Estrategias de retroalimentación inmersas en tecnologías de asistencia para promover la participación social de niños con parálisis cerebral: revisión sistemática / Feedback strategies in assistive technology to promote social participation in children with cerebral palsy: Systematic review

Introducción: Vivir con parálisis cerebral tiene consecuencias en la participación social. Las tecnologías utilizadas para generar independencia se limitan a resultados en variables biológicas y fisiológicas. El objetivo es sintetizar la evidencia en intervenciones con tecnologías de asistencia que incluyan sistemas de retroalimentación, con el fin de conocer los desenlaces en la participación social en niños con parálisis cerebral. Metodología: Se tomaron 5 bases de datos de rehabilitación y se obtuvieron 683 artículos, de los cuales se incluyeron 9. Resultados: Los estudios evaluaron la participación social con diversos instrumentos; la mayoría sugieren efectos positivos en actividades como caminar, escribir y jugar, favoreciendo la interacción social en el entorno, utilizando tecnologías como lápices electrónicos, switches, exoesqueletos, entre otros.Conclusión: Debido a la baja calidad metodológica de los estudios, no se establecen conclusiones sólidas. Sin embargo, la evidencia propone que las tecnologías de asistencia con retroalimentación tienen un impacto positivo en los componentes de la participación social.(AU)

Introduction: Living with cerebral palsy has consequences such as social interaction. Assistive technologies used for improving independence only focuses on biological and physiological variables. The main objective in this review is to synthesize the evidence on interventions with assistive technologies, including feedback systems, with the aim of discovering outcomes of social participation in children with cerebral palsy. Methodology: There were 5 databases from rehabilitation which showed 683 articles in which only 9 were included. Results: The studies assessed social participation with several instruments. The majority suggested positive effects in activities such as: walking, writing, playing, and social interaction. There were tools such as electronic pencils, switches, and exoskeletons present. Conclusion: Due to the poor quality of the methodologies of these studies, the search does not establish solid conclusions. However, the evidence suggests that assistive technologies with feedback have a positive impact on aspects of social participation.(AU)

Similar outcomes after newly implemented rats approach compared to standard vats for anatomical lung resection. A propensity-score matched analysis / Resultados similares de un abordaje robótico (RATS) recientemente implementado comparado con un abordaje VATS convencional para resecciones pulmonares anatómicas: análisis de datos emparejados por puntuación de propensión

Introduction Outcomes after the introduction of surgical innovations can be impaired by learning periods. The aim of this study is to compare the short-term outcomes of a recently implemented RATS approach to a standard VATS program for anatomical lung resections. Methods Retrospective review of consecutive patients undergoing pulmonary anatomical resection through a minimally invasive approach since RATS approach was applied in our department (June 01, 2018, to November 30, 2019). Propensity score matching was performed according to patients’ age, gender, ppoFEV1, cardiac comorbidity, type of malignancy, and type of resection. Outcome evaluation includes: overall morbidity, significant complications (cardiac arrhythmia, pneumonia, prolonged air leak, and reoperation), 30-day mortality, and length of hospital stay. Data were compared by two-sided chi-square or Fisher's exact test for categorical and Mann–Whitney U test for continuous variables. Results A total of 273 patients (206 VATS, 67 RATS) were included in the study. After propensity score matching, data of 132 patients were analyzed. The thirty-days mortality was nil. Overall morbidity (RATS: 22.4%, VATS: 29.2%; p=0.369), major complications (RATS: 9% vs VATS: 9.2%; p=0.956) and the rates of specific major complications (cardiac arrhythmia RATS: 4.5%, VATS: 4.6%, p=1; pneumonia RATS:0%, VATS:4.6%, p=0.117; prolonged air leak RATS: 7.5%; VATS: 4.6%, p=0.718) and reoperation (RATS: 3%, VATS: 1.5%, p=1) were comparable between both groups. The median length of stay was 3 days in both groups (p=0.101) (AU)

Introducción La introducción de innovaciones quirúrgicas se asocia con períodos de aprendizaje que pueden afectar a los resultados. El objetivo de este estudio es comparar los resultados postoperatorios de un abordaje RATS para resecciones pulmonares anatómicas implementado recientemente frente a los de un abordaje VATS convencional. Métodos Revisión retrospectiva de los pacientes sometidos a resección pulmonar anatómica mediante un abordaje mínimamente invasivo en nuestro centro desde el inicio del programa de cirugía RATS (junio de 2018) hasta noviembre de 2019. Los pacientes fueron emparejados por puntuación de propensión según variables de riesgo. Los resultados analizados fueron: morbilidad global, complicaciones (mayores, arritmia, neumonía, fuga aérea prolongada y reintervención), mortalidad a los 30 días y estancia hospitalaria. Los datos se compararon mediante la prueba de chi-cuadrado o la exacta de Fisher para variables categóricas y la prueba de U de Mann-Whitney para variables continuas. Resultados Se incluyeron en el estudio 273 pacientes (206 VATS, 67 RATS). Tras el emparejamiento, se analizaron los datos de 132 pacientes. La mortalidad a los 30 días fue nula. La morbilidad global (RATS: 22,4%, VATS: 29,2%; p=0,369), complicaciones mayores (RATS: 9%, VATS: 9,2%; p=0,956), arritmia (RATS: 4,5%, VATS: 4,6%, p=1); neumonía (RATS: 0%, VATS: 4,6%, p=0,117); fuga aérea prolongada (RATS: 7,5%; VATS: 4,6%, p=0,718) y reintervención (RATS: 3%, VATS: 1,5%, p=1) fueron comparables entre ambos grupos. La mediana de la estancia hospitalaria fue de 3 días en ambos grupos (p=0,101). Conclusiones Un programa RATS para resecciones pulmonares anatómicas puede implementarse de manera segura por cirujanos experimentados en VATS sin aumentar los índices de morbilidad (AU)

[Feedback strategies in assistive technology to promote social participation in children with cerebral palsy: Systematic review]. / Estrategias de retroalimentación inmersas en tecnologías de asistencia para promover la participación social de niños con parálisis cerebral: revisión sistemática.

INTRODUCTION: Living with cerebral palsy has consequences such as social interaction. Assistive technologies used for improving independence only focuses on biological and physiological variables. The main objective in this review is to synthesize the evidence on interventions with assistive technologies, including feedback systems, with the aim of discovering outcomes of social participation in children with cerebral palsy. METHODOLOGY: There were 5 databases from rehabilitation which showed 683 articles in which only 9 were included. RESULTS: The studies assessed social participation with several instruments. The majority suggested positive effects in activities such as: walking, writing, playing, and social interaction. There were tools such as electronic pencils, switches, and exoskeletons present. CONCLUSION: Due to the poor quality of the methodologies of these studies, the search does not establish solid conclusions. However, the evidence suggests that assistive technologies with feedback have a positive impact on aspects of social participation.

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Recomendaciones de la Sociedad Española de Cirugía Torácica y de la Sección de Cardiotorácica y Cirugía Vascular de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor, para los pacientes sometidos a cirugía pulmonar incluidos en un programa de recuperación intensificada / Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program

En los últimos años se están implementando programas multidisciplinares que incluyen diferentes actuaciones durante el periodo pre, intra y postoperatorio, encaminadas a disminuir el estrés perioperatorio y, por tanto, a mejorar los resultados de los pacientes sometidos a intervenciones quirúrgicas. Inicialmente, estos programas se desarrollaron para cirugía colorrectal y de ahí se han ido extendiendo a otras cirugías. La cirugía torácica, considerada de elevada complejidad, al igual que otras cirugías con una alta tasa de morbimortalidad postoperatoria, puede ser una de las especialidades que más se beneficien de la implantación de estos programas. En esta revisión se presentan las recomendaciones elaboradas por diferentes especialidades implicadas en los cuidados perioperatorios de los pacientes que requieren la resección de un tumor pulmonar. Para la elaboración de las recomendaciones presentadas en esta guía se han tenido en cuenta los metaanálisis, las revisiones sistemáticas, los estudios controlados aleatorizados y no aleatorizados y los estudios retrospectivos realizados en pacientes sometidos a este tipo de intervenciones. Para la clasificación de las recomendaciones se ha empleado la escala GRADE, valorando, por un lado, el nivel de evidencia publicado sobre cada aspecto concreto, y por otro, la fuerza de la recomendación con la que los autores proponen su aplicación. Las recomendaciones consideradas más importantes para este tipo de cirugía son las que se refieren a la prehabilitación, a la minimización de la agresión quirúrgica, a la excelencia en el manejo del dolor perioperatorio y a los cuidados postoperatorios encaminados a proporcionar una rápida rehabilitación postoperatoria.(AU)

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.(AU)

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. / Recomendaciones de la Sociedad Española de Cirugía Torácica y de la Sección de Cardiotorácica y Cirugía Vascular de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor, para los pacientes sometidos a cirugía pulmonar incluidos en un programa de recuperación intensificada.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Empleo de la espirometría incentiva en el análisis de la función pulmonar y la predicción de complicaciones postoperatorias en cirugía torácica / Incentive spirometry in lung function analysisi and prediction of postoperative complications in thoraci surgery

INTRODUCCIÓN: La disminución de la función pulmonar tras la cirugía torácica se involucra en la etiología de las complicaciones respiratorias. Concretamente, el FEV1 y la morbimortalidad postoperatorios se relacionan inversamente. La medición del FEV1 durante el postoperatorio requiere una dotación tecnológica no disponible en la mayoría de las unidades de Cirugía Torácica. La espirometría incentiva es un método sencillo y ampliamente utilizado en este periodo perioperatorio. OBJETIVOS: Cuantificar la correlación entre los resultados del la espirometría incentiva y del FEV1 durante el día preoperatorio y los siguientes días a la intervención, en los pacientes sometidos a intervenciones torácicas. MATERIAL Y MÉTODOS: Estudio prospectivo durante 6 meses de pacientes sometidos a intervenciones programadas mediante técnicas de toracotomía, toracotomía vídeo asistida, videotoracoscopia (VATS) y esternotomía. Recogida de los valores de volumen inspiratorio máximo mediante espirometría incentiva y de FEV1 empleando espirometría forzada durante el día prey postoperatorios hasta el alta. RESULTADOS: De los 74 pacientes estudiados se obtuvieron las mediciones en 56 hombres y 7 mujeres, edad media 58+16 años. El 57% se intervino mediante toracotomías, el 25% con toracotomías vídeo asistidas, 13% VATS y 5% esternotomías. 43 sujetos fueron sometidos a cirugía de resección pulmonar (8 neumonectomías, 19 lobectomías y 16 segmentectomías). La estancia media alcanzó los 5 + 3 días, ingresando todos el día previo a la cirugía. Se obtuvo un coeficiente de correlación de 0,719 (p = 0,0005). CONCLUSIONES: Existe una correlación lineal significativa entre los valores de volumen inspiratorio máximo y de FEV1 en los pacientes sometidos a intervenciones de Cirugía Torácica

INTRODUCTION: Decreased lung function following thoracic surgery is involved in the etiology of respiratory complications. Specifically, FEV1 and postoperative morbidity and mortality are related inversely. Measuring postoperative FEV1 requires technological equipment not available in most units of Thoracic Surgery. The incentive spirometry is a simple and widely method used in the perioperative period. OBJECTIVES: To quantify the correlation between the results of the incentive spirometry and FEV1 during the preoperative day and the days following surgery, in patients undergoing thoracic surgery. MATERIAL AND METHODS. A prospective study of patients undergoing thoracic surgery techniques (video assisted thoracotomy, video-assisted thoracoscopy (VATS) and sternotomy) were included. Collecting values encourages maximum inspiratory volume by using spirometry and spirometry FEV1 during the pre and postoperative day until discharge. Follow-up 6 months. RESULTS: 74 patients were included (56 men and 7 women), mean age 58 +16 years were obtained. 57% were operated by thoracotomy, 25% with video assisted thoracotomy, VATS 13%, and 5 % sternotomy. 43 subjects underwent lung resection surgery (8 pneumonectomies, 19 lobectomies and 16 segmentectomies). The average stay reached 5 +3 days, starting the hospital stay the day before surgery. A correlation coefficient of 0.719 (p = 0.0005) was obtained. CONCLUSIONS: there is a significant linear correlation between the values of maximum inspiratory volume and FEV1 in patients undergoing thoracic surgery interventions

[Sleeve lobectomy compared to pneumonectomy for the treatment of N0-N1 non-small cell lung cancer]. / La lobectomía broncoplástica frente a la neumonectomía en el tratamiento del carcinoma de pulmón no microcítico.

OBJECTIVE: To compare survival, morbidity, and mortality rates for a series of patients who underwent either bronchoplastic sleeve lobectomy or pneumonectomy to treat non-small cell lung cancer (NSCLC). PATIENTS AND METHOD: We reviewed the clinical records for patients who underwent sleeve lobectomy or pneumonectomy for NSCLC from January 1994 through December 2003. RESULTS: From January 1994 through December 2003, 35 sleeve lobectomies and 220 pneumonectomies were performed at our department on patients with NSCLC. The perioperative mortality rate was 2.8% for the lobectomy group and 9.1% for the pneumonectomy group. The mean survival time for the pneumonectomy group was 45 months (95% confidence interval [CI], 37-53), with a 5-year survival rate of 32% (SE, 5.1%). The mean survival time for the sleeve lobectomy group was 72 months (95% CI, 56-87) (P< or =.0041), with a 5-year survival rate of 56% (SE, 9.6%). If we stratify the groups according to node involvement, patients classified as N0-N1 had a mean survival time of 52 months (95% CI, 43-61), with a 5-year survival rate of 39% (SE, 6.2%) for the pneumonectomy group. The mean survival time for patients undergoing sleeve lobectomy was 75 months (95% CI, 59-92) (P< or =.018), with a 5-year survival rate of 60% (SE, 10.4%). Survival for patients with N2 disease was similar to that of patients with N0-N1 disease. CONCLUSION: For patients with N0-N1 non-small cell lung cancer, sleeve lobectomy offers better survival than pneumonectomy.

La lobectomía broncoplástica frente a la neumonectomía en el tratamiento del carcinoma de pulmón no microcítico / Sleeve lobectomy compared to pneumonectomy for the treatment of N0-N1 non-small cell lung cancer

Objetivo: Comparar la supervivencia, morbilidad y mortalidad de una serie de pacientes operados por cáncer de pulmón no microcítico (CPNM) mediante lobectomía broncoplástica o neumonectomía. Pacientes y método: Hemos revisado los datos de pacientes a quienes se realizó una lobectomía broncoplástica o una neumonectomía por CPNM entre enero de 1994 y diciembre de 2003. Resultados: Entre enero de 1994 y diciembre de 2003 se realizaron en nuestra unidad 35 lobectomías con broncoplastia y 220 neumonectomías en pacientes con CPNM. La mortalidad perioperatoria fue del 2,8% en el grupo de las lobectomías y del 9,1% para las neumonectomías. La media de supervivencia de las neumonectomías fue de 45 meses (intervalo de confianza [IC] del 95%, 37-53) y la supervivencia a los 5 años del 32% (error estándar [EE]: 5,1). En el grupo de lobectomías broncoplásticas la media de supervivencia fue de 72 meses (IC del 95%, 56-87) (p ≤ 0,0041) y la supervivencia a los 5 años del 56% (EE: 9,6). Si estratificamos los grupos según la afectación ganglionar, entre los pacientes clasificados como N0-N1 la media de supervivencia fue de 52 meses (IC del 95%, 43-61) y la supervivencia a los 5 años del 39% (EE: 6,2) en las neumonectomías. Los pacientes con lobectomía broncoplástica presentaron una media de supervivencia de 75 meses (IC del 95%, 59-92) (p ≤ 0,018) y la supervivencia a los 5 años del 60% (EE: 10,4). La supervivencia no fue diferente en caso de enfermedad N2. Conclusión: La lobectomía broncoplástica ofrece mejor supervivencia que la neumonectomía en pacientes con CPNM con afectación N0-N1

Objective: To compare survival, morbidity, and mortality rates for a series of patients who underwent either bronchoplastic sleeve lobectomy or pneumonectomy to treat non-small cell lung cancer (NSCLC). Patients and method: We reviewed the clinical records for patients who underwent sleeve lobectomy or pneumonectomy for NSCLC from January 1994 through December 2003. Results: From January 1994 through December 2003, 35 sleeve lobectomies and 220 pneumonectomies were performed at our department on patients with NSCLC. The perioperative mortality rate was 2.8% for the lobectomy group and 9.1% for the pneumonectomy group. The mean survival time for the pneumonectomy group was 45 months (95% confidence interval [CI], 37-53), with a 5-year survival rate of 32% (SE, 5.1%). The mean survival time for the sleeve lobectomy group was 72 months (95% CI, 56-87) (P≤.0041), with a 5-year survival rate of 56% (SE, 9.6%). If we stratify the groups according to node involvement, patients classified as N0-N1 had a mean survival time of 52 months (95% CI, 43-61), with a 5-year survival rate of 39% (SE, 6.2%) for the pneumonectomy group. The mean survival time for patients undergoing sleeve lobectomy was 75 months (95% CI, 59-92) (P≤.018), with a 5-year survival rate of 60% (SE, 10.4%). Survival for patients with N2 disease was similar to that of patients with N0-N1 disease. Conclusion: For patients with N0-N1 non-small cell lung cancer, sleeve lobectomy offers better survival than pneumonectomy

[Agreement between type of lung resection planned and resection subsequently performed on lung cancer patients]. / Concordancia entre el tipo de resección programada y la efectuada en pacientes con carcinoma pulmonar.

OBJECTIVE: To assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended. METHOD: Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned--lobectomy (or bilobectomy) or pneumonectomy--was compared with the operation finally performed. Rates of agreement and Wilks' lambda statistic were calculated. RESULTS: Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks' lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement. CONCLUSIONS: The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread.

Concordancia entre el tipo de resección programada y la efectuada en pacientes con carcinoma pulmonar / Agreement between type of lung resection planned and resection subsequently performed on lung cancer patients

OBJETIVO: Cuantificar la concordancia entre la cirugía de resección planeada y la efectuada en una serie de pacientes, evaluar si la localización del tumor (central o periférico) influye en el grado de discrepancia encontrado y valorar, en los casos de neumonectomías no programadas, la causa que obligó a ampliar la resección prevista. MÉTODO: Estudio clínico prospectivo observacional en 199 pacientes programados para intervención quirúrgica por cáncer de pulmón. Se clasificaron los tumores preoperatoriamente como centrales o periféricos, y el tipo de intervención programada –lobectomía (o bilobectomía) o neumonectomía– se comparó con la efectuada. Se han calculado las tasas de concordancia y el estadístico lambda. RESULTADOS: Se practicaron 20 neumonectomías no programadas. Se encontró concordancia entre lo programado y lo efectuado en el 86,9% de los casos (un 76,9% en tumores centrales y un 95,4% en periféricos). El valor del estadístico lambda es de 0,38 (0,42 en tumores centrales y 0,17 en periféricos). En 7 ocasiones la neumonectomía no programada se debió a afectación ganglionar hiliar. CONCLUSIONES: En el 13% de los pacientes sometidos a cirugía por carcinoma bronquial, la resección efectuada no coincide con la que se había programado inicialmente, la mayor parte de las veces debido a la necesidad de efectuar una neumonectomía cuando se había previsto una lobectomía. Este hecho es más frecuente en los tumores centrales y es debido con más frecuencia a invasión directa de las estructuras anatómicas que a extensión ganglionar hiliar

OBJECTIVE: To assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended. METHOD: Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned—lobectomy (or bilobectomy) or pneumonectomy—was compared with the operation finally performed. Rates of agreement and Wilks’ lambda statistic were calculated. RESULTS: Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks’ lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement. CONCLUSIONS: The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread

[A descriptive analysis of a series of patients diagnosed with acute mediastinitis]. / Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda.

Acute mediastinitis is one of the most aggressive chest diseases. The mortality rate ranges between 14% and 42%. We present a retrospective analysis of a series of 26 cases (20 men and 6 women) treated between January 1994 and March 2002 and review the literature. Mediastinitis originated in the esophagus in 17 patients (8 postoperative, 4 due to iatrogenic perforation, 4 due to noniatrogenic perforation, and 1 due to a foreign body) and in the oropharynx in 6 patients; mediastinitis was secondary to median sternotomy in 3. Twenty-five patients were treated surgically. In addition to radical debridement and drainage, which were carried out on all the patients, 10 also underwent esophagectomy or resection of the esophago-gastric reconstruction, 5 received primary sutures of the esophagus, 1 received reconstructive surgery with a pectoral muscle flap, and 1 underwent sternectomy plus intrathoracic omental transposition. Four patients died within 30 days of surgery (15.4%). The mortality rate in our practice is similar to that described in the literature. The results argue for early, aggressive treatment.

Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda / A descriptive analysis of a series of patients diagnosed with acute mediastinitis

La mediastinitis aguda es una de las enfermedades torácicas más agresivas. La mortalidad varía entre el 14 y el 42 por ciento. Nuestro objetivo es presentar un análisis retrospectivo de una serie de 26 casos (20 varones y 6 mujeres) tratados entre enero de 1994 y marzo de 2002 y una revisión de la bibliografía. La mediastinitis fue de origen esofágico en 17 pacientes (8 posquirúrgicas, 4 por rotura iatrogénica, 4 por rotura no iatrogénica y una por cuerpo extraño), de origen bucofaríngeo en 6 pacientes y secundarias a esternotomía media en 3. Se trató quirúrgicamente a 25 pacientes; además del desbridamiento radical y los drenajes, que se hicieron en todos los pacientes, en 10 se practicó una esofaguectomía o resección de plastia gástrica; en 5, suturas primarias de esófago; en uno, plastia de pectoral mayor, y en otro, esternectomía más omentoplastia. Cuatro pacientes fallecieron en los 30 días después de la intervención (15,4 por ciento). La mortalidad en nuestro entorno es similar a la descrita en la bibliografía. Los resultados justifican el tratamiento agresivo y temprano (AU)

[A model to predict death after lung cancer resection: applicability to individual cases]. / Aplicabilidad de un modelo predictivo de muerte por resección de cáncer de pulmón a la toma de decisiones individualizadas.

OBJECTIVE: To evaluate the reliability of a logistic regression model to predict individual risk of death related to lung cancer resection. METHOD: A study of 515 consecutive patients undergoing anatomical pulmonary resection (lobectomy or pulmonectomy) for lung cancer between January 1994 and December 2001. Dependent variable: death in or out of hospital within 30 days of surgery. Continuous independent variables: age, body mass index, and percent of predicted postoperative FEV1. Binary independent variables: ischemic heart disease, diabetes mellitus, preoperative arrhythmia, induction chemotherapy, type of resection (lobectomy or pneumonectomy), chest wall resection, tumor extension (localized or extended tumor) and perioperative blood transfusion. All data were gathered prospectively. A univariate analysis was performed using contingency tables for binary variables and analysis of variance for continuous ones; stepwise logistic regression analysis was then performed and the likelihood of death for each individual was calculated. A receiver operating characteristic (ROC) curve was constructed with the data, using surgical death as the state variable. RESULTS: The following variables were found to be independently related to death in the univariate analysis: age (p < 0.001, odds ratio 1.11); tumor extension (p = 0.002; OR 3.47) and perioperative transfusion (p = 0.004; OR 3.87). The area under the ROC curve was 0.77, attributable to high specificity given that none of the complications could have been predicted. CONCLUSION: Although some variables are related to surgical death, the described model is not able to give a prediction. Therefore, the model is of little use for application in making decisions about individual cases.

Aplicabilidad de un modelo predictivo de muertepor resección de cáncer de pulmón a la tomade decisiones individualizadas / A model to predict death after lung cancer resection: applicability to individual cases

OBJETIVO: Evaluar la fiabilidad de un modelo de regresión logística para predecir el riesgo individual de muerte por resección de cáncer pulmonar (CP).MÉTODO: Estudio de 515 casos consecutivos sometidos a resección pulmonar anatómica (lobectomía o neumonectomía) por CP entre enero de 1994 y diciembre de 2001. La variable dependiente fue la mortalidad hospitalaria o extrahospitalaria en los 30 días siguientes a la intervención; las variables independientes continuas: la edad, el índice de masa corporal y el volumen espiratorio forzado en el primer segundo, en porcentaje del teórico (FEV1ppo), y las variables independientes binarias: cardiopatía isquémica, diabetes mellitus, arritmia preoperatoria, quimioterapia de inducción, tipo de resección realizada (lobectomía o neumonectomía), resección de pared torácica, extensión tumoral (tumor localizado o extendido) y transfusión sanguínea perioperatoria. Todas las variables han sido recogidas de forma prospectiva. Se ha realizado un análisis univariante utilizando tablas de contingencia para las variables binarias y ANOVA para las continuas; posteriormente, se ha efectuado un análisis de regresión logística por pasos hacia atrás y se ha calculado la probabilidad de muerte para cada caso individual. Con este valor se ha construido una curva ROC utilizando como variable de estado la aparición de muerte operatoria. RESULTADOS: En el análisis multivariante, las siguientes variables se han encontrado relacionadas de forma independiente con la mortalidad: edad (p < 0,001; odds ratio [OR] = 1,11), extensión tumoral (p = 0,002; OR = 3,47) y transfusión perioperatoria (p = 0,004; OR = 3,87). El área bajo la curva ROC es de 0,77, pero esto es debido a una especificidad elevada, ya que ningún caso de complicación pudo ser predicho. CONCLUSIÓN: Aunque se encuentran algunas variables relacionadas con la muerte operatoria, el modelo descrito no es capaz de predecir la muerte operatoria. Por tanto, la aplicabilidad a la toma de decisiones individualizadas es de escasa utilidad (AU)

Una opinión contraria al incremento del número de cirujanos torácicos / A word against increasing the nunber of chest surgeons

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Applicability of logistic regression (LR) risk modelling to decision making in lung cancer resection.

The objective of this study was to evaluate the performance of a locally derived risk-adjusted model to predict cardiorespiratory morbidity after major lung resection for bronchogenic carcinoma. A logistic regression risk model has been developed using a database of 515 patients undergoing major lung resection between 1994 and 2001. Independent studied variables were: age of the patient, body mass index, predicted postoperative forced expiratory volume in the first second (ppoFEV1%), cardiovascular co-morbidity, diabetes mellitus, induction chemotherapy, tumour staging, extent of resection, chest wall resection, and perioperative blood transfusion. The analyzed outcome was the occurrence of postoperative cardiorespiratory complications prospectively recorded and codified. Variables with an influence on the outcome on univariate analysis were entered in the risk model. The calculated probabilities of complication were compared to its actual occurrence in 53 consecutive cases operated on between January and June 2002 and a receiver operating characteristic (ROC) curve was constructed. On logistic regression analysis, age (P < 0.001) and ppoFEV1 (P = 0.003) independently correlated with the outcome. The accuracy for morbidity prediction (area under the ROC curve) was 0.55 (95% CI: 0.31-0.78). These data show that this locally derived lung resection risk-adjusted model fails to predict postoperative cardiorespiratory morbidity in individual patients.

Morbidity after surgery for non-small cell lung carcinoma is not related to neoadjuvant chemotherapy.

OBJECTIVES: To compare postoperative morbidity and mortality rates in two groups of operated non-small cell lung carcinoma patients (NSCLC) with or without induction chemotherapy. METHODS: This is a case-control study on 42 cases and 42 controls. Cases (Group A) underwent induction chemotherapy. Chemotherapy indications and regimens were variable. Control cases (Group B) were randomly selected among 494 NSCLC comparable patients operated on in the same period of time. The selection criteria for operation were the same in both groups. Dependent outcomes were operative death and complications. Independent selected variables were: age, co-morbidity, predicted postoperative FEV1% (1 s forced expiratory volume in percentage), type of surgery and clinical and pathological staging. All postoperative events and independent variables were prospectively registered. Chi-square and risk calculations on contingence tables and one-way ANOVA have been tested. RESULTS: Both series are comparable in demographics, preoperative variables and type of surgery. No mortality has been registered. In Group A, the overall morbidity was 26.2% (11 out of 42 cases), and in Group B, this was 42.9% (18 out of 42 cases; P=0.084). Morbidity was not related to the type of surgery (pneumonectomy vs. other; P=0.205 in Group A and P=0.08 in Group B). Pathological staging did not influence the postoperative outcome, either in Group A (P=0.72; odds ratio, 1.515; 95% confidence interval (CI), 0.375-6.122) or Group B (P=0.299; odds ratio, 0.4; 95% CI, 0.089-1.797). CONCLUSIONS: Induction chemotherapy in NSCLC has no influence on postoperative morbidity.

[How long should a patient stay in the hospital after lung resection?]. / Cuál es la estancia hospitalaria adecuada para una resección pulmonar?

OBJECTIVE: To describe the hospital stay of patients undergoing lobectomy or pneumonectomy in comparison with reference data from the Spanish National Health Service. MATERIAL AND METHOD: Prospective study of all consecutive lobectomy or pneumonectomy cases from January 1998 through December 2000. Data collected prospectively were as follows: date of birth, main diagnosis, dates of admission and discharge, surgical procedure, complications and postoperative exitus. Data collected retrospectively included all information related to readmission over the 30 days following discharge. Reference data were obtained from the web page of the Spanish Ministry of Health and Consumer Affairs. RESULTS: Mean hospital stay for the 279 patients studied was 8.3 days (8.4 for 214 lobectomy patients and 7.7 for 65 pneumonectomy patients). For either of the procedures the 50 percentile was 7 days. The rate of readmission was 8.6%. The 83 patients with postoperative complications required a mean stay of 11.9 days (p < 0.001). The reference data for 1998 were 17.5 days for a lobectomy (n = 1,443) and 19.8 days (n = 693) for pneumonectomy. CONCLUSION: The mean hospital stay of reference is far longer than that which we consider adequate for pulmonary resection.