Cirugia Espanola最新文献

Introduction

It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC).

Objective

To analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report.

Methods

Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI).

Results

The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively.

The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7% in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35%-67.5% in operations of greater complexity.

The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively.

Conclusions

The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

Introduction

Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.

Methods

Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.

Results

The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621–3284) in 2018, and 3484 (IQR: 2306–4156) in 2022 (P = .000). These differences remained significant after adjusting for the number of available positions (P = .000).

The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Pediatrics also declined during this period, while plastic surgery, dermatology, ophthalmology, anesthesiology, and endocrinology improved their numbers.

Conclusion

The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018–2022. The increase in the number of available positions has not been associated with a proportional increase in demand.

Introduction

Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence.

Methods

Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria.

Results

Twenty-three patients were included in the study, with a median age of 53 years (6-68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3-36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III-IV) of 13%, with no postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64.6% and 34.5%, respectively. Histological grade was the most influential prognostic factor for survival.

Conclusions

The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.

Conformity in decision making has a relevant impact in surgical environments. This manuscript reveals how group opinions can distort the surgeon's individual judgment, even in critical situations. Two key phenomena are analyzed: communication cascades and group polarization, which amplify conformity and lead to extreme and sometimes harmful decisions.

It is important to highlight the importance of evidence-based education, critical thinking, and diversification of information sources to counteract the negative effects of conformity. Self-identifying conformist tendencies, encouraging open debate, and implementing constructive dissent strategies can help mitigate the effects of conformity on decision making. Reviewing authority models and promoting diversity in surgical settings can improve decision making and the quality of patient care.