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Cano-García L, Manrique-Arija S, Redondo-Rodríguez R, Vera-Ruiz M, Lisbona-Montañez JM, Mucientes-Ruiz A, García-Studer A, Ortiz-Marquez F, Mena-Vázquez N, Fernández-Nebro A. Impact of the COVID-19 pandemic on psychosocial health in rheumatic patients: A longitudinal study. REUMATOLOGIA CLINICA 2024; 20:297-304. [PMID: 38991823 DOI: 10.1016/j.reumae.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 07/13/2024]
Abstract
AIM To describe the impact of the COVID-19 on the psychosocial health of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and systemic lupus erythematosus (SLE). DESIGN Longitudinal observational study of a series of patients with rheumatic disease. METHODS The main outcome measure was impairment of the ability to participate in social activities, as measured using the PROMIS-APS instrument Short Form-8a. We evaluated social activities in various settings and performed a multivariate analysis to study the association between worsening of social participation during the COVID-19 pandemic and implicated factors. RESULTS One hundred and twenty-five patients had completed the prospective follow-up: 40 with AR (32%), 42 with SpA (33.6%), and 43 with SLE (34.4%). Overall, poorer mean PROMIS scores were recorded after the COVID-19 pandemic for: satisfaction with social roles (p=0.029), depression (p=0.039), and ability to participate in social activities (p=0.024). The factors associated with ability to participate in social activities after the COVID-19 pandemic were older age (β=-0.215; p=0.012), diagnosis of SLE (β=-0.203; p=0.015), depression (β=-0.295; p=0.003) and satisfaction with social roles (β=0.211; p=0.037). CONCLUSION The ability to participate in social activities after the COVID-19 pandemic is affected in patients with rheumatic disease, especially in SLE.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain.
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Marta Vera-Ruiz
- Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Jose Manuel Lisbona-Montañez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Arkaitz Mucientes-Ruiz
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Aimara García-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Ortiz-Marquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Spain
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Mudarra Vela AM, Rivas Ruiz F, Atienza Carrasco J, Medina Cano FJ. Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:354-360. [PMID: 35810102 PMCID: PMC9192794 DOI: 10.1016/j.rgmxen.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.
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Affiliation(s)
- A M Mudarra Vela
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain.
| | - F Rivas Ruiz
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - J Atienza Carrasco
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - F J Medina Cano
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Mena-Vázquez N, Rojas-Gimenez M, Romero-Barco CM, Gandía-Martínez M, Perez-Gómez N, Godoy-Navarrete FJ, Manrique-Arija S, Garcia-Studer A, Calvo-Gutiérrez J, Varela CF, Morales-Garrido P, Pérez PC, Mouriño-Rodriguez C, Añón-Oñate I, Espildora F, Aguilar-Hurtado MC, Redondo R, Conde AH, de Los Ríos RAD, César EC, Velloso-Feijoo ML, Fernández-Nebro A. Analysis of comorbidity in rheumatoid arthritis-associated interstitial lung disease: a nested case-cohort study. Biomed Pharmacother 2023; 157:114049. [PMID: 36459713 DOI: 10.1016/j.biopha.2022.114049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe comorbid conditions in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity. METHODS Nested case-cohort study of 2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD. RESULTS The final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 [72.7] vs 60 [57.7]; p = 0.021). In both groups, multimorbidity was associated with ILD (OR [95% CI] 1.92 [1.03-3.59]; p = 0.039), age (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004), CRP (OR [95% CI] 1.16 [1.05-1.29]; p = 0.003), and erosions (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004); in the cases, it was associated with CRP (OR [95% CI] 1.17 [1.01-1.35]; p = 0.027), anti-citrullinated peptide antibody (OR [95% CI] 1.23 [1.14-13.02]; p = 0.049), and forced vital capacity (OR [95% CI] 0.79 [0.96-0.99]; p = 0.036). CONCLUSION In patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
| | - Marta Rojas-Gimenez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Carmen María Romero-Barco
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Nair Perez-Gómez
- UGC de Reumatología, Complejo Hospitalario Universitario de Vigo, 36214 Vigo, Spain
| | | | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Jerusalem Calvo-Gutiérrez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Clara Fuego Varela
- UGC de Reumatología, Hospital Universitario de Jerez, 11407 Cádiz, Spain
| | - Pilar Morales-Garrido
- UGC de Reumatología, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | | | | | | | - Francisco Espildora
- UGC de Neumología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | | | - Rocío Redondo
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Ana Hidalgo Conde
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Eva Cabrera César
- UGC Neumología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
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Mudarra Vela M, Rivas Ruiz F, Atienza Carrasco J, Medina Cano FJ. [Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2022; 88:S0375-0906(22)00046-5. [PMID: 35528028 PMCID: PMC9058025 DOI: 10.1016/j.rgmx.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.
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Affiliation(s)
- M Mudarra Vela
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
| | - F Rivas Ruiz
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
- Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
| | - J Atienza Carrasco
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
| | - F J Medina Cano
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
- Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
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Ability to Participate in Social Activities of Rheumatoid Arthritis Patients Compared with Other Rheumatic Diseases: A Cross-Sectional Observational Study. Diagnostics (Basel) 2021; 11:diagnostics11122258. [PMID: 34943495 PMCID: PMC8700244 DOI: 10.3390/diagnostics11122258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To compare the ability to participate in social activities among rheumatoid arthritis patients with other rheumatic disease patients and identify potentially implicated factors. PATIENTS AND METHODS Between June and November 2019, we consecutively selected patients aged ≥18 years with RA (defined according to ACR/EULAR 2010), SpA (ASAS/EULAR 2010), and SLE (ACR 1997). MAIN OUTCOME MEASURES Ability to participate in social roles and activities evaluated using the PROMIS score v2.0 short-form 8a (PROMIS-APS). SECONDARY OUTCOMES Participation in social activities according to a series of variables (mobility, depression, satisfaction with social relationships, social isolation, company, emotional support, instrumental support, and support via information). We evaluated the association between the ability to participate in social activities and associated variables using multivariable linear regression analysis. RESULTS The study population comprised 50 patients with RA (33.1%), 51 patients (33.8%) with SpA, and 50 patients (33.1%) with SLE. The mean PROMIS-APS scores were similar in the three groups. The multivariable analysis for the whole sample showed that the ability to participate in social activities was inversely associated with depression and directly with social satisfaction, mobility, company, and age. The stratified analysis revealed an inverse association between inflammatory activity and ability to participate in social activities in patients with RA and SpA, but not in those with SLE. CONCLUSION All patients with RA, SpA, and SLE had a similar ability to participate in social activities. This was associated with other psychosocial factors (social satisfaction, mobility, company, depression) and clinical factors (age and inflammatory activity).
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Damasceno AM, Kesley R, Paolino BS, Dos Santos do Amaral MR, Pitombo MB. Perioperative score for octogenarian patients eligible for rectal cancer surgery. J Surg Oncol 2021; 124:1409-1416. [PMID: 34363616 DOI: 10.1002/jso.26634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer incidence increases with age; therefore, rectal cancer treatment in elderly patients is increasingly common. Surgery is a common rectal cancer treatment, and the risks involve complicated surgical decisions. There are currently few surgical outcome data for rectal cancer in elderly patients. The aim of this study is to identify new perioperative risk factors that could be associated with higher 30- and 180-day mortality in elderly patients in good clinical condition considering traditional perioperative risk scores and to develop a risk score. METHODS A single-centre, retrospective cohort study was performed by reviewing the medical records of patients from the National Cancer Institute of Brazil aged 80 years or older who electively underwent rectal cancer surgery; several independent variables correlated with death from all causes at 30 and 180 days were studied. RESULTS Multivariate analysis found new variables (CEA, albumin and reoperation) that had independent correlations with increased 30- and 180-day mortality. A clinical risk score was developed with survival profiles ranging from 29.3% to 97.2% within 30 days and 2.45% to 91.8% within 180 days. CONCLUSIONS This score can aid in deciding whether a patient should undergo rectal cancer surgery.
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Affiliation(s)
- Arthur Mota Damasceno
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Kesley
- Department of Abdominal Surgery, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Souza Paolino
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Rubens Dos Santos do Amaral
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Bettini Pitombo
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Eguaras Córdoba I, Herrera Cabezón J, Sánchez Acedo P, Galbete Jiménez A, Guillén Grima F. The Urgent Surgery Elderly Mortality risk score: a simple mortality score. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:677-682. [PMID: 31317752 DOI: 10.17235/reed.2019.6187/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). PATIENTS AND METHODS this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. RESULTS in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). CONCLUSIONS a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.
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Affiliation(s)
| | - Javier Herrera Cabezón
- Cirugía General/ Jefe Unidad Hepatobiliopancreatic, Complejo Hospitalario de Navarra, España
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Laviano E, Sanchez M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, Calmarza P, Rezusta A, Serrablo A. Surgical site infection in hepatobiliary surgery patients and its relationship with serum vitamin D concentration. Cir Esp 2020; 98:456-464. [PMID: 32723503 DOI: 10.1016/j.ciresp.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. METHODS Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. RESULTS Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. CONCLUSIONS High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.
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Affiliation(s)
- Estefania Laviano
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España.
| | - María Sanchez
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
| | | | | | - Javier López
- Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Miguel Servet, Zaragoza, España
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Miguel Servet, Zaragoza, España
| | - Alejandro Serrablo
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
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Laviano E, Sanchez Rubio M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, Calmarza P, Rezusta A, Serrablo A. Association between preoperative levels of 25-hydroxyvitamin D and hospital-acquired infections after hepatobiliary surgery: A prospective study in a third-level hospital. PLoS One 2020; 15:e0230336. [PMID: 32214325 PMCID: PMC7098583 DOI: 10.1371/journal.pone.0230336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Evidence implicates vitamin D deficiency in poorer outcomes and increased susceptibility to hospital-acquired infections (HAIs). This study examined the association between serum vitamin D levels and HAIs in a population of hepatobiliary surgery patients. Methods Participants in this prospective analytical observational study were patients who underwent hepatobiliary surgery in a tertiary hospital in Aragon, Spain, between February 2018 and March 2019. Vitamin D concentrations were measured at admission and all nosocomial infections during hospitalization and after discharge were recorded. Results The mean 25-hydroxyvitamin D concentration of the study population (n = 301) was 38.56 nmol/L, which corresponds to vitamin D deficiency. Higher vitamin D concentrations were associated with a decreased likelihood of developing a HAI in general (p = 0.014), and in particularly surgical site infection (p = 0.026). The risk of HAI decreased by 34% with each 26.2-nmol/L increase in serum vitamin D levels. Conclusions Vitamin D levels may constitute a modifiable risk factor for postoperative nosocomial infections in hepatobiliary surgery patients.
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Affiliation(s)
- Estefania Laviano
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
- * E-mail:
| | - Maria Sanchez Rubio
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
| | | | | | - Javier López
- Medicina Familiar y Comunitaria, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Miguel Servet, Zaragoza, Spain
| | - Alejandro Serrablo
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, Spain
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Suárez-Llanos JP, Benítez-Brito N, Vallejo-Torres L, Delgado-Brito I, Rosat-Rodrigo A, Hernández-Carballo C, Ramallo-Fariña Y, Pereyra-García-Castro F, Carlos-Romero J, Felipe-Pérez N, García-Niebla J, Calderón-Ledezma EM, González-Melián TDJ, Llorente-Gómez de Segura I, Barrera-Gómez MÁ. Clinical and cost-effectiveness analysis of early detection of patients at nutrition risk during their hospital stay through the new screening method CIPA: a study protocol. BMC Health Serv Res 2017; 17:292. [PMID: 28424063 PMCID: PMC5397674 DOI: 10.1186/s12913-017-2218-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/01/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system. METHODS The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention. DISCUSSION This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital. TRIAL REGISTRATION Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Néstor Benítez-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Laura Vallejo-Torres
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Adriá Rosat-Rodrigo
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Juan Carlos-Romero
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jennifer García-Niebla
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio Llorente-Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Manuel Ángel Barrera-Gómez
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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González-Martínez S, Martín-Baranera M, Martí-Saurí I, Borrell-Grau N, Pueyo-Zurdo JM. Comparison of the risk prediction systems POSSUM and P-POSSUM with the Surgical Risk Scale: A prospective cohort study of 721 patients. Int J Surg 2016; 29:19-24. [PMID: 26970177 DOI: 10.1016/j.ijsu.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The outcomes of surgery are subject to variability and difficult to be accurately predicted. Different score systems have been developed to estimating the risk of undergoing a surgical procedure. The aim of this study was to assess the predictive ability of POSSUM and P-POSSUM scoring systems, compared to the Surgical Risk Scale (SRS), in Spanish patients undergoing general surgery. PATIENTS AND METHODS In this prospective observational study, 721 consecutive patients needing a surgical procedure were included. Observed morbidity and mortality after surgery were compared to the expected ones obtained by applying POSSUM, P-POSSUM and SRS. RESULTS Mean age was 59.2 years (standard deviation (SD): 17.4 years), 43.5% were women. 616 (85.5%) patients underwent elective general surgery and 105 (14.5%) emergency surgery. The 30-day morbidity was 15.4%. The reintervention rate was 2.1% and mortality was 2.1%. The discrimination ability was excellent in predicting mortality. The Area Under the Curve (AUC) values were: POSSUM: AUC = 0.97, C.I.95%: 0.948-0.992, p < 0.0001; P-POSSUM: AUC = 0.966, C.I.95%: 0.941-0.991, p < 0.0001; SRS: AUC = 0.91, C.I.95%:0.853-0.967, p < 0.0001. POSSUM was also discriminative in the prediction of morbidity (AUC = 0.772, C.I.95%: 0.719-0.826, p < 0.0001). POSSUM predicted morbidity and mortality were higher than the observed ones (p = 0.01 and p = 0.04). Predicted and observed mortality were very similar for P-POSSUM (p = 0.93) and SRS (p = 0.37). CONCLUSIONS Expected morbidity and mortality determined by POSSUM score showed values significantly above the observed ones. P-POSSUM and SRS systems were effective in predicting mortality. The SRS application is simple and may contribute to appropriate medical decision making.
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Affiliation(s)
- Sergio González-Martínez
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain.
| | - Montserrat Martín-Baranera
- Department of Clinical Epidemiology, Consorci Sanitari Integral, Av. Josep Molins 29-41, E-08906, L'hospitalet de Llobregat, Barcelona, Spain.
| | - Isidro Martí-Saurí
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain
| | - Nuria Borrell-Grau
- Clinical Nursing, Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
| | - José M Pueyo-Zurdo
- Department of Surgery Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
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Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg 2015; 43:79-83. [PMID: 26696088 DOI: 10.1007/s00068-015-0619-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Acute cholecystitis and pancreatitis are acute forms of cholecystolithiasis. The presence of acute cholecystitis can lead to important changes in therapy in the early course of acute pancreatitis. The aim of this study was to identify the accuracy of ultrasonography in diagnosing acute cholecystitis with coexistent acute pancreatitis. METHODS Subjects were all those patients admitted to our hospital with a diagnosis of acute pancreatitis between 1998 and 2015 who underwent cholecystectomy within 15 days of the ultrasonography performed on admittance. Patient data were analyzed retrospectively to compare the ultrasound findings with the pathological findings of the resected gallbladders. Patients were allocated to two groups according to the signs of acute cholecystitis on ultrasonography: group 1 negative and group 2 positive. RESULTS One hundred and twenty patients were enrolled in the study: 77 in group 1 and 43 in group 2. Similar results were found for the two groups with respect to the pathological diagnosis of acute cholecystitis, i.e., 31.2 % for group 1 and 27.9 % for group 2. Analysis indicated that there was no correlation between the ultrasonography data and pathological findings (p = 0.708). CONCLUSIONS On the basis of our study, ultrasound findings alone cannot be used to accurately diagnose acute cholecystitis in the setting of acute pancreatitis.
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