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1. Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

Author

Andres Zorrilla-Vaca, Alexander B. Stone, Javier Ripolles-Melchor, Ane Abad-Motos, Jose M. Ramirez-Rodriguez, Patricia Galan-Menendez, Gabriel E. Mena, Michael C. Grant, Cristina Garcia-Perez, Eva Higuera-Míguelez, José M. Marcos-Vidal, María Merino-García, Ana B. Rubio-López, María E. Pascual-Diez, Francisco J. García-Miguel, Luis R. Cabezudo-Sanjose, Ruth Martínez-Díaz, Sara Alegría-Rebollo, José L. González-Rodríguez, María S. Vega-Cruz, Gema Martínez-Ragüés, Manuel A. Gómez-Ríos, Eva Mosquera-Rodríguez, Sara Del-Río-Regueira, Domingo Bustos-García, María P. Sánchez-Conde, Antonio Rodríguez-Calvo, María A. Hernández-Valero, María Angoso-Clavijo, Luis M. González-Fernández, Miguel A. Bravo-Riaño, María V. Arnes-Muñoz, José R. Perez-Valdivieso, Marta Martin-Vizcaino, Susana Hernandez-Garcia, Francisco J. Yoldi-Murillo, Miguel Salvador-Bravo, Manuela Rubial-Alvarez, Fabiola Oteiza-Martinez, Enrique Balen-Rivera, José A. Garcia-Erce, Ana Zugasti-Murillo, María E. Petrina-Jáuregui, Filadelfo Bustos-Molina, Daniel Paz-Martín, Bárbara Vázquez-Vicente, Lourdes González-López, Conrado Mínguez-Marín, Susana Diz-Jueguen, Jaime Seoane-Antelo, Julio Ballinas-Miranda, Ester Carrera-Dacosta, Erica Barreiro-Domínguez, Alexandra Piñeiro-Teijeiro, Raquel Sanchez-Santos, Marina Varela-Duran, Pilar Diaz-Parada, Aránzazu Calero-Lillo, Manuel Ángel López-Lara, Salvador Muñoz-Collado, Juan Valverde-Sintas, Silvia Aznar-Puig, Daniel Troyano-Escribano, Sandra Marmaña-Mezquita, Jesús Fernanz-Antón, Lucia Catot-Alemany, Jaume Balust, Marta Ubré, Carlos Ferrando-Ortolá, Graciela Martínez-Pallí, Ainitze Ibarzabal, Antonio M. Lacy, Rubén Sánchez-Martín, Karina Martins-Cruz, Paula Pérez-Jiménez, Rubén Casans-Francés, Javier Longás, José M. Ramírez Rodríguez, Ana Mugarra-Llopis, Cristina Crisan, Estefanía Gracia-Ferrándiz, Esther Romero-Vargas, Marina Soro-Domingo, Rita Rodríguez-Jiménez, Blanca Prada-Martin, Henar Muñoz-Hernández, José I. Gómez Herrera, Sara Cocho-Crespo, Sandra Fernández-Caballero, Miguel Flores-Crespo, Andrea Vázquez-Fernández, Carlo Brugiotti, Estefanía Ollé-Sese, Carla R. Houghton-Acuña, Marta López-Doucil, Ernesto A. Tarazona-López, Iván BEL-Marcobal, Sonia González-Cogollor, Manuel Llácer-Pérez, Alberto Arias-Romano, María C. Arrabal-Taborda, Mercedes Caballero-Domínguez, Rafael García-López, Julio Ontoria-Muriel, Antonio Vivó-Blasco, Francisco J. Blanco, Enrique DEL-Cojo-Peces, Jose M. Tena-Guerrero, Aitor Landaluce-Olavarria, Izaskun Badiola, Marta Calvo, Unai DE-Andres, Vicente Portugal-Porras, Bakarne Ugarte-Sierra, Ana Pedregosa-Sanz, Laura Perelló-Cerdà, Yobanys Rodríguez-Téllez, Joanna Grössl-Meleán, Xavier Viñas-Truñén, Enrique Alday-Muñoz, Elena Bermejo-Marcos, Pedro A. Alonso-Casado, Francisco A. Gimeno-Calvo, Ana Rodriguez-Sánchez, Carmen Montes-López, Laura Álvarez-Llano, María J. FAS-Vicent, Juan M. Ortega-Monzó, Gustavo Flores-Flores, José L. Tristancho, Montserrat Bayo-Sans, María C. Deiros-Garcia, María L. GIL-Gómez, Lourdes Parra, Vanesa Tejedor-DE-LA-Fuente, Carlos Jericó-Alba, Núria Borrell-Brau, David Camacho-Martín, Jose L. Ortiz-DE-Zarate, Daniel López-Ruiz, Vicens Rodriguez-Bustamante, M. Martinez-Vilalta, Daniel Amoros-Ruiz, Marc Sadurni-Sarda, Fernando A.L.C.A.L.D.E. Matas, Hernán Giordano, Jose M. Perez Peña, Luis Olmedilla-Arnal, Pilar Benito-SAZ, Elena López-GIL, Adela Ruiz-Ortega, Sara Zapatero-García, Emilio DEL-Valle-García, Víctor Soria-Aledo, Carmen V. Pérez-Guarinos, Enrique Pellicer-Franco, Graciela Valero-Navarro, Mónica Mengual-Ballester, José Andrés García-Marín, Manuel Romero-Simó, Ibán Caravaca-García, Teresa Blasco-Segura, Carlos F. Campo-Betancourth, Rafael David Costa-Navarro, Laura Jordá-Sanz, María I. DE-Miguel-Cabrera, José M. España-Pamplona, Silvia GIL-Trujillo, Francisco J. Redondo-Calvo, Víctor Baladrón-Gónzalez, Remedios Moreno-Ballesteros, José L. Muñoz-Rodes, Elena Miranda, Marta Roselló-Chornet, Lourdes Alós-Zaragoza, Juan Catalá-Bauset, María A. Pallardo-López, Noemí Almenara-Almenara, Lorena Muñoz-Devesa, Benito Alcaide-Pardo, Pablo Gimeno-Fernández, José L. Gómez-Agraz, Carla Iglesias-Morales, Paola B. Ordoñez-Enireb, Ana M. Ríos-Villalba, Joselvy Rodríguez-Pinto, Sergio Sánchez-Cortés, María J. Montoya-Tabares, Vicente Ruiz, Francisco González-Sánchez, Víctor Soriano-Giménez, José M. Muñoz-Camarena, Jorge Benavides-Buleje, Juan C. Estupiñán-Jiménez, Irene Portero-Larragueta, David Alias, María J. Alberola-Estellés, Óscar Díaz-Cambronero, María S. Matoses-Jaén, María D. Ruiz-Boluda, Carlos Maristany-Bienert, José A. Pardo-López, Álvaro Ramiro-Ruiz, Pablo García, Arantza Martínez-DE-Guereñu, Belinda Montalbán, Claudia Olea, David Benguría, Javier Silva, Adriana Calderón, Jordi Escoll-Rufino, Carlos Cerdan-Santacruz, José E. Sierra-Grañón, María Rufas-Acín, Nuria Mestres-Petit, Ingrid C. Penagos-Saavedra, Cristina Moreno-Castilla, Jordi Riera-RIU, Ana Cuellar-Martínez, R.C. González-Álvarez, Míriam Sánchez-Merchante, Santiago García-DEL-Valle-Y-Manzano, Sara García-Zamorano, Natalia Gijón-Herreros, Patricia Robles-Ángel, Margarita Logroño-Ejea, Rodrigo Sanllorente-Sebastian, Maria C. Villalain-Perez, Mihaela Siclama-Stroe, Judith Benítez-Villar, Alberto Sánchez-Campos, Alberto Martínez-Ruiz, Patricia Alonso-Carnicero, Francisco J. DE-LA-Torre-González, Carolina Naranjo-Checa, Fernando Pereira-Pérez, Elena Ruiz-Ucar, Alfredo Rivera, Cristina GIL-Lapetra, Enrique Roca-Castillo, María L. Mariscal-Flores, Mario Morales-Cayuela, Irene Alonso-Ramos, Virginia Jiménez-Carneros, Lucas Casalduero-Garcia, Javier Jimenez-Miramón, L. José, Eva M. Nogués-Ramia, Yolanda Sosa-Quesada, Alonso Gómez, Laura M. Martínez-Meco-Ortiz, Mercedes Cabellos-Olivares, José R. Rodríguez-Fraile, María Labalde-Martínez, null Ramos-Rodríguez, Beatriz Nacarino-Alcorta, Raquel Fernández-García, Borja DE-LA-Quintana-Gordon, Justyna Drewniak, Fátima Senra-L, Pablo Galindo-Jara, Ana B. Gallardo-Herrera, Cesar García-Llorente, Laura Colao-García, Luz-Divina Rellan-Álvarez, Miguel Miro-Murillo, Sahely-CLARET Flores-Risco, Jordi Serrat-Puyol, Adrian Medina-Gallardo, Yuhami Mitsahid-Curbelo-Peña, null Orenzana, Alfredo Abad-Gurumeta, Norma Aracil-Escoda, Eugenio Martínez-Hurtado, Beatriz Nozal-Mateo, Elena Sáez-Ruiz, Rut Salvachua-Fernández, Javier Ripollés-Melchor, María L. DE-Fuenmayor-Valera, Elena Sánchez, Begoña Toribio, Antonio Navarro-Sánchez, José López-Fernández, Dácil Montesdeoca-Cabrera, Francisco J. Alcalá-Serrano, Azahara Sancho-DE-Avila, Sofia Diaz-Carrasco, Almudena Martín-Martín, Alejandro Suarez-DE-LA-Rica, Rafael UÑA-Orejón, Emilio Maseda, Guillermo Tejón-Pérez, María V. Alfaro-Martínez, Marta Alonso-Fernández, María A. Álvarez-Cebrián, María J. Álvarez-DEL-Vayo-Rodríguez, Mariana Carrillo-Rivas, María Fernández-Rodríguez, Sonia Trabanco-Morán, José L. Rábago-Morán, Javier Martínez-Ubieto, Ana M. Pascual-Bellosta, Sonia M. Ortega-Lucea, Maria P. Santero-Ramirez, Maria V. Duque-Mallen, Cristian Aragon-Benedi, Andrea Vallejo-Tarrat, Carmen Colillas-Calvet, Maria J. Laso, Javier Martinez-Cabañero, Javier Hernández-Salván, Beatriz Ledesma-Muñoz, Carolina Ochoa-Osorio, Máximo Sanz-García, Begoña Herrero-Garrote, Alma Blázquez-Martin, Manuel Díez-Alonso, Pilar Hernández-Juara, José M. Muguerza-Huguet, Macarena Barbero-Mielgo, Belén SAN-Antonio-SAN-Román, Laura Alonso-Aguilar, Viktoria Molnar, María C. Delgado-Naviero, Encarnación Meléndez-Leal, Virginia Cavero-García, África Fernández-Sánchez, Daniela A. Cubek-Quevedo, Rocío D.Í.E.Z. Munar, Francisco J. Blázquez-Fernández-DE-LA Pradilla, Ana B. Serrano, Alberto Balvís, Alberto Berruezo, Elena Esparza, Inés D.E.L.A. HOZ, Ana Palavicini, Lucia Pereira, Ximena Vega, Judith Villahoz, Gema Villanueva, José I. Alonso-Fernández, César Aldecoa, Clara Bolaño-Pérez, Teresa Villán-González, Astrid Batalla, G. Azparren, M. Basttita, M. Felipe, L. Cueva, Marta Gine, A.M. Gómez-Caro, I. India, S. Piñol, Neus Esteve-Pérez, Carlos Mora-Fernández, Ana Ferrer-Robles, Juan J. Segura-Sampedro, Natalia Alonso-Hernández, Angels Camps-Cervantes, Ivette Chocrón-DA-Prat, Carolina C. Coronado-Silva, Héctor Duque-Santos, Elena Esclapez-Sempere, Patricia Galan-Menéndez, Silvia Matarín-Olmo, M.P. Tormos-Pérez, Laura Villarino-Villa, Héctor Bergés-Gutiérrez, Miguel Aisa-Gasca, Verónica Arbona-Camillero, José D. Bautista-González, Francisco J. Carballido-Pascual, Mercedes Gutiérrez-Moreno, Ana Muñoz-Durán, Jesús Cañete-Gómez, Esther Cáceres-Fabrega, José M. Lorente-Herce, Octavio Mulet-Zayas, Rocío Gómez-Pérez, Cristina Monje-Salazar, Luis Lobato-Bancalero, Carmelo Torres-Moreno, Elena Sanchez-Cárdenas, Juan J. Daza-González, Teresa Sanchez-Viguera, Antonio DEL-Fresno-Asensio, Laura Bermudez-Román, José L. Jover-Pinillos, Francisco J. Orts-Micó, Coral Cózar-Lozano, Olga Blasco-Delgado, Andrea Nonnemacher-SAN-Julián, José A. Pérez, Laura D.U.R.Á.N. Cruces, and Pablo Renedo-Corcóstegui

Subjects
medicine.medical_specialty, Perioperative medicine, Quality management, business.industry, Colorectal surgery, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Patient satisfaction, Enhanced recovery, 030202 anesthesiology, Multidisciplinary approach, Spain, Anesthesiology, Anesthesia, Secondary analysis, Emergency medicine, Medicine, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, business, Colorectal Surgery
Abstract

Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P 0.01) were negatively associated with adherence.Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.

Published
2021

2. Standard Outcome Indicators After Colon Cancer Resection. Creation of a Nomogram for Autoevaluation

Author

José Viñas Martinez, Blas Flor-Lorente, Jordi Escoll Rufino, Manolo López Bañeres, Manuel Romero Simó, David Hervás, Matteo Frasson, José Luis Ramos Rodríguez, Marta Santamaría Olabarrieta, Jorge Sancho-Muriel, and Eduardo García-Granero

Subjects
medicine.medical_specialty, Percentile, business.industry, Colorectal cancer, Mortality rate, medicine.medical_treatment, General Engineering, 030230 surgery, Nomogram, Anastomosis, medicine.disease, Surgery, Nomograms, 03 medical and health sciences, 0302 clinical medicine, Colon surgery, 030220 oncology & carcinogenesis, Colonic Neoplasms, Outcome Assessment, Health Care, Colon cancer resection, Humans, Medicine, business, Colectomy
Abstract

Introduction Lately there has been an increasing interest in identifying quality standards in different pathologies, among them colon cancer due to its great prevalence. The main goal of this study is to define the quality standards of colon cancer surgery based on a large prospective national study dataset. Methods Data from the prospective national study ANACO were used. This study included a consecutive series of patients operated on for colon cancer in 52 Spanish hospitals (2011–2012). Centers with less than 30 patients were excluded. The present analysis finally included 42 centers (2975 patients). Based on the results obtained in 4 main indicators from each hospital (anastomotic leak, lymph-nodes found in the specimen, mortality and length of stay), a nomogram that allows the evaluation of the performance of each center was designed. Standard results for further 5 intraoperative and 5 postoperative quality indicators were also reported. Results Median of anastomotic leak and mortality rate was 8.5% (25th–75th percentiles 6.1%–12.4%) and 2.5% (25th–75th percentiles 0.6%–4.7%), respectively. Median number of nodes found in the surgical specimen was 15.1 (25th–75th percentiles 18–14 nodes). Median length of postoperative stay was 7.7 days (25th–75th percentiles 6.9–9.2 days). Based on these data, a nomogram for hospital audit was created. Conclusions Standard surgical results after colon cancer surgery were defined, creating a tool for auto-evaluation and allowing each center to identify areas for improvement in the surgical treatment of colon cancer.

Published
2017

3. Prospective, Randomized Comparative Study Between Single-port Laparoscopic Appendectomy and Conventional Laparoscopic Appendectomy

Author

Rafael Villalobos Mori, M. Carmen Mias Carballal, Jordi Escoll Rufino, Jorge Juan Olsina Kissler, Fernando Herrerías González, and Alfredo Escartín Arias

Subjects
Adult, Male, Laparoscopic surgery, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Young Adult, Port (medical), medicine, Appendectomy, Humans, Prospective Studies, Laparoscopy, Abscess, Aged, medicine.diagnostic_test, business.industry, General surgery, Significant difference, General Engineering, Middle Aged, Appendicitis, medicine.disease, Surgery, Acute appendicitis, Operative time, Female, business
Abstract

Introduction Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). Material and methods From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 and 65 years were selected, with onset of symptoms less than 48 h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology, and costs. Results The median age, BMI, sex, and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake, or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P =.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5 mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. Conclusion SILS appendectomy is safe, effective, and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique.

Published
2014

4. Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term

Author

Jordi Escoll-Rufino, Jacques Mégevand, Eloy Espin-Basany, Andrea Rusconi, Leonardo Lenisa, Roberto Lozoya-Trujillo, Luigi Mascheroni, and Francesc Vallribera-Valls

Subjects
Adult, Male, Anal fistula, medicine.medical_specialty, Adolescent, Fistula, Fistulotomy, Young Adult, Recurrence, Internal medicine, medicine, Humans, Rectal Fistula, Postoperative Period, Major complication, Young adult, Child, Digestive System Surgical Procedures, Aged, Aged, 80 and over, business.industry, Gastroenterology, Middle Aged, Hepatology, Surgical Instruments, medicine.disease, Surgery, Clinical trial, Treatment Outcome, Operative time, Female, Collagen, business, Fecal Incontinence
Abstract

This prospective, two-centre study was designed to evaluate long-term outcomes when using a collagen plug to treat cryptoglandular anal fistulae. Over 3 years, 60 consecutive patients with cryptoglandular fistulae were treated using an anal fistula plug by experienced surgeons. Preoperative, postoperative and follow-up data were collected in a dedicated database. Success was defined as the closure of all fistula openings and the absence of discharge. Faecal incontinence scores were administered at baseline and at 6 months follow-up. Eleven patients had multiple fistula tracts. All fistulae treated in this series were classified as complex. Seventeen fistulae were anterior tracts in females, and the remaining tracts were trans-sphincteric in nature. Thirty-eight tracts were recurrent. Mean operative time was 26 ± 10 min. No major complications, active sepsis or mortality were observed. Success rate with a mean follow-up of 13 months was 60% of patients and 70% of tracts. Mean time for recurrence was 5.7 months. Two recurrent patients were successfully treated with a redo plug procedure, and five were successfully closed with a post-plug fistulotomy, leading to a global 72% success rate without continence impairment. Of the patients with a minimum follow-up of 6 months (mean, 18.5 months; range, 6–34 months), 29 in 32 (90.6%) were healed at final evaluation. In these patients, the mean preoperative CCF incontinence score was 0.73. This was reduced to 0.14 at 6-month follow-up. The mean reduction of CCF incontinence score was −0.6 (95% CI, 1.3 to −0.1; p = 0.01). Fistula tract treatment with the anal fistula plug is a safe and viable surgical option that should be offered to complex fistula patients. The reasons and risk factors for recurrence remain to be explored.

Published
2010

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