aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities: a simplified auditing tool for community-acquired gastrointestinal surgical emergencies

Villodre, C.; Rebasa, Pere; Estrada, José L.; Zaragoza, Carmen; Zapater, Pedro; Mena, Luís; Lluı́s, Fèlix; Alcázar, C.; Campos, Luís; Franco, Mariano; Espinosa, Javier; Bravo, José Antonio; Carbonell, Sílvia; Apio, Ana Belén; Lillo, Miriam; Saeta, Rebeca; Rey, Mónica Kateryn Vargas; Rojas, Noel; Parra, Judit; Doménech, Estefanía; Gil, María José; Negre, David; Caravaca, Ibán

doi:10.1016/j.amjsurg.2016.01.041

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…These trials will recruit too few patients if the associations of mortality (and other outcomes) with birth cohort and age are mistaken as associations with fitness or anaemia, etc. Standard peri‐operative models, such as APACHE, POSSUM, NHFS, EuroSCORE and SORT, do not incorporate the steady reduction in population mortality, which is why they increasingly overestimate mortality with time, and predictably they are revised as sequential iterations, from ‘Mark B’ to ‘Mark Z’ . The ‘new’ model is out‐of‐date as soon as it is published.…”

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confidence: 99%

Risk prediction models for major surgery: composing a new tune

Carlisle

2019

Anaesthesia

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In this paper I explain why I think that most of the models that predict postoperative mortality should not be used when we're talking to patients about postoperative survival. Available models are isolated in time (from survival in the present) and space (from survival outside hospital). We know a lot about survival outside hospitals, with sufficient detail that we can discriminate between a man born in 1975 vs. 1976, or a woman aged 64 years vs. 65 years. We can use survival outside hospitals to inform what we do in hospital. I use my own survival to contrast with the survival of people older or younger than me. I will use my survival to illustrate how I might expect my mortality hazard to temporarily change when I have a scheduled operation (total hip replacement) and when I'm unwell and have an operation (for a fractured femoral neck). People live longer and longer and we operate on people older and older. We are also intervening earlier in progressive diseases, knowing that people are living long enough to experience harm from their progression. There is an evolving conflict between operating on older people and operating on younger people. Who has most to gain from the operation and who has most to gain from peri-operative critical care? Do we prioritise on reducing death now, in patients with relatively short life expectancies, or do we invest in the long-term survival of patients with relatively low rates of dying now? This conundrum is not informed by current risk models, with their focus on one to three postoperative months: we need to know survival outside hospital to gauge the value of what we do in hospital.'Indicate precisely what you mean to say' 1 It is time to face the music. Any peri-operative risk prediction model that reports odds ratios, risk ratios or their coefficients is unfit to inform pre-operative discussions with patients. Peri-operative models were developed to 'audit surgical practice': they cannot tell patients how the probabilities of outcomes change during the months and years that follow an operation, or the months and years after deciding not to have an operation. They are the wrong tools for the pre-operative assessment consultation.

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confidence: 99%

Risk prediction models for major surgery: composing a new tune

Carlisle

2019

Anaesthesia

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“…The present study is a post hoc secondary analysis of the data collected in the LUCENTUM -- aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities -- project, an observational, prospective, multicenter, nationwide study endorsed by the Spanish Association of Surgeons (AEC), designed to find avenues for quality improvement in emergency general surgery 26 – 28 . The study followed the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 29 .…”

Section: Methodsmentioning

confidence: 99%

Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes

Lluís¹,

Carbonell²,

Villodre³

et al. 2023

International Journal of Surgery

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Background and aims: Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. Methods: Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. Results: The study included 2 645 patients with acute appendicitis [32 years (22–51), 44.3% women], 1 182 with acute cholecystitis [65 years (48–76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50–76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2–4); lap, 2 days (1–4); P<0.001], acute cholecystitis [open, 7 days (4–12); lap, 4 days (3–6); P<0.001], and gastrointestinal tract perforation [open, 11 days (7–17); lap, 6 days (5–8.5); P<0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P<0.001), acute cholecystitis (open, 41%; lap, 21.7%; P<0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P<0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P=0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P=0.013). Conclusions: This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.

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“…The data were obtained from a database in Access 2003 Ò format (Microsoft Corporation, Redmont, Washington, USA), hosted on the hospital's internal network, from which anonymized data tables were generated for statistical analysis. This network prospectively has recorded the variables of the POSSUM scale for all emergency and scheduled surgical interventions performed at the General Surgery service since 2009 14,15 .…”

Section: Methodsmentioning

confidence: 99%

Rates of textbook outcome achieved in patients undergoing liver and pancreatic surgery

Villodre

Alcázar-López

Melgar

et al. 2023

Preprint

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Textbook outcome (TO) is a composite measure that reflects the most desirable surgical results as a single indicator. The aim of this study was to assess the achievement of TO at a hepatopancreatobiliary (HPB) surgery unit in a Spanish tertiary hospital. Methods: Retrospective observational study of all consecutive patients who underwent HPB surgery over a 4-year period. Morbidity (defined according to the Clavien-Dindo classification) and mortality at 30 days, hospital stay, risk of morbidity and mortality according to the POSSUM scale and readmissions at 90 days were recorded. TO was considered when a patient presented no major complications (³IIIA), no mortality, no readmission, and not prolonged length of stay (LOS: £ 75th percentile of the sample). Results: A total of 283 patients were included (median age: 65 years, 65.4% men). Morbidity >IIIA was reported in 21.6%, and 5.7% died; median postoperative stay was 4 days. TO was achieved in 56.2% of patients. Comparing patients that presented TO with those that did not, significant differences were recorded for the type of procedure and the expected risk of morbidity and mortality calculated according to the POSSUM scale. There were significant differences between patients with major resections (TO rates of 46.3% in major hepatectomy and 52.5% in major pancreatectomy) and those with minor resections (rates of 67.7% in minor hepatectomy and 40.7% in minor pancreatectomy). Conclusion: The rate of TO in our series (56.2%) was like those published internationally. TO is a very useful management tool for assessing postoperative results.

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aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities: a simplified auditing tool for community-acquired gastrointestinal surgical emergencies

Cited by 8 publications

References 13 publications

Risk prediction models for major surgery: composing a new tune

Risk prediction models for major surgery: composing a new tune

Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes

Rates of textbook outcome achieved in patients undergoing liver and pancreatic surgery

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