Surgical complications in a population-based colorectal cancer screening program: Incidence and associated factors. / Complicaciones posquirúrgicas en un programa de cribado poblacional de cáncer colorrectal: incidencia y factores asociados.

INTRODUCTION: Colorectal cancer (CRC) screening programs produce risks, including those derived from colorectal surgeries. The objective of this analysis is to evaluate the complications associated with the surgery. PATIENTS AND METHODS: Retrospective analysis including patients who required colorectal surgery within the population-based CRC screening program in Galicia (May 2013-June 2019). We analyzed the indication for surgery and the rate of in-hospital (mildI-II, severeIII-V, Clavien-Dindo classification) and at discharge complications. We performed a multivariate analysis to determine the variables independently associated. RESULTS: In the analyzed period, 1092 patients underwent surgery (benign lesion 16.5%, pT1 CRC 18.2%, rest of CRC 64.6%) laparoscopic approach in 69.8% of the cases. In-hospital complications were detected in 19.2% of patients (mild: 13.4%; severe: 5.9%; deaths: 0.2%) and at discharge in 159 (14.6%) patients. Male sex was associated with in-hospital complications (OR: 2.0; 95%CI: 1.3-3.0). The variables associated with severe complications were: male sex (OR: 2.6; 95%CI: 1.2-5.5), tertiary hospital (OR: 0.5; 95%CI: 0.2-0.9) and ECOGI (OR: 0.2; 95%CI: 0.05-0.6). The factors associated with complications after discharge were age ≥60years (OR: 1.5; 95%CI: 1.0-2.3), rectal location (OR: 1.6; 95%CI: 1.1-2.3) and in-hospital complications (OR: 2.2; 95%CI: 1.5-3.2). CONCLUSIONS: Surgery is the main cause of morbidity and mortality associated with a CRC screening program. These results must be taken into account in the decision making of lesions that are candidates for endoscopic resection.

Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study.

BACKGROUND: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. METHODS: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist's adenoma detection rate (ADR) classified into quartiles and the hospital's complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). RESULTS: We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87-1.19), due to colonoscopy complications (0.02, 95% CI 0.00-0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85-1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11-2.23), sex (female = 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87-185.59; intermediate risk = 5.63, 95% CI 1.89-16.80; low risk = 1.43; 95% CI 0.36-5.75), the endoscopist's ADR (Q4 = 0.44, 95% CI 0.28-0.68; Q3 = 0.44, 95% CI 0.27-0.71; Q2 = 0.71, 95% CI 0.44-1.14) and the hospital (tertiary = 0.54, 95% CI 0.38-0.79). CONCLUSIONS: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist's ADR and the hospital's complexity.

[Burden of disease in Spanish population under 15 years old in 1999]. / Carga de enfermedad de la población española menor de 15 años para el año 1999.

BACKGROUND AND OBJECTIVE: Burden of disease (DALYs) can help define health priorities. Our objective was to assess DALYs of those illnesses most important in Spanish children and teenagers. MATERIAL AND METHOD: We calculated DALYs components (YLL, YLD) by age groups and sex. Sources used were Spanish mortality data and WHO DALY's estimates. RESULTS: Total DALYs was 46.57/1000 habitants and it was highest in children aged less than 1 year. The first cause was represented by non-communicable diseases and the second by communicable-perinatal diseases in less than 1 year and 1-4 years and injuries in 5-14 years. CONCLUSIONS: DALYs is a good indicator to define health's population.