Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy.

Introduction: Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy.

Introducción: Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC.

An Update on Resources, Procedures and Healthcare Provision in Pain Units: A Survey of Spanish Practitioners.

Multidisciplinary pain treatment units are recommended to provide comprehensive diagnosis and treatment of chronic pain, a complex clinical syndrome and one of the leading causes of disability worldwide. The objective of this study was to provide updated results on the situation of pain treatment units in Spain and to determine compliance with recommendations proposed by de Spanish Ministry of Health (SMH). A cross-sectional, prospective, multicenter survey was performed, collecting data on resources, procedures and healthcare provision. Between March and May 2019, the Spanish Pain Society sent an invitation letter to 183 pain units with a link to the questionnaire. Sixty-nine units from 13 regions agreed to participate. According to the International Association for the Study of Pain criteria, only 12 units were classified as multidisciplinary pain centers. Most (95.7%) were in hospitals, 82.6% from the public sector, and 46.4% had protocols to coordinate with primary care. Interviewees rated the adequacy of facilities at 6.3 (from 0 to 10). Moreover, 67% of interviewees found that there were insufficient staff, with no mental health professionals, physical therapists or social workers in 49.3%, 87.0% and 97.1% units, respectively. Only 24 pain units had a day hospital, 44.9% offered psychological interventions, and 79.7% supported teaching and research activities. Results suggest that a small proportion of Spanish pain units meet the national standards for multidisciplinary pain units proposed by the SMH.

Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy / La hipoalbuminemia y la edad avanzada son factores de riesgo de vaciamiento gástrico lento tras duodenopancreatectomía cefálica

Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy. (AU)

Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC. (AU)