Impacto de la pandemia COVID-19 en la cirugía de columna en un centro de segundo nivel / Impact of COVID-19 pandemia on spine surgery in 2nd level hospital

Introducción: Las consecuencias de la pandemia por COVID-19, como en otros aspectos de la medicina, se han visto reflejadas también en la actividad quirúrgica de columna vertebral. Objetivos: El objetivo principal del presente estudio es cuantificar el número de intervenciones realizadas entre los años 2016 y 2021 y analizar el tiempo de espera en los pacientes intervenidos como medida indirecta del volumen de la lista de espera. Como objetivos secundarios se realiza un análisis del tiempo de estancia hospitalaria y el tiempo quirúrgico a lo largo de la serie. Métodos: Se ha realizado un estudio descriptivo retrospectivo en relación con el volumen de intervenciones y diagnósticos durante un periodo que incluye desde la etapa previa a la pandemia (2016) hasta finales del año 2021, en que la situación global llegó a una cuasi-normalización de la actividad. Se han identificado un total de 1.039 registros. Se incluyen las variables edad, género, días en lista de espera antes de la intervención, diagnóstico, tiempo de estancia hospitalaria y tiempo quirúrgico. Resultados: Se objetiva una disminución en el número total de intervenciones durante la pandemia respecto al año 2019 (32,15% menos el año 2020 y 23,5% menos el 2021). Tras el análisis de los datos, se observa un aumento en la dispersión y la mediana del tiempo de espera global y por patologías a partir de 2020, sin detectarse diferencias significativas en el tiempo de hospitalización ni en el tiempo quirúrgico. Conclusión: Durante la pandemia se ha producido una disminución del número de intervenciones debido a la necesidad de redistribuir recursos humanos y materiales para hacer frente al incremento de pacientes críticos afectados por la COVID-19. El aumento de la dispersión y de la mediana global y por patologías de la variable tiempo de espera se traduce como un aumento del tiempo de espera en las cirugías diferibles realizadas durante los años de...(AU)

Introduction: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. Objectives: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. Methods: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. Results: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. Conclusion: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.(AU)

[Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital / Impacto de la pandemia COVID-19 en la cirugía de columna en un centro de segundo nivel

Introducción: Las consecuencias de la pandemia por COVID-19, como en otros aspectos de la medicina, se han visto reflejadas también en la actividad quirúrgica de columna vertebral. Objetivos: El objetivo principal del presente estudio es cuantificar el número de intervenciones realizadas entre los años 2016 y 2021 y analizar el tiempo de espera en los pacientes intervenidos como medida indirecta del volumen de la lista de espera. Como objetivos secundarios se realiza un análisis del tiempo de estancia hospitalaria y el tiempo quirúrgico a lo largo de la serie. Métodos: Se ha realizado un estudio descriptivo retrospectivo en relación con el volumen de intervenciones y diagnósticos durante un periodo que incluye desde la etapa previa a la pandemia (2016) hasta finales del año 2021, en que la situación global llegó a una cuasi-normalización de la actividad. Se han identificado un total de 1.039 registros. Se incluyen las variables edad, género, días en lista de espera antes de la intervención, diagnóstico, tiempo de estancia hospitalaria y tiempo quirúrgico. Resultados: Se objetiva una disminución en el número total de intervenciones durante la pandemia respecto al año 2019 (32,15% menos el año 2020 y 23,5% menos el 2021). Tras el análisis de los datos, se observa un aumento en la dispersión y la mediana del tiempo de espera global y por patologías a partir de 2020, sin detectarse diferencias significativas en el tiempo de hospitalización ni en el tiempo quirúrgico. Conclusión: Durante la pandemia se ha producido una disminución del número de intervenciones debido a la necesidad de redistribuir recursos humanos y materiales para hacer frente al incremento de pacientes críticos afectados por la COVID-19. El aumento de la dispersión y de la mediana global y por patologías de la variable tiempo de espera se traduce como un aumento del tiempo de espera en las cirugías diferibles realizadas durante los años de...(AU)

Introduction: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. Objectives: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. Methods: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. Results: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. Conclusion: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.(AU)

[Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital.

INTRODUCTION: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.

Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. / Impacto de la pandemia COVID-19 en la cirugía de columna en un centro de segundo nivel.

INTRODUCTION: The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES: The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS: We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS: We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION: The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.

Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año / Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality

Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, así como analizar las diferencias de mortalidad al año, y el sangrado perioperatorio según la pauta de cirugía precoz (< 48 h) vs. demorada (> 5 días). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y método. Sobre 175 pacientes mayores de 65 años con fractura de cadera de baja energía se aleatorizaron 3 grupos: antiagregados con cirugía precoz, antiagregados con cirugía demorada, y no antiagregados con cirugía precoz; se recogieron prospectivamente los mismos datos clínicos y analíticos para todos ellos. La agregabilidad plaquetaria se determinó mediante un sistema informatizado semicuantitativo basado en la agregometría por impedancia en sangre completa. Resultados. El sangrado, los requerimientos transfusionales y los resultados analíticos no mostraron diferencias estadísticamente significativas entre los grupos. Un 59,8% de los pacientes que no referían tomar antiagregantes se encontraban analíticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El análisis multivariante mostró mayor mortalidad a 12 meses para las variables del índice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y número de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 días mayor en el grupo demorado. Conclusión. La pauta de cirugía precoz para los pacientes en tratamiento antiagregante tiene resultados clínicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregación farmacológica referida por el paciente resultó poco concordante con la determinación de la agregabilidad(AU)

Objective. A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study. Patients and methods. A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Conclusion. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation(AU)

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality]. / Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año.

OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

Migración posterior epidural de fragmento discal / Epidural posterior migration of disc fragment

Introducción. La migración posterior epidural de un fragmento de hernia discal lumbar es una presentación clínica infrecuente. Caso clínico. Presentamos el caso de un paciente varón de 76 años, que acude por dolor lumbar y paraparesia progresiva en extremidades inferiores, con la aparición a los 4 días del ingreso de un síndrome de cauda equina. La resonancia magnética muestra espondilosis lumbar y una masa intrarraquídea bien delimitada en el espacio epidural posterior. Se realiza una exéresis quirúrgica de la masa epidural. El estudio anatomopatológico informó de fragmento de disco intervertebral, por lo que se trataba de una migración completa de una hernia discal lumbar. Tras la intervención quirúrgica y un tratamiento rehabilitador específico remitió la clínica del paciente. Conclusiones. Los pacientes con migración posterior de un fragmento de disco presentan graves déficits neurológicos como el síndrome de cauda equina. Debido a que las imágenes radiológicas de los fragmentos del disco son similares a los de otras lesiones como metástasis, quiste sinovial, absceso dural o hematoma, el diagnóstico definitivo se realiza mediante exéresis y estudio anatomopatológico. El tratamiento quirúrgico urgente es necesario para evitar déficits neurológicos severos (AU)

Introduction. The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation. Case report. We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment. Conclusions. Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits (AU)

[Epidural posterior migration of disc fragment]. / Migración posterior epidural de fragmento discal.

INTRODUCTION: The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation. CASE REPORT: We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment. CONCLUSIONS: Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits.

[Total prosthetic knee and hip joint infection. Descriptive epidemiology, therapeutics and evolution in a secondary hospital during ten years]. / Infección de prótesis total de rodilla y cadera. Epidemiología descriptiva, terapéutica y evolución en un hospital de segundo nivel durante 10 años.

OBJECTIVE: Epidemiological description, retrospective in its classification, evolution and therapeutics of total prosthesis knee and hip infected among the arthoplasties made between 1st of January 1994 and 31st of December 2003 in our hospital. RESULTS: The global infection rate was 2.4% (confidence interval of 95% [CI 95%], 1.6%-3.2%) over 40 cases in 1,666 joint implants. The average age +/- standard deviation (SD) was 69.5 years old +/- 5.1 years, mainly in women (67.5%). The most common location was the knee, 31 cases (77.5%). In 90.0% of the patients the aetiology was identified: 64,0% were gram-positive cocci (plasmacoagulase-negative staphylococci, and Staphylococcus aureus); 14.0% were gram-negative bacilli and mixed flora (11.0%). Acute infections were found in most of the cases (45,0%). The joint replacement had a healing rate of 66.7% in the first replacement and of 83.3% in the second replacement. CONCLUSIONS: The gram-positive cocci are the main microorganisms in these infections. More extensive studies about multiple aspects are necessary to evaluate the effectiveness of the different surgical techniques, the new antibiotics and the combined antibiotic therapies.

Infección de prótesis total de rodilla y cadera. Epidemiología descriptiva, terapéutica y evolución en un hospital de segundo nivel durante 10 años / Total prosthetic knee and hip joint infection. Descriptive epidemiology, therapeutics and evolution in a secondary hospital during ten years

Objetivo: Descripción epidemiológica retrospectiva en su clasificación,evolución y terapéuticas de las prótesis totales de cadera y rodilla infectadas entre las artroplastias realizadas desde el 1 de enero de 1994 al 31 de diciembre del 2003 en nuestro hospital. Resultados: La tasa de infección global de artroplastias fue 2,4% (intervalo de confianza del 95% [IC 95%], 1,6% -3,2%) sobre 40 casos de 1666 implantes articulares. La media de edad ± desviación estándar (DE) fue de 69,5 ± 5,1 años, en su mayoría mujeres (67,5%). La localización más frecuente fue rodilla, 31 casos (77,5%). En un 90,0% de los enfermos se filió la etiología, siendo un 64,0% cocos grampositivos (Staphylococcus plasmocoagulasa negativos y S. aureus), un 13,0% bacilos gramnegativos y flora mixta (11,0%). Predominaron las infecciones agudas (45,0%). El recambio articular en un tiempo tuvo una curación del 66,7% frente a un 83,3% en recambio en 2 tiempos. Conclusiones: Los cocos gram positivos son los principales microrganismos en estas infecciones. Son necesarios estudios amplios multicéntricos para valorar la eficacia de las distintas técnicas quirúrgicas, los nuevos antibióticos y las terapias antibióticas combinadas

Objective: Epidemiological description, retrospective in its classification, evolution and therapeutics of total prosthesis knee and hip infected among the arthoplasties made between 1st of January 1994 and 31st of December 2003 in our hospital. Results: The global infection rate was 2.4% (confidence interval of 95% [CI 95%], 1.6%-3.2%) over 40 cases in 1,666 joint implants. The average age +/- standard deviation (SD) was 69.5 years old +/- 5.1 years, mainly in women (67.5%). The most common location was the knee, 31 cases (77.5%). In 90.0% of the patients the aetiology was identified: 64,0% were gram-positive cocci (plasmacoagulase-negative staphylococci, and Staphylococcus aureus); 14.0% were gram-negative bacilli and mixed flora (11.0%). Acute infections were found in most of the cases (45,0%). The joint replacement had a healing rate of 66.7% in the first replacement and of 83.3% in the second replacement. Conclusions: The gram-positive cocci are the main microorganisms in these infections. More extensive studies about multiple aspects are necessary to evaluate the effectiveness of the different surgical techniques, the new antibiotics and the combined antibiotic therapies