Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel / Incidence of postoperative adverse events in a tertiary hospital

Objetivos. Determinar la proporción de reintervenciones, mortalidad, incidencia, gravedad y grado de evitabilidad de eventos adversos posquirúrgicos (EAP) en un hospital de tercer nivel. Métodos. Revisión retrospectiva de una muestra aleatoria de 350 cirugías realizadas en 2009 en pacientes mayores de 14 años. Para identificar los EAP, determinar su gravedad y establecer su grado de evitabilidad se utilizaron clasificaciones preestablecidas. Resultados. Se detectaron 113 EAP en 61 pacientes, el 17,4% de los 350 pacientes estudiados. El 4,3% de los pacientes fue reintervenido y la mortalidad a los 30 días fue del 2,6%. Los EAP más frecuentes fueron: infección de herida quirúrgica (15,0%), hematoma o hemorragia de herida (9,7%) y anemia por sangrado (8,8%). Los factores asociados a los pacientes que adquirieron un EAP fueron el uso anestesia general, grado ASA≥3, estancia media, edad media y servicios con cirugía de mayor repercusión sistémica. Cerca del 70% de los EAP estaban recogidos en el informe de alta. El 72,6% de EAP fueron de gravedad leve, el 11,5% de gravedad moderada y el 15,9% muy graves. Un 39,9% de EAP tenían una probabilidad alta de haberse evitado. No se encontró relación entre la evitabilidad y la gravedad de los EAP. Conclusiones. La alta proporción de pacientes intervenidos con EAP, las reintervenciones consecuentes y la mortalidad en el postoperatorio inmediato señalan la importancia de implantar acciones para reducir la magnitud y el impacto de los eventos adversos, teniendo en cuenta que más del 40% de los EAP podría ser evitado(AU)

Objectives. To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. Methods. Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. Results. Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. Conclusions. The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided(AU)

[Incidence of postoperative adverse events in a tertiary hospital]. / Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel.

OBJECTIVES: To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. METHODS: Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. RESULTS: Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. CONCLUSIONS: The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided.

Validación de un instrumento para evaluar el funcionamiento y repartir incentivos entre los servicios de un hospital / Validation of an instrument to assess functioning and distribute incentives among the services of a hospital

Objetivo: Diseñar y examinar la fiabilidad de una herramienta para evaluar los resultados y distribuir incentivos entre los servicios del hospital. Material y Métodos: Se definieron de forma explícita las características de la herramienta de evaluación (representatividad, transparencia, claridad, pertinencia, accesibilidad, veracidad, carácter reproducible, sensibilidad, especificidad, estabilidad, eficiencia y aceptación) y se utilizaron dichos criterios para seleccionar indicadores y desarrollar los modelos de evaluación específicos de cada servicio. Para validar el método se midió su precisión (coherencia intra e interobservador, coeficiente de variación y bondad de ajuste a la normal) y su validez de contenido, de construcción y de criterio con respecto a una encuesta de opinión previa entre el equipo directivo (correlación de Pearson e índice Kappa). Resultados: La herramienta desarrollada constaba de 15 modelos de evaluación elaborados a partir de 49 indicadores (31 de actividad, cuatro de costes y 14 de calidad asistencial). Se evaluaron 56 unidades aistenciales, cuya calificación media fue de 73,5 ñ 18,1 puntos, con un mínimo de 29 y un máximo de 100. En Actividad la puntuación media fue de 52,1 ñ 14,7 sobre 70, en Costes de 13,7 ñ 7,4 sobre 20 y en Calidad de 7,6 ñ 2,1 sobre 10. El modelo se ajustaba a una distribución normal, con un CV de 0,25, un error intraobsevador de 0,25 por ciento e interobservador del 0,48 por ciento. La correlación con la opinión del equipo directivo era positiva (r = 0,43 p = 0,004), pero los índices de concordancia kappa eran bajos (0,21). Conclusiones: El método de evaluación probado es preciso, está bien construido y tiene una aparente validez de criterio. Queda ahora por demostrar si sirve para mejorar los resultados y la calidad de la asistencia prestada (AU)

Evaluación histopatológica de la acción de derivados de la vitamina e en el proceso cicatricial de un modelo de cirugía filtrante / Histopathological evaluation of vitamin e in surgical fistula closure

Objetivo: Describir el efecto de los derivados del a-tocoferol (acetato y succinato ácido) sobre las características histopatológicas de la fístula quirúrgica en un modelo experimental de cirugía filtrante. Material y métodos: 30 conejos pigmentados fueron divididos en 3 grupos de estudio. Veinticuatro horas antes de la cirugía se inyectaron subconjuntivalmente 0,5 ml de solución según el grupo de tratamiento: grupo I (n=10) solución salina balanceada (BSS) en etanol al 0,75 por ciento, grupo II (n=10) 100 µgrs de acetato de alfa-tocoferol (AT) en BSS con etanol al 0,75 por ciento, y grupo III (n=10) 100 µgrs de succinato ácido de alfa-tocoferol (ST) en BSS con etanol al 0,75 por ciento. Se evaluaron los hallazgos histológicos 30 días después de la cirugía. Resultados: Los grupos tratados con derivados del alfa-tocoferol mostraron mayor porcentaje de fístulas permeables y áreas cicatriciales de menor extensión. Existió un infiltrado celular subconjuntival de células mononucleares y eosinófilos. Conclusiones: El empleo de derivados del alfa-tocoferol en cirugía filtrante experimental mejora los parámetros histológicos de inhibición de los procesos de cicatrización vinculados al fracaso de la cirugía filtrante (AU)

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[Histopathological evaluation of vitamin E derivatives effects on the healing process of a model of filtration surgery]. / Evaluación histopatológica de la acción de derivados de la vitamina E en el proceso cicatricial de un modelo de cirugía filtrante.

PURPOSE: To describe the effect of alpha-tocopherol derivatives (acetate and acid succinate) on the histopathological characteristics of the surgical fistulae in an experimental model of filtering surgery. METHODS: 30 pigmented rabbits were randomly divided into 3 study groups. Twenty-four hours before surgery the animals were injected subconjunctivally with 0.5 ml of solution: group I (n=10) 0.75% ethanol in balanced saline solution (BSS), group II (n=10) 100 microgrs alpha-tocopherol acetate (AT) in 0.75% ethanol in BSS, group III (n=10) 100 microgrs alphatocopherol acid succinate (ST) in 0.75% ethanol in BSS. Histological findings were evaluated 30 days after surgery. RESULTS: The groups treated with alpha-tocopherol derivatives showed a higher percentage of fistular persistence and smaller wound healing areas. There was a subconjunctival cellular infiltrate of mononuclear and eosinophilic cells. CONCLUSIONS: Histological findings support the clinical use of alpha tocopherol derivatives, AT and ST. to inhibit the wound healing processes associated to filtering surgery failure.

[Granular cell tumor of the larynx]. / Tumor de células granulomatosas de laringe.

Granular cell tumor is an unusual growth of probably neuroectodermal histogenesis, first reported by Abrikossoff in 1926 with the name of myoblastoma. Of the about 1200 cases reported since, the 50 percent were found in the head and neck. Of second mentioned 10 percent had a laryngeal sitting. A case of glottic granular cell tumor surgically removed with free borders is presented. Bibliographical review.

[Primary mucous melanoma of the nasal cavity: a case report]. / Melanoma mucoso primario de fosas nasales. A propósito de un caso.

Mucous melanoma in the nasal cavity are unusual tumours that develop from common melanocytes pre-existent in the respiratory epithelium. They manifest a high diagnostic and therapeutic difficulties as well as an obscure prognosis. A case of this rare tumour is exposed and a bibliographic review in which clinical, diagnostic, histological, therapeutic and prognostic features are contemplated.

[Laryngeal histoplasmosis]. / Histoplasmosis laríngea.

A case of laryngeal histoplasmosis is reported. This laryngeal mycosis was diagnosed by histological identification of intracellular hyphae of Histoplasma capsulatum. Laryngoscopy revealed edema, erythema and leukoplakia of the righ vocal cord. Itrakonazole treatment was successful. The relevant literature is reviewed.

[Mucoepidermoid carcinoma of the larynx. A case report]. / Carcinoma mucoepidermoide de laringe. A propósito de un caso.

We report a case of laryngeal mucoepidermoid carcinoma that was diagnosed in the Hospital Miguel Servet of Zaragoza. The unusual tumor site and difficult diagnosis were notable and, above all the fatal outcome after local recurrence and metastasis in spite of good overall prognosis.

Microfilariae in the mammary gland of a bitch.

A microfilarial infection of the mammary gland of a bitch with Dirofilaria immitis was diagnosed by fine needle aspiration biopsy. The animal had had a progressively enlarging, painful, pendulous, cystic swelling, measuring 12 x 18 cm, in the second left abdominal mammary gland for four to five months. Two separate biopsies revealed microfilariae and mammary duct epithelial cells, but no inflammatory cells. A histological examination revealed atrophic and necrotic mammary lobules with dilated and cystic ducts. Solid carcinoma was also observed in a small area of the mammary mass. The interlobular connective tissue was oedematous and the lymphatic and vascular channels were dilated. Microfilariae were observed within both the small blood vessels and capillaries and in the interlobular stroma of the mammary tissue, but there was no evidence of an inflammatory response.

[Reported case of cystic cervical lymphangioma in an adult]. / Presentación de un caso de linfangioma quístico cervical en adulto.

Cystic lymphangiomas are abnormalities derived from lymphatic vessels that are characterized by the formation of cysts. The are located generally in head and neck and occur most frequently in children. They rarely appear in adults. We present a case of lymphangioma and review the disorder.