Objective: Using clinical outcomes, to validate the comprehensive complication index (CCI) as a measure of postoperative morbidity in all patients undergoing surgery at a general surgery department. Background: The Clavien-Dindo classification (CDC) is the most widely used system to assess postoperative morbidity. The CCI is a numerical scale based on the CDC. Once validated, it could be used universally to establish and compare the real postoperative complications of each surgical procedure. Methods: Observational prospective cohort study. All patients who underwent surgery during the 1-year study period were included. All the complications graded with the CDC and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. Surgical procedures were classified according to the operative severity score (OSS) as minor, moderate, major, or major+. The clinical validation of the CCI was performed by assessing its correlation with 4 different clinical outcomes. Results: A total of 1850 patients were included: 513 (27.7%) presented complications and 101 (5.46%) were readmitted. In the multivariate analysis, the CCI and CDC were associated with postoperative stay, prolongation of postoperative stay, readmission, and disability in all OSS groups (P < 0.001). The CCI was superior to the CDC in all models except for prolongation of stay for OSS moderate and major+. Conclusions: The CCI can be applied in all the procedures carried out at general surgery departments. It is able to determine the morbidity and allows the comparison of the outcomes at different services.

Objective: To validate the Comprehensive Complication Index (CCI) via an assessment of its relation to postoperative costs. Background: The CCI summarizes all the postoperative complications graded by the Clavien-Dindo classification (CDC) on a numerical scale. Its relation to hospital costs has not been validated to date. Methods: Prospective observational cohort study, including all patients undergoing surgery at a general surgery service during the 1-year study period. All complications graded with the CDC and CCI and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. The surgeries were classified according to their Operative Severity Score (OSS) and in 4 groups of homogeneous surgeries. All postoperative costs were recorded. Results: In all, 1850 patients were included, of whom 513 presented complications (27.7%). The CDC and the CCI were moderately to strongly correlated with overall postoperative costs (OPCs) in all OSS groups (r s = 0.444–0.810 vs 0.445–0.820; P < 0.001), homogeneous surgeries (r s = 0.364–0.802 vs 0.364–0.813; P < 0.001), prolongation of postoperative stay (r s = 0.802 vs 0.830; P < 0.001), and initial operating room costs (r s = 0.448 vs 0.451; P < 0.001). This correlation was higher in emergency surgery. With higher CDC grades, the OPC tended to increase an upward trend. In the multivariate analysis, CDC, CCI, age, and duration of surgery were all associated with OPC (P < 0.001). Conclusions: In our environment, the CCI presented associations with OPC. This demonstration of its economic validity enhances its clinical validity.

The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

An analysis is presented of the trends in the annual number of radiological examinations and in the average effective dose equivalent for each type of examination in a big Spanish hospital. Annual frequencies for each type of examination, annual average effective dose equivalent values for each study group, and the contribution of each examination group to the collective dose are presented. Also, sex and age distributions for several important examinations are given, and their impact on the collective dose is reviewed.

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Background: Squamous cell carcinoma of the pyriform sinus(SCCPS) is a rare tumour with poor prognosis due to delayed diagnosis. It usually metastasizes to the lymphatic region or nearby organs. Distant dissemination is uncommon. We report the case of a patient diagnosed with SCCPS and a single liver metastasis. Methods: A 63-year-old man diagnosed with SCCPS 3 years ago, stage IVa(T1N2b), treated with QT/RT and a complete response. A control CT showed a liver mass of 68x59x48mm located in segments V-VI. The biopsy demonstrated a liver metastasis of SCCPS. The patient received 6 cycles of QT, with partial response. We decided to perform a segmentectomy V-VI. The specimen was compatible with metastasis of SCCPS, poorly differentiated. At present free-disease after 8 months. Results: SCCPS is the most frequently tumour in hypopharynx(70%), with an incidence of 1750/year. It is usually found in patients with tobacco or ethanol abuse. Only a small percentage present with early stage(T1-T2)without nodal involvement or distant metastases. Those are rare, with an incidence of 5%. Most of these patients have stage III or IV disease at presentation and, when present, they commonly involve lung and mediastinum(53%), bone(15%), skin(7%), and CNS(3%). To the present, this is the first report describing a liver metastasis from SCCPS resected. Conclusion: SCCPS is a low-frequency tumour with poor prognosis which rarely metastasizes to distant organs. We report a liver metastasis from SCCPS which was successfully treated with surgery.

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