Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy.

BACKGROUND AND OBJECTIVE: Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. METHODS: A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. RESULTS: Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. CONCLUSION: Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934

Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy: a randomized clinical trial.

BACKGROUND: There is no consensus on the efficacy of postoperative infusion of local anesthetics after radical mastectomy. METHODS: A randomized, double-blind, placebo-controlled, parallel-groups clinical trial was conducted in a tertiary hospital. Eighty consecutive women with operable breast cancer with indications for modified radical mastectomy without breast reconstruction were assigned randomly to receive infusion of levobupivacaine (0.5%) or saline at 2 ml/hour for 48 hours through a wound catheter. Seventy-three women finished the study (intervention group, n = 34; control group, n = 39). During surgery, all patients received 0.25% levobupivacaine (30 ml). RESULTS: The levobupivacaine group reported less pain (p < 0.001) than controls in the postanesthesia care unit (1.6 ± 1.3 versus 6.7 ± 1.8) and on the ward at 24 (0.8 ± 0.9 versus 4.2 ± 1.9) and 48 (0.4 ± 0.7 versus 3.3 ± 2.3) hours. In the postanesthesia care unit, the levobupivacaine group consumed less metamizole (0.4 ± 0.5 versus 0.8 ± 0.4; p < 0.001) and dexketoprofen (0.1 ± 0.3 versus 0.7 ± 0.4; p < 0.001), with differences in paracetamol use being insignificant (0.8 ± 0.4 versus 0.9 ± 0.3; p = 0.140). On the ward, the levobupivacaine group used significantly less paracetamol (0.5 ± 0.7 versus 2.0 ± 2.0; p < 0.001) and metamizole (0.2 ± 0.4 versus 1.2 ± 1.4; p < 0.001), but differences in dexketoprofen were not significant (0.03 ± 0.2 versus 0.2 ± 0.6; p = 0.074). In the postanesthesia care unit, the levobupivacaine and control groups consumed 0 ± 0 and 0.7 ± 1.2 doses of opioids (p = 0.001), respectively. The authors observed no differences in nausea and vomiting at any stage in the postanesthesia care unit (0.2 ± 0.4 versus 0.4 ± 0.5; p = 0.081) or on the ward (0.3 ± 0.5 versus 0.4 ± 0.5; p = 0.563). All participants reported high levels of satisfaction. CONCLUSION: Continuous infusion of local anesthetic reduces pain and analgesic consumption, with high satisfaction, but does not affect rates of nausea and vomiting.

Tratamiento de la colecistitis aguda en el anciano: cirugía urgente frente a terapia médica y cirugía diferida / Treatment of acute Cholecystitis in the elderly: urgent surgery versus medical therapy and surgery delay

INTRODUCCIÓN. La colecistitis aguda (CA) en el anciano es una entidad clínica frecuente, caracterizada por la elevada tasa de complicaciones y mortalidad. La elección entre cirugía urgente o tratamiento conservador más cirugía diferida es un motivo de controversia. MATERIAL Y MÉTODOS. Estudio de una cohorte retrospectiva sobre pacientes con edad igual o superior a 70 años tratados de colecistitis aguda entre 2003 y 2009. Se analizaron parámetros epidemiológicos, clínicos, diagnósticos, quirúrgicos y de coste-efectividad. Método estadístico: utilizamos los test Chi-2, ôtõ de Student y ANOVA. El nivel de significación se estableció paravalores p < 0.05. RESULTADOS. Durante los 6 años estudiados fueron tratados 173 episodios de CA en 147pacientes (52 por ciento mujeres), con una edad media de 80.6 años (máximo 101). En 103 episodios (77 pacientes) se adoptó tratamiento médico de los que 31 se operaron de forma electiva conun 100 por ciento de abordajes laparoscópicos, baja tasa de conversión (6.4 por ciento) y morbilidad (9.6 por ciento) sin registrarse mortalidad. Otros 85 pacientes fueron intervenidos de urgencia con un 78.5 por ciento de abordajes laparoscópicos, tasa de conversión del 19.7 por ciento, morbilidad 53 por ciento y mortalidad 3.5 por ciento. CONCLUSIONES. Considerando todas las variables la cirugía urgente y el tratamiento médico seguido de colecistectomía electiva obtienen resultados similares, aunque los enfermos sometidos a colecistectomía laparoscópica precoz fueron los que mejor evolucionaron.

INTRODUCTION. Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS. Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical, diagnostic, surgical and cost effectiveness parameters were analysed. Statistical method: Weuse Chi squared test, Student´s t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS. During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52 percent females), with an average age of 80.6 years (maximum 101). In 103 episodes(77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100 percent laparoscopic approach, 6,4 percent conversion rate, 9,6 percent morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5 percent of them through laparoscopy approach with a conversion rate of 19.7 percent , 53 percent morbidity and 3,5 percent mortality. Conclusions. Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.

[Puerperal peritonitis due to vernix caseosa]. / Peritonitis puerperal por vernix caseosa.

Vernix caseosa peritonitis (VCP) is a complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity during a cesarean section.The physiopathology mechanisms are still incompletely understood. However, keratina granulomas could be induced by the squamous cells inside the vernix.In spite of its infrequent condition this entity should be included in the differential diagnosis of abdominal pain and acute abdomen in the post-partum after cesarean section.In this article, we present a case of VCP, and we discuss the clinical and histopathologic findings that allow its prompt recognition as well as to guide us towards the correct surgical and therapeutic technique.

[Treatment of acute cholecystitis in the elderly: urgent surgery versus medical therapy and surgery delay]. / Tratamiento de la Colecistitis Aguda en en el Anciano: Cirugía Urgente frente a Terapia Médica y Cirugía Diferida.

INTRODUCTION: Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS: Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed. STATISTICAL METHOD: We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS: During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. CONCLUSIONS: Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.

Influencia de la bibliografía en la calidad de los proyectos de tesis presentados en un departamento universitario. Modelos de regresión / Influence of bibliography on the quality of thesis proposals presented in a university department. Regression models

Objetivo: Evaluar cuál es la situación actual de la bibliografía aportada en los proyectos de tesis doctoral en el Departamento de Obstetricia, Ginecología y Cirugía de la Universidad de Zaragoza entre los años 1995 y 2002, y dilucidar cómo influye ésta en la calidad de los proyectos de tesis, para poder hacer predicciones sobre la calidad de cualquier proyecto de tesis en función de sus parámetros bibliográficos. Material y método: Estudio analítico de casos y controles (proyectos con bibliografía y sin ella, respectivamente) en el que se analizan 273 proyectos de tesis corregidos por dos personas (546 sujetos evaluados) presentados en el Departamento de Obstetricia, Ginecología y Cirugía de la Universidad de Zaragoza entre los años 1995 y 2002. Resultados: Se halló asociación estadística entre la variable bibliografía (existente, incorrecta y no existente) y la calidad del proyecto de tesis (valoración corregida) comprobada mediante dos tests estadísticos. El número de citas bibliográficas parece estar algo relacionada linealmente con la valoración corregida (0,229). Mediante regresión lineal múltiple se proponen varios modelos, pero resultan de escaso poder predictivo. Conclusiones: 1. Para responder a la hipótesis conceptual de trabajo se podría decir que el apartado bibliográfico no influye en la calidad de los proyectos de tesis doctoral. 2. Sí que se observan relaciones ya comentadas, como que a grandes cantidades de citas el trabajo suele estar algo mejor calificado, de ahí que aunque nos salgan algunas variables significativas no nos expliquen prácticamente nada de la variabilidad de la respuesta. 3. La única variable que tiene valor predictivo o explicativo de la calidad del proyecto de tesis es el número de citas: a mayor número de citas, mayor calidad del proyecto de tesis, pero desgraciadamente es muy pobre, apenas un 8,5%

Objective: To evaluate the current situation of the publications cited in doctoral thesis proposals in the Department of Obstetrics, Gynecology and Surgery of the University of Zaragoza (Spain) between 1995 and 2002 and to determine the influence of the bibliography on the quality of thesis proposals with a view to predicting the quality of thesis proposals according to their bibliographic parameters. Material and method: We performed a case-control study (proposals with and without bibliography, respectively). A total of 273 thesis proposals corrected by two evaluators (546 subjects under study) and presented in the Department of Obstetrics, Gynecology and Surgery in the University of Zaragoza between 1995 and 2002 were analyzed. Results: A statistically significant association was found between the variable of bibliography (present, incorrect, or absent) and the quality of thesis proposals (corrected evaluation) verified by two statistical tests. The number of citations seemed to be linearly related to the corrected evaluation (0.229). Various models were proposed through multiple linear regression but these models had little predictive power. Conclusions 1. The publications cited did not influence the quality of doctoral thesis proposals. 2. Although some significant variables were found (a large number of cited publications was weakly correlated with higher quality), these variables explained practically none of the variability in quality. 3. The only variable with predictive or explanatory value on the quality of thesis proposals was the number of citations: the greater the number of citations the higher the quality but this variable explained only 8.5% of the variability in quality