Study Design. Economic evaluation of the costs of low back pain (LBP) in Spain from a societal perspective, including direct and indirect costs, based on a national representative sample of the general population, the National Health Survey of 2017 (NHS 2017). Objective. To estimate the costs attributable to LBP in Spain. Summary of Background Data. LBP has a high prevalence and is associated with lower quality of life, functional status, and increased use of health services. Studies that assess the socio-economic burden of LBP from a general population perspective have not been published yet in Spain. Methods. Data from NHS 2017 were used. Direct costs (consultations—general practitioner, specialist and emergency departments-, diagnostic tests, hospitalizations, physiotherapy, psychologist, and medication consumption) and indirect costs (absenteeism and presenteeism) were assessed. Multivariate models were obtained to determine the independent attributable effect of LBP in each variable. Costs were determined through existing regional healthcare services public data. Results. Prevalence of LBP was 17.1% for men and 24.5% for women, and increased with age, low educational status, higher body mass index, and was associated with less physical activity, and lower self-perceived health. Multivariate analysis demonstrated that LBP was independently associated with a significant increase both in the utilization of all health services and on work day losses. Attributable costs of LBP were 8945.6 million euros, of which 74.5% implied indirect costs, representing overall 0.68% of Spanish Gross Domestic Product. Conclusion. Spain is paying a heavy price for LBP, mostly associated with its significant impact on absenteeism and presenteeism, as well as a noteworthy effect on excess health services utilization. These findings underscore the need to address this considerable public health and social problem through interventions that address widely LBP and that have demonstrated to be cost-effective. Level of Evidence: 3

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Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant. (REV INVEST CLIN. [AHEAD OF PRINT]

Introduction. Malnutrition and weight loss in cancer patients is a common problem that affects the prognosis of the disease. In the case of CRC, malnutrition rates range between 30 and 60%. Objectives. Description of the preoperative nutritional status of patients diagnosed with colorectal neoplasia who will undergo surgery. Materials and Methods. A prospective observational study is performed. Results. Of 234 patients studied, we observed that 139 (59%) had some degree of nutritional risk. Of all of them, 44.9% (N = 47) had 1-2 points according to MUST and 25% (N = 27) had more than 2 points. No differences were found when studying nutritional risk according to the location of the neoplasm. It was observed that 2.15% of the patients were underweight, 51% overweight, and 23% obese. 19.4% of patients lost less than 5 kg in the 3–6 months prior to diagnosis, 20.7% lost between 5 and 10 kg, and 2.1% lost more than 10 kg. In asymptomatic patients, the weight loss was lower than in symptomatic patients, loss <5 kg, 8.2% vs. 22.8%, and loss 5–10 kg, 16.2% vs. 29.3%, with a value of p = 0.016 . 5% (N = 7) of the patients had hypoalbuminemia record. 16.5% (N = 23) had some degree of prealbumin deficiency and 20.9% (N = 29) of hypoproteinemia. Symptomatic patients had more frequent analytical alterations, 1-2 altered parameters in 48.8% (N = 20) of asymptomatic vs. 61.2% (N = 22) in the symptomatic, p = 0.049 .

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