1
|
de la Plaza Llamas R, Parés D, Soria Aledó V, Cabezali Sánchez R, Ruiz Marín M, Senent Boza A, Romero Simó M, Alonso Hernández N, Vallverdú-Cartié H, Mayol Martínez J. Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey. Cir Esp 2024; 102:364-372. [PMID: 38615908 DOI: 10.1016/j.cireng.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.
Collapse
Affiliation(s)
- Roberto de la Plaza Llamas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - David Parés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Víctor Soria Aledó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario JM Morales Meseguer, Murcia, Spain
| | | | - Miguel Ruiz Marín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Ana Senent Boza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Romero Simó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - Natalia Alonso Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | |
Collapse
|
2
|
Book T, Engelke C, Brüggerhoff R, Winny M, Kraus M, Benecke C, Zimmermann M, Trostdorf U, Wedemeyer H, Marquardt JU, Voigtländer T, Wedemeyer J, Kirstein MM. Endoscopic vacuum-assisted closure therapy for leakage of the lower gastrointestinal tract: multicenter experiences. Endosc Int Open 2023; 11:E212-E217. [PMID: 36845275 PMCID: PMC9949981 DOI: 10.1055/a-1990-0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/29/2022] [Indexed: 02/25/2023] Open
Abstract
Background and study aims Only a few studies are available regarding endoscopic vacuum-assisted closure (E-VAC) therapy for the post-surgery leakage of the lower gastrointestinal tract. Patients and methods In this multicenter German study, we retrospectively analyzed patients treated with E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract from 2000-2020 at Hannover Medical School, University Medical Center Schleswig-Holstein, Campus Luebeck, and Robert Koch Hospital Gehrden. Results Overall, 147 patients were included in this study. Most patients had undergone tumor resections of the lower gastrointestinal tract (n = 88; 59.9 %). Median time to diagnosis of leakage was 10 days (interquartile range [IQR] 6-19). Median duration of E-VAC therapy was 14 days (IQR 8-27). Increase of C-reactive protein (CRP) levels significantly correlated with first diagnosis of leakage ( P < 0.001). E-VAC therapy led to closure or complete epithelialization of leakage in the majority of patients (n = 122; 83.0 %) and stoma reversal was achieved in 60.0 %. Stoma reversal was significantly more often achieved in patients with CRP levels ≤ 100 mg/L at first diagnosis compared to patients with CRP levels > 100 mg/L (78.4 % vs. 52.7 %; P = 0.012). Odds ratio for failure of stoma reversal was 3.36 in cases with CRP values > 100 mg/L ( P = 0.017). In total, leakage- and/ or E-VAC therapy-associated complications occurred in 26 patients (17.7 %). Minor complications included recurrent E-VAC dislocations and subsequent stenosis. Overall, 14 leakage- or E-VAC-associated deaths were observed most often due to sepsis. Conclusions E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract is safe and effective. High levels of CRP are a negative predictor of E-VAC therapy success.
Collapse
Affiliation(s)
- Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Carsten Engelke
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Raphael Brüggerhoff
- Department of Internal Medicine, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Markus Winny
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Kraus
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claudia Benecke
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Markus Zimmermann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Ulf Trostdorf
- Clinic for General, Visceral, and Vascular Surgery, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jens U. Marquardt
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jochen Wedemeyer
- Department of Internal Medicine, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Martha M. Kirstein
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| |
Collapse
|