EP-209Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life of the resident in a young team practicing such surgery in a developing country look like? Methods: Surgical residents interested in acquiring advanced training in HBP surgery should take a fellowship in this kind of surgery, spending at least four years in a specialized center. Results: The pre and postoperative management of patients is a core function of a junior doctor, but they have to be involved in every step of the journey represented by complex HBP surgery: from establishing anesthesia routine to training team and taking part in tumor board meetings. Mentorship is also a key factor in promoting and maintaining fulfillment in surgical practice. Conclusions: In a young HBP team, bidirectional growth -both mentors and residents is crucial to developing this king of surgery. Working hard, studying and training every day are very important steps in order to build a career as a HBP surgeon.
Objective: There was a critical inconsistency in making therapeutic choices regarding anticoagulation in patients with COVID-19. This study aims to evaluate and determine the causes that led to the formation of hematomas, spontaneous bleeding or what is involved in this hypothesis and the elements related to this aspect.
Patients and methods: The present study is a case series analysis that aims to identify and verify the cause of spontaneous hematomas in COVID positive patients for whom surgery was required. Thus, we analysed patients who presented various spontaneous hematomas during the covid pandemic (March 2020 - May 2021) for which surgery was performed, having as a control group (CG) a homogeneous group in terms of age, covid infection severity, and comorbidities with the study group (SG).
Results: Regarding the preoperative and postoperative days, SG had average values of 4.76±5.36 (Mean±SD) for preoperative days and 9.5±9.327 for postoperative days. Given that one of the most suspected causes of hematomas was considered an anticoagulant overdose, we compared the anticoagulant doses and the type of anticoagulant, so the anticoagulant doses did not show statistically significant differences (0.836±0.294ml in SG versus 0.866±0.343ml in CG with p=0.588). As expected, hemoglobin (Hb) was significantly lower for SG with mean values of 7.266±1.431mg/dl compared to CG that had mean values of 12.9±2.092mg/dl (p=0.001). The correlation between the value of Hb (average value was 12.9 mg/dl, a minimum of 8.7 mg/dl and a maximum of 16.6 mg/dl) and the value of procalcitonin (average value was 0.13, a minimum of 0.02 and a maximum of 0.7) is statistically significant having p=0.012. In SG, hemoglobin can be correlated with ESR (erythrocyte sedimentation rate), p=0.008 and with procalcitonin, p=0.05. Both have a negative correlation explained by a proinflammatory status that can aggravate low hemoglobin levels, but without a direct link to high ESR and procalcitonin values.
Conclusions: The hypothesis of anticoagulant overdose is not supported or verified by the present study, we consider that additional thromboelastography tests are necessary to be able to completely refute it. Mortality did not increase statistically significantly
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