Cirugía española
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To assess the level of implementation and the factors associated with the compliance to the surgical check list (SCL) proposed by the WHO, in surgery departments in public hospitals in the Murcia Region of Spain. ⋯ The SCL is used, but is not always complied with, and not homogeneously in all its sections. There is also significant variation between the public hospitals in the Murcia Region of Spain.
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Comparative Study
[Development of the surgical approach to acute cholecystitis in an emergency surgical unit].
The application of the laparoscopic technique in acute cholecystitis is still subject to controversy. The aim of this study is to asses the applicability, safety, benefits and complications of the laparoscopic approach in patients with acute cholecystitis, as well as the development of this technique in the emergency surgery department of a tertiary hospital, compared to laparotomy. ⋯ The laparoscopic approach continues to play an increasing role in the treatment of this disease, becoming the main surgical option in our hospital.
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The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. ⋯ The lactic acid results in the first 24 hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable.
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With the progressive aging of the population surgical candidates have more comorbidities resulting in a higher risk to develop postoperative complications. One of the most frequent postoperative complications in the elderly is acute confusional state or delirium, which may have devastating consequences: higher mortality, and risk of medical complications during admission and, a higher risk of functional decline, institutionalization, and cognitive impairment at discharge. For all these reasons and with the aim of optimising surgical procedures, it is essential to identify patients at risk of delirium in order to take appropriate preventive action and provide early treatment. In the present article we review the current evidence on the management of postoperative delirium in the elderly.
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Tertiary peritonitis is the most delayed and severe outcome of patients with complicated intra-abdominal infections. The major difficulty lies in giving a common, precise and consensus definition in order to know when to make its diagnosis and how it can be avoided and/or treated. ⋯ Despite all this, the prognosis is extremely poor since it has a mortality which can reach up to 60%, with preventions being the most important measure to avoid it developing. In this article, we have made a specific review of tertiary peritonitis, of the accepted definitions, the risk factors, its pathophysiology, the microbiological flora involved, and its treatment.