Surgical complications and costs among octogenariansBackground: Old age is a negative prognostic factor among patients subjected to surgical procedures. Aim: To assess the clinical profi le and hospital stay costs among patients aged 80 years or more in a surgical department. Material and Methods: Retrospective review of medical records of 115 surgical patients aged 84 ± 4 years (67% males), hospitalized during 2007. Clinical presentation, surgical treatment, functional status on admission and discharge and hospitalization costs, was analyzed. Results: Ninety percent of patients had associated diseases and 83% had previous surgical procedures. On admission, 88% of patients had a normal functional status. Hernia was the most common surgical diagnosis in 17%. Thirty percent required emergency surgery. Mean hospital stay was 11 days, 47% required admission to the critical patients unit, 20% had complications, 8% required a second operation and two patients died. At discharge, 27% had a functional impairment. Hospitalization costs were 3.8 times greater among those that had complications, 3.1 times higher among those that required a second intervention and 1.8 times higher among those classifi ed as III or IV according to American Surgical Association physical status classifi cation, compared with those classifi ed as I or II. Conclusions: Surgical patients aged more than 80 years, are more prone to complications and their hospitalization costs are higher.
Factors associated with early morbidity in laparoscopic colorectal surgery Introduction: Different factors have been associated with increased risk of complications in laparoscopic colorectal surgery. The aim of this study is to identify these factors in our series. Method: Retrospective cohort. All patients undergoing laparoscopic colorectal surgery between January 2000 and June 2012 were included. Patients who had postoperative complications until 30 days postoperatively were identified and analyzed by univariate and multivariate logistic regression. A p value less than 0.2 was used was used as a criteria for entry into the multivariate model. Results: The series consists of 848 patients with a median age of 58 ± 22 years. Main surgical indications were: neoplasia (42.3%), diverticular disease (27.8%) and inflammatory bowel disease (8.8%). Most frecuently-performed procedures were: sigmoidectomy (39.5%), anterior resection of the rectum (13.4%), right hemicolectomy (13%) and total colectomy (8.7%). On univariate analysis, factors associated with complications were age over 75 years (OR 1.82, 95% CI 1.02 to 3.25) and red blood cell transfusion (OR 8.47, 95% CI 3.69 to 19.43). On multivariate analysis, red blood cell transfusion (OR 7.9 95% CI 1.78 to 35.88) and ASA III or IV (OR 3.26 95% CI 1.01 to 17.23) were independent factors associated with postoperative complications. Conclusion: Intraoperative red blood cell transfusion and ASA score III or IV are independent risk factors associated with complications in laparoscopic colorectal surgery.
Exactitud de la endosonografía rectal en la estadifi cación tumoral en pacientes con cáncer de recto sin quimio-radioterapia preoperatoria* Drs. GONZALO AbstractAccuracy of endoscopic ultrasound in tumor staging of rectal cancer patients not treated with preoperative chemo-radiation Introduction: Preoperative T staging of rectal cancer is essential for an adequate treatment strategy. Endoscopic ultrasonography (EUS) is one of the available modalities. The reported accuracy of this technique for T staging is variable. This inconsistency might be due to neoadyuvancy, and its downstaging properties. Aim: Determine the accuracy of rectal EUS for T staging of middle and lower rectal tumors in patients not treated with neoadyuvant chemo-radiotherapy. Materials and Methods: Clinical records of all consecutive patients evaluated by rectal EUS between years 2001-2009 in the Catholic University Clinical Hospital were accessed. Of 2.120 patients, 294 had the exam performed for middle or lower rectal cancer. Those who did not receive neoadyuvant chemo-radiation and whose histopathology was available were analyzed. Result: Data was obtained for 69 patients. The overall accuracy of EUS for T staging was 85%. For T1 tumors, the sensibility, specifi city and accuracy were 82%, 96% and 94% respectively. For T2 tumors the sensibility, specifi city and accuracy were 72%, 83% and 78 respectively. For T3 tumors the sensibility, specifi city and accuracy were 82%, 83% and 83% respectively. Conclusion: Rectal EUS continues to be a valuable staging procedure for tumor depth invasion, with an overall accuracy of 85%.Key words: Endoscopic ultrasonography, rectal cancer, accuracy. ResumenIntroducción: La estadifi cación tumoral (T) preoperatoria es esencial para el tratamiento del cáncer de recto. La endosonografía rectal (ER) es una de las modalidades disponibles. La exactitud de esta técnica para la estadifi cación tumoral es variable en la literatura, y se sospecha que esta inconsistencia se debe a la neoadyuvancia, por el descenso de estadio que esta produce. Objetivo: Analizar la exactitud de la endoso- Los autores no refi eren confl ictos de interés.
Analysis of predictive factors for conversion to open surgery in laparoscopic colorectal surgeryBackground: Conversion to open surgery of laparoscopic procedures is not in essence a complication, but invalidates the benefi ts of laparoscopy. Aim: To identify the predictive factors for conversion in laparoscopic colorectal surgery. Material and Methods: Revision of medical records of all patients with colorectal disease operated using a laparoscopic approach, from 1998 to 2010. Gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), previous abdominal surgery, elective/urgency procedure, benign/malignant disease, type of resection and surgeon experience were recorded. A logistic regression model was done to determine which variables were predictive for conversion to open surgery. Results: The medical records of 582 patients aged 57 ± 17 years (45% men) were analyzed. The rate of conversion to open surgery was 7.1%. The logistic regression model selected as predictors of conversion a BMI over 25 kg/m
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