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Aquest treball preten valorar la utilitat del model de risc d'evisceracio desenvolupat per Van Ramshorst et al. entre els pacients sotmesos a cirurgia abdominal per laparotomia mitja en el Servei de Cirurgia General i de l'Aparell Digestiu de l'Hospital de Sabadell – Corporacio Sanitaria i Universitaria Parc Tauli – Barcelona. El model de risc inclou dades postoperatories que fan perdre capacitat pronostica clinica, per aquest motiu es proposa una modificacio d'aquest model (Van Ramshorst modificat), tenint en compte nomes les variables preoperatories. Podem concloure que mentre el model de risc d'evisceracio de Van Ramshorst et al. es util en la nostra mostra de pacients, la modificacio proposada necessitaria retocs per a millorar la seva capacitat pronostica.

The aim of this study is to determine the usefulness of the risk model developed by van Ramshorst et al., and a modification of the same, to predict the abdominal wound dehiscence's risk in patients who underwent midline laparotomy incisions.Observational longitudinal retrospective study.Patients who underwent midline laparotomy incisions in the General and Digestive Surgery Department of the Sabadell's Hospital-Parc Taulí's Health and University Corporation-Barcelona, between January 1, 2010 and June 30, 2010. Dependent variable: Abdominal wound dehiscence.Global risk score, preoperative risk score (postoperative variables were excluded), global and preoperative probabilities of developing abdominal wound dehiscence.176 patients. Patients with abdominal wound dehiscence: 15 (8.5%). The global risk score of abdominal wound dehiscence group (mean: 4.97; IC 95%: 4.15-5.79) was better than the global risk score of No abdominal wound dehiscence group (mean: 3.41; IC 95%: 3.20-3.62). This difference is statistically significant (P.001). The preoperative risk score of abdominal wound dehiscence group (mean: 3.27; IC 95%: 2.69-3.84) was better than the preoperative risk score of No abdominal wound dehiscence group (mean: 2.77; IC 95%: 2.64-2.89), also a statistically significant difference (P.05). The global risk score (area under the ROC curve: 0.79) has better accuracy than the preoperative risk score (area under the ROC curve: 0.64).The risk model developed by van Ramshorst et al. to predict the abdominal wound dehiscence's risk in the preoperative phase has a limited usefulness. Additional refinements in the preoperative risk score are needed to improve its accuracy.

Resumen Introduccion La introduccion del libro informatico del residente, de la Asociacion Espanola de Cirujanos (LIR-AEC), nos ha permitido realizar evaluaciones particulares y generales de cada residente. El objetivo ha sido conocer la media de actividades asistenciales, cientificas y quirurgicas segun el programa de la especialidad. Material y metodo Registro de la actividad de los residentes en el LIR-AEC. Se ha cuantificado la actividad general por ano y por rotacion. Se ha analizado la relacion de intervenciones asistidas y realizadas y segun grados de complejidad. La media de actividades cientificas y asistenciales y la de guardias al mes. Resultados Desde 2004, 8 residentes han registrado su actividad en el LIR-AEC. Asisten a una media de 1.514 intervenciones, de las cuales realizan como cirujano 922 (62%). Asisten a 185 intervenciones laparoscopicas, de las que realizan 72 (39%). Como cirujanos, 864 (94%) de los 922 procedimientos son de los niveles 1, 2 y 3 (el 64, el 75 y el 53%, respectivamente). Realizan una media de 5,75 guardias por mes. Acuden de media durante la residencia a un total de 21 cursos y congresos. Participan en un total de 24 comunicaciones y posters, asi como en 6 publicaciones de media en la residencia. Conclusiones El LIR-AEC permite una evaluacion continua de la actividad del residente. Hemos podido conocer la media de actividades que realiza cada residente durante una rotacion y un ano determinados, esto permite conocer con exactitud si se cumplen los minimos definidos.

Introduction The introduction of the Spanish Association of Surgeons resident's electronic book (AEC-E-Book), has meant that we can perform particular and overall assessments of each resident. The objective of this article has been to find out the mean health care, scientific, and surgical activities according to the speciality program. Material and method A register of the activities of residents in the AEC-E-Book. The overall activity per year and per rotation has been measured. The relationships of assisted interventions performed and their level of complexity have been analysed. The mean scientific and health care activities and the mean on-call periods per month. Results A total of 8 residents have registered their activity in the AEC-E-Book since the year 2004. They assisted in a mean of 1514 operations, of which 922 were performed as surgeon (62%). They assisted in 185 laparoscopic interventions, of which they performed 72 (39%). As surgeon, 864 (94%) of the 922 procedures 64% were level 1, 75% level 2, and 53% were level 3. They were on-call a mean of 5.75 times per month. They attended a total of 21 courses and congresses during residency. They took part in 24 presentations and posters, as well as in 6 journal publications during residence. Conclusions The AEC-E-Book enables the activity of the resident to be continually assessed. We have been able to find out the mean activities carried out by each resident during a particular rotation and year, thus being able to know exactly if they have fulfilled the defined minimums