[Postoperative dehiscence of the abdominal wound and its impact on excess mortality, hospital stay and costs]. / Dehiscencia de la laparotomía y su impacto en la mortalidad, la estancia y los costes hospitalarios.

INTRODUCTION: The objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. METHODS: Retrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. RESULTS: Among 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). CONCLUSIONS: Certain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.

Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach.

BACKGROUND: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients' quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. OBJECTIVE: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. METHODS: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. RESULTS: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. CONCLUSIONS: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50157.

Development of a Novel Prediction Model for Red Blood Cell Transfusion Risk in Cardiac Surgery.

BACKGROUND: Cardiac surgery is a complex and invasive procedure that often requires blood transfusions to replace the blood lost during surgery. Blood products are a scarce and expensive resource. Therefore, it is essential to develop a standardized approach to determine the need for blood transfusions in cardiac surgery. The main objective of our study is to develop a simple prediction model for determining the risk of red blood cell transfusion in cardiac surgery. METHODS: Retrospective cohorts of adult patients who underwent cardiac surgery between 2017 and 2019 were studied to identify hypothetical predictors of blood transfusion. Finally, a multivariable logistic regression model was developed to predict the risk of transfusion in cardiac surgery using the AUC and the Hosmer-Lemeshow goodness-of-fit test. RESULTS: We included 1234 patients who underwent cardiac surgery. Of the entire cohort, 875 patients underwent a cardiac procedure 69.4% [CI 95% (66.8%; 72.0%)]; 119 patients 9.6% [CI 95% (8.1%; 11.4%)] underwent a combined procedure, and 258 patients 20.9% [CI 95% (18.7; 23.2)] underwent other cardiac procedures. The median perioperative hemoglobin was 13.0 mg/dL IQR (11.7; 14.2). The factors associated with the risk of transfusion were age > 60 years OR 1.37 CI 95% (1.02; 1.83); sex female OR 1.67 CI 95% (1.24; 2.24); BMI > 30 OR 1.46 (1.10; 1.93); perioperative hemoglobin < 14 OR 2.11 to 51.41 and combined surgery OR 3.97 CI 95% (2.19; 7.17). The final model shows an AUC of 80.9% for the transfusion risk prediction [IC 95% (78.5-83.3%)]; p < 0.001]. CONCLUSIONS: We have developed a model with good discriminatory ability, which is more parsimonious and efficient than other models.

Dietary changes and colorectal cancer trends in Spain during 1951-2007.

OBJECTIVES: Analysis of the evolution of colorectal cancer in Spain during the period 1951-2007 and its relationship with diet. MATERIAL AND METHODS: Calculation of incidence rates, standardized mortality and years of potential life lost (world population) and per capita consumption of different foods. RESULTS: Red and processed meats, poultry, fish and fruits intake has increased and consumption of vegetables, cereals and legumes has decreased. The incidence of colorectal cancer has steadily increased in both genders, more markedly among men, and across all age groups, in contrast to what has been observed in other countries. Mortality increased during the period 1951-2000, but from that time until 2007 these rates have kept steady in men and fallen in women. The years of potential life lost (YPLL) shows a similar distribution to mortality. The correlation coefficients have values close to one for consumption of red meat, poultry, fish, vegetables and fruits and strongly negative values for the consumption of cereals and vegetables with the incidence and mortality in both genders, and the YPLL, but only among men, with weaker correlations for women. CONCLUSIONS: In colorectal cancer, a minimal time span of ten-fifteen years is necessary for changes in exposure to risk factors to be able to modify the incidence of this tumour. Therefore, Spanish State and Regional Governments should implement legislative and educational measures in the field of Health Promotion regarding the diet urgently.

Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending.

INTRODUCTION: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. METHODS: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. RESULTS: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). CONCLUSIONS: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

Alcohol use disorders among surgical patients: unplanned 30-days readmissions, length of hospital stay, excessive costs and mortality.

AIMS: Alcohol use disorders (AUD) have been associated with an increased risk of unplanned hospital readmissions (URA). We analyzed in a sample of 87 Spanish Hospitals if surgical patients with AUD had a higher risk of URA and if among patients with URA, those with AUD had an excess length of hospital stay, higher hospital expenses and increased risk of mortality. METHOD: We analyzed data of patients who underwent surgical operations during the period between 2008 and 2010. URA was defined as unplanned readmissions during the first 30 days after hospital departure. The primary outcome was risk of URA in patients with AUD. Secondary outcomes were mortality, excess length of stay and over expenditure. RESULTS: A total of 2,076,958 patients who underwent surgical operations were identified: 68,135 (3.3%) had AUD, and 62,045 (3.0%) had at least one URA. Among patients with AUD 4212 (6.2%) had at least one URA and among patients without AUD 57,833 (2.9%) had at least one URA. Multivariable analysis demonstrated that AUD was an independent predictor of developing URA (Odds ratio: 1.56; 95% CI: 1.50-1.62). Among surgical patients with URA, those with AUD had longer lengths of hospital stay (2.9 days longer), higher hospital costs (2885.8 Euros or 3858.3 US Dollars), higher risk of death (OR: 2.16, 95% CI: 1.92-2.44) and higher attributable mortality (11.2%). CONCLUSIONS: Among surgical patients, AUD increase the risk of URA, and among patients with URA, AUD heighten the risk of in-hospital death, and cause longer hospital stays and over expenditures.