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Cost of postoperative complications:How to avoid calculation errors

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World Journal of Gastroenterology 2020年第21期26卷 2682-2690页

作者： roberto de la plaza Llamas JoséM Ramia department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it *** studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and *** payment system in place often rewards the volume of services provided rather than the quality of patients’clinical *** a thorough registration of PC,the economic costs involved cannot be *** accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic *** article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various *** availability of accurate and impartially audited data on PC will help reduce their incidence and bring down ***,the health authorities,and society as a whole are sure to benefit.

关键词： Morbidity Postoperative complications Costs and cost analysis Economic evaluation Healthcare costs Opportunity cost Clavien-Dindo classification Comprehensive complication index

Complete clinical response of liver metastasis after chemotherapy:To resect or not?

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World Journal of Gastrointestinal Oncology 2011年第7期3卷 107-110页

作者： Jose M Ramia-Angel roberto de la plaza Jose E Quiones HPB Surgical Unit department of Surgery Universitary Hospital of Guadalajara

This paper aims to update the therapeutical strategies in liver metastasis with complete clinical response(CCR) after chemotherapy and to determine if surgery is always necessary after *** aim of chemotherapy is to achieve a good clinical response rather than CCR of liver *** CCR of liver metastasis after chemotherapy cannot be considered synonymous with a *** resection of the hepatic segment where there was hepatic metastases with CCR after chemotherapy theoretically prevents recurrence,improves survival and makes it possible to conf irm whether there has been a complete pathological ***,the medical literature about this topic is scarce and sometimes contradictory.

关键词： Metastasis Liver Clinical response Chemotherapy Surgery

laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

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World Journal of Gastroenterology 2018年第18期24卷 1978-1988页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua Carmen Ramiro-Pérez Aylhin López-Marcano roberto de la plaza-Llamas José Manuel Ramia department of General and Digestive Surgery University Hospital of Guadalajara

The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

关键词： Duodenal obstruction Gastrojejunostomy Gastroenterosmy Gastric outlet obstruction Gastric bypass laparoscopy laparoscopic surgery Sytematic review

Liver metastasis of endometrial stromal sarcoma

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World Journal of Hepatology 2012年第12期4卷 415-418页

作者： Jose M Ramia roberto de la plaza Ines Garcia Cristian Perna Pilar Veguillas Jorge García-Parreo department of Surgery Hepatopancreatobiliary Surgical UnitHospital Universitario de GuadalajaraGuadalajara28020 MadridSpain department of Oncology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain department of Pathology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain

Resection of liver metastases from gynaecological tumours is *** stromal sarcomas(ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall,and which are exceptionally associated with liver *** present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver *** is very little literature on clinical management about liver metastasis from ESS,but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours,we should recommend resection as this is considered a resectable extrauterine *** cases with more sites of extrauterine disease,liver resection should also be performed if the other sites are resectable.

关键词： Sarcoma Stromal Endometrial Liver Metastasis Review

Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess:Is it worth it?

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World Journal of Hepatology 2017年第2期9卷 114-118页

作者： Aylhin J Lopez-Marcano Jose M Ramia Vladimir Arteaga roberto de la plaza Jhonny D Gonzales Anibal Medina Hepato-Pancreato-Biliary Surgical Unit Department of SurgeryHospital Universitario de Guadalajara19002 GuadalajaraSpain

AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.

关键词： Hydatidosis Review Surgery Abscess Liver

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

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World Journal of Gastroenterology 2017年第16期23卷 2972-2977页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua Carmen Ramiro-Pérez Aylhin López-Marcano Farah Al-Shwely roberto de la plaza-Llamas JoséManuel Ramia department of General and Digestive Surgery University Hospital of Guadalajara19002 GuadalajaraSpain

AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

关键词： Cholecystectomy 90-d Hospital readmission Readmission rate Cholelithiasis

Ambispective comparative study of two surgical strategies for liver hydatidosis

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World Journal of Gastroenterology 2012年第6期18卷 546-550页

作者： Jose M Ramia Francisco Ruiz-Gomez roberto de la plaza Pilar Veguillas Jose Quiones Jorge García-Parreo department of Surgery Hepato-Bilio-Pancreatic Surgery UnitGuadalajara University HospitalGuadalajara 19002Spain

AIM:To investigate the morbidity,mortality,recurrence and technical aspects of two distinct surgical strategies that were implemented in successive ***:Ninty-two patients with 113 cysts underwent surgical *** study was divided into 2 *** from first period(P1) were compiled *** surgical strategy was conservative *** second period(P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically ***:Patients of both periods showed no statistically significant differences in age,gender,cyst location or *** the P2 group,patients exhibited more preoperative jaundice,and cyst size was smaller(P decreases morbidity and in-hospital stay(P death of two old patients(4.8%) who had undergone conser-vative *** rate of radical surgery in P2 was around 75%.CONCLUSION:Radical surgery should be the technique of choice whenever it is feasible,because it diminishes morbidity and in-hospital *** surgery must be employed only in selected cases.

关键词： Hydatid disease Surgery Morbidity Liver

Hepatic gastrointestinal stromal tumor: Systematic review of an exceptional location

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World Journal of Meta-Analysis 2019年第5期7卷 224-233页

作者： Alba Manuel-Vázquez Raquel latorre-Fragua roberto de la plaza-Llamas José Manuel Ramia General and Digestive Surgery University Hospital of Guadalajara

BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional *** To characterize epidemiological,clinical and pathological features and options of *** We performed a systematic review to search for articles on primary hepatic *** This review shows that right hepatic lobe was the most frequent *** pathological and immunohistochemical features,mitotic count was≥5/50 High Power Fields in more than 50%;and CD117 was negative in only 1 *** than 70%of patients had a lesion with high risk of *** The diagnosis of E-GIST must be considered in a liver *** an accurate diagnosis is a challenge,as well as the confirmation of their primary or metastatic nature.

关键词： Gastrointestinal stromal tumors Extra-gastrointestinal stromal tumor Primary hepatic tumor CD117 Primary hepatic gastrointestinal stromal tumor Primary gastrointestinal stromal tumor of the liver

Quality-adjusted life years and surgical waiting list:Systematic review of the literature

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1155-1164页

作者： roberto de la plaza Llamas Lorena Ortega Azor Marina Hernández Yuste Ludovica Gorini Raquel Aránzazu latorre-Fragua Daniel Alejandro Díaz Candelas Farah Al Shwely Abduljabar Ignacio Antonio Gemio del Rey department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain department of Surgery Medical and Social SciencesFaculty of Medicine and Health SciencesUniversity of AlcaláAlcaláde Henares 28871MadridSpain

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and *** waiting lists(SWLs)represent a pressing problem in public *** QALY measure has rarely been used in the context of *** would be interesting to know how many QALYs are lost by patients on *** To investigate the relationship between QALYs and SWLs in a systematic review of the scientific *** The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** unlimited search was carried out in PubMed,updated on January 19,*** on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions *** Forty-eight articles were selected for the *** data were found regarding QALYs lost on *** specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles *** country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 ***(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions ***-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were *** survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.T

关键词： Quality-adjusted life year Waitlist Quality of life Surgery Systematic review