los factores predictivos estudiados en la recidiva litiásica (AU)

Objectives: To create a relational database for monitoring lithiasic patients. We describe the architectural details and the initial results of the statistical analysis. Methods and materials: For a reliability analysis of the database the number of correctly stored data was gathered. To evaluate the performance of the database, a prospective analysis was conducted, from May 2004 to August 2009, on 171 stone free patients after treatment (EWSL, surgery or medical) from a total of 511 patients stored in the database. Lithiasic status (stone free or stone relapse) was used as primary end point, while demographic factors (age, gender), lithiasic history, upper urinary tract alterations and characteristics of the stone (side, location, composition and size) were considered as predictive factors. An univariate analysis was conducted initially by chi square test and supplemented by Kaplan Meier estimates for time to stone recurrence. A multiple Cox proportional hazards regression model was generated to jointly assess the prognostic value of the demographyc factors and the predictive value of stones characteristics. Results: For the reliability analysis 22,084 data were available corresponding to 702 consultations on 511 patients. Analysis of data showed a recurrence rate of 85.4% (146/171, median time to recurrence 608 days, range 70–1758). In the univariate and multivariate analysis, none of the factors under consideration had a significant effect on recurrence rate (p=ns). Conclusions: The relational database is useful for monitoring patients with urolithiasis. It allows easy control and update, as well as data storage for later use. The analysis conducted for its evaluation showed no influence of demographyc factors and stone features on stone recurrence (AU)