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Background: There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department., Materials and Methods: All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded., Results: Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%)., Conclusion: A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital., (Copyright © 2024 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The BREAST-Q (breast reduction module) is a specific and validated questionnaire to evaluate breast reduction in the treatment of symptomatic macromastia, offering information on their quality of life and degree of satisfaction., Methods: Prospective study of a cohort of 34 patients treated by bilateral breast reduction in a breast unit in 2017-2020 surveyed with the Spanish version of BREAST-Q version 2. The statistical study to assess the effect of reduction, changes from the pre to postoperative scores of the domains were performed using the Wilcoxon signed rank test. Statistical significance was determined with p values ​​<0.05., Results: The mean time elapsed from surgery to the postoperative survey was 16 (SD 9) months. Post-surgical complications or sequelae occurred in 14 (42%) patients with 23 events. The preoperative scores, median and interquartile range, in satisfaction with the breasts (28, 26), psychological (33, 14), physical (42, 19) and sexual (34, 14) well-being improved in the postoperative survey to (82, 15), (81.29), (82, 30) and (90, 38), respectively. These changes were statistically significant, p < 0.001., Conclusions: The first application of the BREAST-Q in its version in Spanish for Spanish women in patients with symptomatic macromastia treated surgically in a breast unit shows that breast reduction improves the quality of life of patients and that they are very satisfied with the outcome of the surgery and its surgeon, although the information received should clearly be improved., (Copyright © 2022 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals., (Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.)

Objective: The complaints to a medical service are a measure of the quality of health care perceived by the patients. The aim of this study was to analyse the differences found in the percentage of complaints made to the General and Gastrointestinal Surgery Department (GGSD) with the changes made due to moving to a new hospital., Material and Methods: A longitudinal study of the percentage of complaints made to the GGSD in two 6 month periods in the same year (periods A and B). The Department was moved to a new hospital between the two periods. The percentage complaints associated with the hospital and outpatient activity is compared., Results: The percentage complaints made to the GGSD was 3.02% directed at the hospital service and 0.44% to outpatient care. When both periods were compared, a statistically significant difference was observed in the hospital complaints (A: 3.74% vs B: 2.20%, P=.006) and in the outpatient complaints (A: 0.53% vs. B: 0.34%, P=.005). It could also be shown that there was a continuous significant correlation in the parallel decrease in the hospital and outpatient complaints (R:0.988 P<.001)., Conclusions: The structural and functional change due to moving to a new hospital showed that the percentage of complaints made to the GGSD changed significantly in the period studied. Prospective multicentre studies are required to evaluate whether these results can be extrapolated to other services., (Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: Intrathyroidal parathyroid adenomas (IPA) are a not an uncommon cause of persistent hyperparathyroidism. There is no consensus on their prevalence, embryological origin and position within the thyroid., Patients and Method: Retrospective review of prospectively recorded surgical protocols of patients having had parathyroidectomy for primary (n = 437) or secondary (n = 137) hyperparathyroidism by the same surgeon. Cases with IPA were identified and the following data were recorded: age, most probable embryological origin, position within the thyroid (side and height), results of imaging techniques and surgical implications., Results: Seventeen IPA were detected in 16 patients (6M, 10F, prevalence 3.2%); 9 belonged to IIIP and 8 to IVP. Three lower IPA were supernumerary glands. Eight IPA were included within the right lower thyroid lobe. Twelve IPA (70.6%), were found during the initial parathyroidectomy: 3 were enucleated and 9 were treated with a partial thyroidectomy or hemithyroidectomy. Of the 3 enucleations, 2 had a local benign recurrence due to an incomplete capsule resection. No patients treated with thyroidectomy had a recurrence. The remaining 5 IPA, found in 4 patients, were not identified initially and caused persistence of the disease leading to 5 reinterventions., Conclusions: IPA are present in 3% of patients submitted to parathyroidectomy. They predominate in the right thyroid lobe and can be IIIP, IVP and supernumerary. They often cause persistence. Thyroid resection affords the best results since complete enucleation can be difficult and leaving behind a fragment of the IPA results in local recurrence.

Introduction: To perform sentinel lymph node biopsy (SLNB), nuclear medicine services that have previously undergone a validation phase are required. The aim of the present study was to analyze the possibility of performing this technique with a previously validated, external nuclear medicine service and to study its impact on the indication for radical axillary lymphadenectomy (RAL) and on length of postoperative hospital stay., Patients and Methods: We performed a prospective study in a cohort of patients with breast cancer starting from the introduction of SLNB in our center, which was made possible by collaboration with an external nuclear medicine service that performed lymphoscintigraphy and sentinel node detection. Intraoperative detection was performed through a portable probe. The feasibility of the project and its clinical impact were analyzed, taking a reduction in the number of lymphadenectomies and length of hospital stay as endpoints., Results: A total of 196 patients with 201 breast carcinomas were treated. The most frequent interventions were tumorectomy (TC) with SLNB in 124 patients (62%), and TC with SLNB and RAL in 62 patients (31%). Sentinel node visualization on lymphoscintigraphy was achieved in 187/201 carcinomas (93.1%) and sentinel nodes were detected during the intervention in 182/187 carcinomas (97.4%). Sentinel node detection in the internal mammary chain was achieved in 23/201 carcinomas (11.4%). RAL was avoided in 131 of the 201 carcinomas (65%). Days of postoperative hospital stay with or without RAL showed a mean difference of 1.8 days (3.1 vs. 1.3; P < .001)., Conclusion: SLNB is feasible with the collaboration of an external nuclear medicine service. This technique avoids 65% of RAL and reduces length of postoperative stay by 1.8 days.

Introduction: Secondary renal hyperparathyroidism (SHPT) affects nearly all patients on regular hemodialysis. Between 5% and 10% will need surgery to control the disease. Despite a meticulous technique, the rate of recurrent/persistent hyperparathyroidism after surgery remains between 2% and 12%., Patients and Method: We reviewed the reoperations of 7 patients with recurrent or persistent SHPT from a series of 56 patients, 3 of which were referred from other units for treatment of recurrence. Subtotal parathyroidectomy (ST-PTX) was performed in 51 patients and total parathyroidectomy with autograft (TPTX-AT) was performed in the remaining 5 patients., Results: Seven patients underwent reoperation for recurrent SHPT, 1 of them twice (8 reinterventions in 56 patients). In 2 patients only 3 parathyroid glands were removed at the first intervention and recurrence was due to the presence of a fourth gland. In 4 patients, ST-PTX was performed and recurrence was due to a remnant hyperplasic area in 1 and to a fifth gland in 3. Recurrence in the patient with a TPTX-AT was to due to cervical parathyromatosis. All the patients with recurrence had a positive preoperative Tc-MIBI scintigraphy and the computed tomography/magnetic resonance examination was highly useful for anatomical localization of the lesion and for planning the surgical approach.