Endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in older patients.

BACKGROUND: Older adults are increasing in number and frequently seeking hospital care for acute illness. We aimed to measure the utilization and safety of ERCP in patients aged 85 and older in our hospital. METHODS: This is a single-site, retrospective, observational and descriptive study. We obtained data about admissions and ERCP utilization from our hospital database. We reviewed medical and procedural records of patients aged 85 or older who underwent ERCP for choledocholithiasis between 2013 and 2019. We evaluated technical and medical adverse events after ERCP. RESULTS: 494 ERCP for choledocholithiasis were performed during this period and 154 (31%) were aged 85 or older. We identified 567 (4.8%) admissions for biliary tract diseases in the older population, and 27% of cases had required ERCP. In older patients, the rate of technical adverse events was around 10%. There was no statistical difference between the older and younger groups regarding technical complications (8.8 vs 9.7%; p=0.7). Besides, in 36% of cases, a medical event, decompensated comorbidity or geriatric syndromes appeared after ERCP. The overall mortality for any cause at six months was nearly 20%, and the survival rate was significantly lower in patients who develop adverse events (technical or medical). CONCLUSIONS: Our hospital experiences frequent utilization of ERCP by patients aged 85 and older. Although technical adverse event rates are similar to those of younger adults, medical events appear frequently. We plan to strengthen our care plans for older adults and hope to reduce the medical complications experienced post ERCP.

Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente / A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook

Introducción: No hay datos cuantificados de la actividad real conseguida durante los 5 años de formación en España de la especialidad de Cirugía General y del Aparato Digestivo (CGAD). Igualmente, hay escasos datos en los programas de otros países y especialidades quirúrgicas. El objetivo es estimar la actividad media quirúrgica global, por áreas de capacitación específica y grado de complejidad, del programa español de la especialidad. Participantes y método Estudio multicéntrico prospectivo observacional sobre la actividad de los residentes de CGAD en España a través del libro informático del residente de la Asociación Española de Cirujanos (LIR-AEC). Cada residente registra su propia actividad supervisado por su tutor. El periodo de muestra fue de 6 meses. A partir de los resultados se estimaron las medianas de actividad anual y del periodo de la residencia. Resultados Actividad quirúrgica: se ha estimado que durante la residencia asisten a 1.325 intervenciones, realizan como cirujano principal 654 (49%). Actividad asistencial: la media de guardias es de 5,2±1,8 al mes. La actividad en consultas externas es de 548 primeras visitas y casi el doble de segundas visitas. Actividad científica: el número total de cursos y congresos es de 34. La media estimada de comunicaciones a congresos es de 14 y de publicaciones de 3.ConclusionesEl LIR-AEC es una herramienta adecuada para verificar la actividad del programa español de CGAD. Estos resultados permitirán una evaluación comparativa con la formación de los programas de otros países y especialidades quirúrgicas (AU)

Introduction: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by (..) (AU)

[A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook]. / Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente.

INTRODUCTION: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by specific skill areas and by the level of complexity of the Spanish program in the specialty of GGS. PATIENTS AND METHOD: A prospective, observational, multicentre study was performed on the activity of GGS residents in Spain using the Resident Computerised Logbook of the Spanish Surgeons Association (LIR-AEC). Each of the residents registered their own activity supervised by their tutor. The sample period was 6 months. The medians of the annual activity and the period of residency were calculated from the results. RESULTS: Surgical activity: during the residency, it was estimated that that they attended 1,325 operations, 654 (49%) as lead surgeon. Health care activity: the mean number of times on-call was 5.2±1.8 per month. Activity in outpatient clinics was 548 first visits, and almost double for second visits. Scientific activity: the total number of courses and conferences attended was 34. The estimated mean number of presentations at conferences was 14, with 3 publications. CONCLUSIONS: LIR-AEC is a suitable tool to verify activity in the Spanish GGS Program. These results may be useful for comparing with training programs in other countries and in other surgical specialties.

Results of implementation of a fast track pathway for diagnosis of colorectal cancer.

INTRODUCTION: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission in these circuits. AIMS: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice. MATERIAL AND METHOD: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. RESULTS: of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). Fourteen (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit. CONCLUSIONS: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition.

Resultados de la implementación del circuito de diagnostico rápido de cáncer colorrectal / Results of implementation of a fast track pathway for diagnosis of colorectal cancer

Introducción: los circuitos de diagnóstico rápido de cáncer (CDRC) pretenden disminuir las demoras en el diagnóstico y tratamiento del cáncer colorrectal (CCR). Se recomienda el inicio del primer tratamiento en un plazo de 30 días desde la entrada en el circuito de diagnóstico rápido. Objetivos: conocer las características y fluidez de nuestro circuito de diagnóstico rápido del cáncer colorrectal (CDRC), centrando el interés en los pacientes cuyo primer tratamiento va a ser el quirúrgico. Material y método: se analizan los pacientes que ingresan el circuito de diagnóstico rápido durante un periodo de 2 años (2008- 2009) y también los pacientes diagnosticados durante el tiempo del estudio por otras vías. Resultados: acceden al circuito de diagnóstico rápido 316 pacientes, 78 pacientes (24,7%) presentan cáncer digestivo, siendo finalmente diagnosticados de CCR 61 pacientes (19,3%). El intervalo de tiempo desde la entrada al CDRC hasta la primera visita en el hospital fue de 3 días (rango 1-8), y el intervalo hasta la realización de la colonoscopia fue de 11,5 días (rango 1-41). Los pacientes candidatos a cirugía que fueron intervenidos en un intervalo inferior a 30 días fueron 14 (41,1%), 28 pacientes (82,3%) fueron intervenidos antes de los 45 días. Conclusiones: la rapidez del circuito es aceptable pero cualquier aumento de la demanda puede generar retrasos, con lo que un responsable de seguimiento del proceso posiblemente evitará demoras y mejorará la coordinación en las diferentes fases del circuito y tratamiento. El rendimiento diagnóstico es bajo por lo que hay que pensar en la aplicación de alternativas ya existentes, como el cribado poblacional, que permitan el diagnóstico precoz en pacientes que aún no presentan sintomatología(AU)

Introduction: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission in these circuits. Aims: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice. Material and method: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. Results: of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). Fourteen (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit. Conclusions: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition(AU)

Abscesos esplénicos múltiples / Multiple splenic abscesses

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Cuatro años de experiencia con el libro informático del residente de la AEC / Four years experience with the AEC residents E-Book

Introducción La introducción del libro informático del residente, de la Asociación Española de Cirujanos (LIR-AEC), nos ha permitido realizar evaluaciones particulares y generales de cada residente. El objetivo ha sido conocer la media de actividades asistenciales, científicas y quirúrgicas según el programa de la especialidad. Material y método Registro de la actividad de los residentes en el LIR-AEC. Se ha cuantificado la actividad general por año y por rotación. Se ha analizado la relación de intervenciones asistidas y realizadas y según grados de complejidad. La media de actividades científicas y asistenciales y la de guardias al mes. Resultados Desde 2004, 8 residentes han registrado su actividad en el LIR-AEC. Asisten a una media de 1.514 intervenciones, de las cuales realizan como cirujano 922 (62%). Asisten a 185 intervenciones laparoscópicas, de las que realizan 72 (39%). Como cirujanos, 864 (94%) de los 922 procedimientos son de los niveles 1, 2 y 3 (el 64, el 75 y el 53%, respectivamente). Realizan una media de 5,75 guardias por mes. Acuden de media durante la residencia a un total de 21 cursos y congresos. Participan en un total de 24 comunicaciones y pósters, así como en 6 publicaciones de media en la residencia. Conclusiones El LIR-AEC permite una evaluación continua de la actividad del residente. Hemos podido conocer la media de actividades que realiza cada residente durante una rotación y un año determinados, esto permite conocer con exactitud si se cumplen los mínimos definidos (AU)

Material and method A register of the activities of residents in the AEC-E-Book. The overall activity per year and per rotation has been measured. The relationships of assisted interventions performed and their level of complexity have been analysed. The mean scientific and health care activities and the mean on-call periods per month. Results A total of 8 residents have registered their activity in the AEC-E-Book since the year 2004. They assisted in a mean of 1514 operations, of which 922 were performed as surgeon (62%). They assisted in 185 laparoscopic interventions, of which they performed 72 (39%). As surgeon, 864 (94%) of the 922 procedures 64% were level 1, 75% level 2, and 53% were level 3. They were on-call a mean of 5.75 times per month. They attended a total of 21 courses and congresses during residency. They took part in 24 presentations and posters, as well as in 6 journal publications during residence. Conclusions The AEC-E-Book enables the activity of the resident to be continually assessed. We have been able to find out the mean activities carried out by each resident during a particular rotation and year, thus being able to know exactly if they have fulfilled the defined minimums (AU)

[Four years experience with the AEC residents E-Book]. / Cuatro años de experiencia con el libro informático del residente de la AEC.

INTRODUCTION: The introduction of the Spanish Association of Surgeons resident's electronic book (AEC-E-Book), has meant that we can perform particular and overall assessments of each resident. The objective of this article has been to find out the mean health care, scientific and surgical activities according to the speciality program. MATERIAL AND METHOD: A register of the activities of residents in the AEC-E-Book. The overall activity per year and per rotation has been measured. The relationships of assisted interventions performed and their level of complexity have been analysed. The mean scientific and health care activities and the mean on-call periods per month. RESULTS: A total of 8 residents have registered their activity in the AEC-E-Book since the year 2004. They assisted in a mean of 1514 operations, of which 922 were performed as surgeon (62%). They assisted in 185 laparoscopic interventions, of which they performed 72 (39%). As surgeon, 864 (94%) of the 922 procedures 64% were level 1, 75% level 2, and 53% were level 3. They were on-call a mean of 5.75 times per month. They attended a total of 21 courses and congresses during residency. They took part in 24 presentations and posters, as well as in 6 journal publications during residence. CONCLUSIONS: The AEC-E-Book enables the activity of the resident to be continually assessed. We have been able to find out the mean activities carried out by each resident during a particular rotation and year, thus being able to know exactly if they have fulfilled the defined minimums.

[How are resident physicians evaluated? The residents' computerized activity record]. / 'Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente.

INTRODUCTION: Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD: The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS: The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS: The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.

¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente / How are resident physicians evaluated? The residents’ computerized activity record

Introducción. La evolución de nuestra especialidad en los últimos años obliga a realizar actualizaciones no sólo en contenidos, sino en una evaluación de los conocimientos aprendidos. El objetivo de este artículo es presentar nuestra experiencia en un modelo de evaluación integral. Se basa en una valoración de los conocimientos teóricos y las habilidades quirúrgicas. Material y método. El programa de formación para los MIR que hemos aplicado está fundamentado en 4 apartados: asistencial, formación continuada, investigación (doctorado) y control de la actividad realizada (libro informático del residente). Permite una evaluación de los conocimientos teóricos y las habilidades aprendidas al final de cada rotación. Mediante la creación del libro informático del residente que presentamos, se practica cada 6 meses una cuantificación de la actividad de forma continua y comparada. Resultados. En julio de 2004, iniciamos la puesta en marcha de este sistema de evaluación de la actividad de los residentes. Se entregó a cada uno de ellos su propia base de datos para que iniciara su desarrollo mediante la introducción de todas las actividades realizadas. Se presentan los resultados de la actividad global y particular de cada residente. Conclusiones. El método que utilizamos permite seguir la evolución integral del residente y realizar, al final de cada año y de la residencia, una valoración totalmente objetiva. La generalización de este método o uno similar facilitará la realización de comparaciones con otros centros y bajo premisas similares. Por otra parte, podría unificar criterios y determinar desviaciones de formación (AU)

Introduction. Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. Material and method. The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. Results. The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. Conclusions. The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training (AU)