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Bueno-Lledó J, Rubio-Pérez I, Moreno-Gijón M, Olona-Casas C, Barbosa E, Manuel Molina J, Castellanos G. Corrigendum to: Prophylactic use of incisional negative pressure wound therapy for the prevention of surgical site occurrences in general surgery: Consensus document. Surgery 2023; 173:1522. [PMID: 36973128 DOI: 10.1016/j.surg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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2
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Chavarrías Torija N, Asensio Gómez L, Saavedra Ambrosy J, Rubio-Pérez I. Right-sided colonic diverticulitis: management of an unusual entity. Cir Esp 2022; 100:656-657. [PMID: 35753581 DOI: 10.1016/j.cireng.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Nuria Chavarrías Torija
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain.
| | - Luis Asensio Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
| | - Jorge Saavedra Ambrosy
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
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Chavarrías Torija N, Asensio Gómez L, Saavedra Ambrosy J, Rubio-Pérez I. Diverticulitis aguda de colon derecho: manejo de una entidad poco común. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Moreta-Martínez R, Rubio-Pérez I, García-Sevilla M, García-Elcano L, Pascau J. Evaluation of optical tracking and augmented reality for needle navigation in sacral nerve stimulation. Comput Methods Programs Biomed 2022; 224:106991. [PMID: 35810510 DOI: 10.1016/j.cmpb.2022.106991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Sacral nerve stimulation (SNS) is a minimally invasive procedure where an electrode lead is implanted through the sacral foramina to stimulate the nerve modulating colonic and urinary functions. One of the most crucial steps in SNS procedures is the placement of the tined lead close to the sacral nerve. However, needle insertion is very challenging for surgeons. Several x-ray projections are required to interpret the needle position correctly. In many cases, multiple punctures are needed, causing an increase in surgical time and patient's discomfort and pain. In this work we propose and evaluate two different navigation systems to guide electrode placement in SNS surgeries designed to reduce surgical time, minimize patient discomfort and improve surgical outcomes. METHODS We developed, for the first alternative, an open-source navigation software to guide electrode placement by real-time needle tracking with an optical tracking system (OTS). In the second method, we present a smartphone-based AR application that displays virtual guidance elements directly on the affected area, using a 3D printed reference marker placed on the patient. This guidance facilitates needle insertion with a predefined trajectory. Both techniques were evaluated to determine which one obtained better results than the current surgical procedure. To compare the proposals with the clinical method, we developed an x-ray software tool that calculates a digitally reconstructed radiograph, simulating the fluoroscopy acquisitions during the procedure. Twelve physicians (inexperienced and experienced users) performed needle insertions through several specific targets to evaluate the alternative SNS guidance methods on a realistic patient-based phantom. RESULTS With each navigation solution, we observed that users took less average time to complete each insertion (36.83 s and 44.43 s for the OTS and AR methods, respectively) and needed fewer average punctures to reach the target (1.23 and 1.96 for the OTS and AR methods respectively) than following the standard clinical method (189.28 s and 3.65 punctures). CONCLUSIONS To conclude, we have shown two navigation alternatives that could improve surgical outcome by significantly reducing needle insertions, surgical time and patient's pain in SNS procedures. We believe that these solutions are feasible to train surgeons and even replace current SNS clinical procedures.
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Affiliation(s)
- Rafael Moreta-Martínez
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Mónica García-Sevilla
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain
| | - Laura García-Elcano
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain; Centro de Investigación Médica Aplicada, Clínica Universidad de Navarra, Madrid 28027, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain.
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5
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations. Cir Esp 2022; 100:392-403. [PMID: 35283055 DOI: 10.1016/j.cireng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
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Affiliation(s)
- Josep M Badia
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain.
| | - Mireia Amillo Zaragüeta
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario la Paz, Madrid, Spain
| | - Eloy Espin-Basany
- Servicio de Cirugía General, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | - José M Balibrea
- Servicio de Cirugía General, Hospital Clínic de Barcelona, Barcelona, Spain
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Badia JM, Amillo Zaragüeta M, Rubio-Pérez I, Espin-Basany E, González Sánchez C, Balibrea JM. ¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. [National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic]. Cir Esp 2021; 99:346-353. [PMID: 38620242 PMCID: PMC7368890 DOI: 10.1016/j.ciresp.2020.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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Affiliation(s)
- Benedetto Ielpo
- Unidad de Cirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, España
| | - Mikel Prieto
- Unidad Hepatobiliar, Transplante Hepático y Retroperitoneo, Hospital Universitario Cruces, Bilbao, España
| | - Irene Ortega
- Sección de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Universidad Europea de Madrid, Madrid, España
| | - José María Balibrea
- Servicio de Cirugía Gastrointestinal (ICMDiM), Hospital Clínic de Barcelona, Universitat de Barcelona. Sección de Infección Quirúrgica, AEC, Barcelona, España
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
| | - Montse Juvany
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España
| | | | - José Manuel Ramia
- Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España
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8
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic. Cirugía Española (English Edition) 2021. [PMID: 32892980 PMCID: PMC8088215 DOI: 10.1016/j.cireng.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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9
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Vicario Bravo M, Chavarrías Torija N, Rubio-Pérez I. Digestive symptoms and COVID-19: Importance of ruling out associated surgical pathology. Cirugía Española (English Edition) 2021. [PMID: 32553858 PMCID: PMC8062418 DOI: 10.1016/j.cireng.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
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10
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Vicario Bravo M, Chavarrías Torija N, Rubio-Pérez I. [Digestive symptoms and COVID-19: Importance of ruling out associated surgical pathology]. Cir Esp 2021; 99:385-387. [PMID: 38620272 PMCID: PMC7264039 DOI: 10.1016/j.ciresp.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
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11
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Peña EÁ, Garcia-Botella A, Martín-Pérez E, Gallego MÁ, Cortijo SM, Migueláñez IP, Díaz LP, Ramos Rodríquez JL, Espín-Basany E, Santos RS, Garriga XG, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cirugía Española (English Edition) 2021. [PMCID: PMC7901494 DOI: 10.1016/j.cireng.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals’ safety.
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12
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Álvarez Peña E, Garcia-Botella A, Martín-Pérez E, Álvarez Gallego M, Martínez Cortijo S, Pascual Migueláñez I, Pérez Díaz L, Ramos Rodríquez JL, Espín-Basany E, Sánchez Santos R, Guirao Garriga X, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cir Esp 2021; 99:174-182. [PMID: 33341242 PMCID: PMC7744030 DOI: 10.1016/j.ciresp.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/30/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.
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Affiliation(s)
| | - Miguel Angel Gómez Bravo
- Cirugía general y del aparato digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Marcello Di Martino
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Mikel Gastaca
- Cirugía general y del aparato digestivo, Hospital Universitario Cruces, Bilbao, España
| | - Elena Martín-Pérez
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Santiago Sánchez Cabús
- Cirugía general y del aparato digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Santiago López Ben
- Cirugía general y del aparato digestivo, Hospital Dr. Josep Trueta, Girona, España
| | | | - Rafael López-Andújar
- Cirugía general y del aparato digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Manuel Barrera
- Cirugía general y del aparato digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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13
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Badia JM, Rubio-Pérez I, López-Menéndez J, Diez C, Al-Raies Bolaños B, Ocaña-Guaita J, Meijome XM, Chamorro-Pons M, Calderón-Nájera R, Ortega-Pérez G, Paredes-Esteban R, Sánchez-Viguera C, Vilallonga R, Picardo AL, Bravo-Brañas E, Espin E, Balibrea JM. The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study. Int J Surg 2020; 82:231-239. [PMID: 32877754 DOI: 10.1016/j.ijsu.2020.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies. METHODS A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures. RESULTS Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions. CONCLUSION Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.
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Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Avinguda Francesc Ribas 1, 08402, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - José López-Menéndez
- Department of Cardiac Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Cecilia Diez
- Surgical Area, Hospital Universitari Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Bader Al-Raies Bolaños
- Department of Vascular Surgery, Hospital de Manises, Av. de La Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain.
| | - Julia Ocaña-Guaita
- Department of Vascular Surgery, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain.
| | - Xose M Meijome
- Gerencia de Asistencia Sanitaria Del Bierzo, León, Gerencia de Asistencia Sanitaria Del Bierzo, Nursing and Healthcare Research Unit, C/ El Medio, 1, 24400, Ponferrada, León, Spain.
| | - Manuel Chamorro-Pons
- Department of Oral and Maxillofacial Surgery, Hospital Ruber Juan Bravo, Calle de Juan Bravo, 49, 28006, Madrid, Spain.
| | - Ramón Calderón-Nájera
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Ruber Internacional, Calle de La Masó, 38 28034, Madrid, Spain.
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033, Madrid, Spain.
| | - Rosa Paredes-Esteban
- Unidad de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Av. Menendez Pidal, S/n, 14004, Córdoba, Spain.
| | - Cristina Sánchez-Viguera
- Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 84, 29010, Málaga, Spain.
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Surgery Unit, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - Antonio L Picardo
- Endocrine-Metabolic and Bariatric Surgery Unit, HM Montepríncipe, Avenida de Montepríncipe Nº 25, 28660, Boadilla Del Monte, Madrid, Spain.
| | - Elena Bravo-Brañas
- Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall D'Hebrón, Passeig de La Vall D'Hebron, 119, 08035, Barcelona, Spain.
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
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Abstract
In view of the current pandemic by SARS-CoV-2 it deems essential to understand the key concepts about the infection: its epidemiological origin, presentation, clinical course, diagnosis and treatment (still experimental in many cases). The knowledge about the virus is still limited, but as the pandemic progresses and the physiopathology of the disease is understood, new evidence is being massively published. Surgical specialists are facing an unprecedented situation: they must collaborate in the ER or medical wards attending these patients, while still needing to make decisions about surgical patients with probable COVID-19. The present narrative review aims to summarize the most relevant aspects and synthetize concepts on COVID-19 for surgeons.
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Affiliation(s)
- Inés Rubio-Pérez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario La Paz, Madrid, España.
| | - Josep M Badia
- Servicio de Cirugía General y Aparato Digestivo, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España
| | - Marta Mora-Rillo
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas y Microbiología Clínica, Unidad de Aislamiento de Alto Nivel, Hospital Universitario La Paz, IdiPAZ, Madrid, España
| | - Alejandro Martín Quirós
- Servicio de Urgencias y Unidad de Aislamiento de Alto Nivel, Hospital Universitario La Paz, Madrid, España
| | | | - Jose M Balibrea
- Servicio de Cirugía General y Aparato Digestivo, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
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15
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Álvarez Gallego M, Gortázar de Las Casas S, Pascual Migueláñez I, Rubio-Pérez I, Barragán Serrano C, Álvarez Peña E, Díaz Domínguez J. SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital. Cir Esp 2020; 98:320-327. [PMID: 32336467 PMCID: PMC7138380 DOI: 10.1016/j.ciresp.2020.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The rapid spread of SARS-CoV-2 infection has led to a radical reorganization of healthcare resources. Surgical Departments need to adapt to this change. METHODS We performed a prospective descriptive observational study of the incidence of COVID-19 in patients and surgeons of a General Surgical Department in a high prevalence area, between the 1st and 31st of March 2020. RESULTS Patients: The incidence of SARS-CoV-2 infection in elective surgery patients was 7% (mean age 59.5 years). All survived. Of 36 patients who underwent emergency surgery, two of them were SARS-CoV-2 positive and one was clinically highly suspicious of COVID-19 (11.1%). All three patients died of respiratory failure (mean age 81 years). Surgeons: There were a total of 12 confirmed SARS-CoV-2+ cases among the surgical department staff (24.4%) (8 out of 34 consultants and 4 out of 15 residents). Healthcare activity: The average number of daily emergency surgical interventions declined from 3.6 in February to 1.16 in March. 42% of the patients who underwent emergency surgery had peritonitis upon presentation. CONCLUSIONS The fast pace of COVID-19 pandemia should alert surgical departments of the need of adopting early measures to ensure the safety of patients and staff.
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Affiliation(s)
- Mario Álvarez Gallego
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | | | | | - Inés Rubio-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | | | - Estíbaliz Álvarez Peña
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Joaquín Díaz Domínguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
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Álvarez Gallego M, Gortázar de las Casas S, Pascual Migueláñez I, Rubio-Pérez I, Barragán Serrano C, Álvarez Peña E, Díaz Domínguez J. SARS-CoV-2 pandemic on the activity and professionals of a General Surgery and Digestive Surgery Service in a tertiary hospital. Cirugía Española (English Edition) 2020. [PMCID: PMC7253976 DOI: 10.1016/j.cireng.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rubio-Pérez I, Badía JM, Mora-Rillo M, Martín Quirós A, García Rodríguez J, Balibrea JM. COVID-19: Key Concepts for the Surgeon. Cirugía Española (English Edition) 2020. [PMCID: PMC7253947 DOI: 10.1016/j.cireng.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In view of the current pandemic by SARS-CoV-2 it deems essential to understand the key concepts about the infection: its epidemiological origin, presentation, clinical course, diagnosis and treatment (still experimental in many cases). The knowledge about the virus is still limited, but as the pandemic progresses and the physiopathology of the disease is understood, new evidence is being massively published. Surgical specialists are facing an unprecedented situation: they must collaborate in the ER or medical wards attending these patients, while still needing to make decisions about surgical patients with probable COVID-19. The present narrative review aims to summarize the most relevant aspects and synthetize concepts on COVID-19 for surgeons.
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Badia JM, Casey AL, Rubio-Pérez I, Arroyo-García N, Espin E, Biondo S, Balibrea JM. Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery. Surg Infect (Larchmt) 2019; 21:218-226. [PMID: 31724910 PMCID: PMC7099413 DOI: 10.1089/sur.2019.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.
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Affiliation(s)
- Josep M Badia
- Department of Surgery, Hospital General de Granollers, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna L Casey
- Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Inés Rubio-Pérez
- Department of Surgery, Hospital Universitario la Paz, Madrid, Spain
| | | | - Eloy Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Sebastiano Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - José M Balibrea
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
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Gortazar de Las Casas S, Rubio-Pérez I, Saavedra Ambrosy J, Sancho de Avila A, Álvarez-Gallego M, Marijuan Martín JL, Pascual Miguelañez I. Sacral nerve stimulation for constipation: long-term outcomes. Tech Coloproctol 2019; 23:559-564. [PMID: 31147802 DOI: 10.1007/s10151-019-02011-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There has been some controversy regarding the efficacy of sacral nerve stimulation (SNS) for the treatment of chronic constipation, due to less positive outcomes and concerns about cost-effectiveness in the long term. The aim of the present study was to evaluate the long-term outcomes of SNS in patients with chronic constipation. METHODS A retrospective study was conducted on patients who had SNS for chronic constipation in 2008-2017 at our institution. Clinical factors, profile of constipation, physiology studies, and patient satisfaction with SNS therapy were investigated during a follow-up period up to 10 years after the implantation. RESULTS Twenty-nine patients [86% female, median age 49 years (range 17-86)] were tested for SNS, and 24 received implants after a positive test phase [median 47 days (range 21-56 days)]. There were 27 bilateral and 2 unilateral implants, in S3 or S4 depending on best response. Mean follow-up was 59 months. Efficacy was considered as a score > 5 (on a scale of 1-10) in general symptom improvement. Nine (37.9%) implanted patients had a satisfaction score > 5. In 6 cases (25%), patient satisfaction was higher than 9. Due to the small sample size, there were no statistically significant variables considered as predictors of response. CONCLUSIONS Our results agree with current studies which describe around a 30% response of SNS for refractory constipation. However, there is a small group of patients highly satisfied with SNS therapy. More studies are needed to better understand this profile and optimize outcomes.
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Affiliation(s)
| | - I Rubio-Pérez
- Department of Surgery, La Paz University Hospital, Madrid, Spain
| | | | - A Sancho de Avila
- Department of Anaesthesiology and Intensive Care, La Paz University Hospital, Madrid, Spain
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Badia JM, Rubio-Pérez I, Arias Díaz J, Guirao Garriga X, Serrablo A, Jover Navalón JM. Surgical protocol for confirmed or suspected cases of Ebola and other highly transmissible diseases. Cir Esp 2015; 94:11-5. [PMID: 26190811 DOI: 10.1016/j.ciresp.2015.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/26/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment.
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Affiliation(s)
- Josep M Badia
- Sección de Infección Quirúrgica, Asociación Española de Cirujanos.
| | - Inés Rubio-Pérez
- Sección de Infección Quirúrgica, Asociación Española de Cirujanos
| | | | | | | | - José M Jover Navalón
- Asociación Española de Cirujanos, por los miembros de la Sección de Infección Quirúrgica y Consejo de Redacción, Asociación Española de Cirujanos
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