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1. Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project)

Author

Karina Cárdenas-Jaén, Sergio A. Sánchez-Luna, Alicia Vaillo-Rocamora, Micaela Riat Castro-Zocchi, Laura Guberna-Blanco, Daniel Useros-Brañas, José M. Remes-Troche, Antonio Ramos-De la Medina, Bryan A. Priego-Parra, José A. Velarde-Ruiz Velasco, Pedro Martínez-Ayala, Álvaro Urzúa, Dannette Guiñez-Francois, Katarzyna M. Pawlak, Katarzyna Kozłowska-Petriczko, Irati Gorroño-Zamalloa, Clara Urteaga-Casares, Inmaculada Ortiz-Polo, Adolfo del Val Antoñana, Edgard E. Lozada-Hernández, Enrique Obregón-Moreno, Guillermo García-Rayado, María José Domper-Arnal, Diego Casas-Deza, Elena I. Esteban-Cabello, Luis A. Díaz, Arnoldo Riquelme, Helena Martínez-Lozano, Francisco Navarro-Romero, Ignasi Olivas, Guillem Iborra-Muñoz, Alicia Calero-Amaro, Ibán Caravaca-García, Francisco J. Lacueva-Gómez, Rubén Pastor-Mateu, Berta Lapeña-Muñoz, Violeta Sastre-Lozano, Nazaret M. Pizarro-Vega, Luigi Melcarne, Marc Pedrosa-Aragón, José J. Mira, Aurora Mula MStat, Irene Carrillo, and Enrique de-Madaria

Subjects
Hepatology, gastrointestinal symptoms, complicaciones gastrointestinales, gastrointestinal complications, Gastroenterology, COVID-19, hospitalización, hepatitis, síntomas gastrointestinales, hospitalization
Abstract

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p0.05 was considered significant.Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Published
2023
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2. Treatment of Peritoneal Surface Malignancies by Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Spain: Results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP)

Author

Group, Israel Manzanedo, Fernando Pereira, Pedro Cascales-Campos, Cristobal Muñoz-Casares, Enrique Asensio, Juan Torres-Melero, Arancha Prada-Villaverde, Ibán Caravaca-García, Alberto Gutiérrez-Calvo, Javier Vaqué, Gloria Ortega, Alberto Titos-García, Laura González-Sánchez, Estíbalitz Pérez-Viejo, Ángel Serrano, Beatriz Martínez-Torres, and REGECOP Group REGECOP

Subjects
peritoneal carcinomatosis, HIPEC, cytoreductive surgery, Peritoneal Surface Malignancies
Abstract

Introduction: Treatment of Peritoneal Surface Malignancies (PSM) with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved results never seen before in these patients, which classically have a poor prognosis. The possibility of conducting clinical trials in these diseases is complicated, since some of them are rare, so the analysis of large databases provides very valuable scientific information. The aim of this study is to analyze the global results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP), whose objective is to register all patients scheduled for HIPEC nationwide. Methods: This is a retrospective analysis of the data recorded in the REGECOP from 36 Spanish hospitals from 2001 to 2021. There were 4159 surgical interventions in 3980 patients. Results: 66% are women and 34% are men with a median age of 59 years (range 17–86). 41.5% of the patients were treated for Peritoneal Metastases (PM) of colorectal cancer (CRC); 32.4% were women with ovarian cancer (OC) with PM; 12.8% were treated for pseudomyxoma peritonei (PMP); 6.2% had PM from gastric cancer (GC); 4.9% had PM of non-conventional origin; and, finally, 2.1% of cases were patients diagnosed with peritoneal mesothelioma. The median Peritoneal Cancer Index (PCI) was 9 (0–39), and complete cytoreduction was achieved in 81.7% of the procedures. Severe morbidity (Dindo–Clavien grade III–IV) was observed in 17.7% of surgeries, with 2.1% mortality. Median hospital stay was 11 days (0–259). Median overall survival (OS) was 41 months for CRC patients, 55 months for women with OC, was not reached in PMP patients, was 14 months for GC patients, and 66 months in mesothelioma patients. Conclusions: large databases provide extremely useful data. CRS with HIPEC in referral centers is a safe treatment with encouraging oncologic results in PSM.

Published
2023
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5. 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

6. 787 TIVURON PROJECT: AN INTERNATIONAL MULTICENTER PROSPECTIVE COHORT STUDY EVALUATING THE GASTROINTESTINAL SYMPTOMS AND COMPLICATIONS OF COVID-19 IN HOSPITALIZED PATIENTS

Author

Sergio A. Sánchez-Luna, Violeta Sastre Lozano, Bryan Adrian Priego Parra, Nazaret M. Pizarro Vega, Pedro Martínez-Ayala, José A Velarde-Ruiz Velasco, Alvaro M. Urzua, Enrique Obregón Moreno, Dannette Guíñez Francois, Adolfo del Val Antoñana, Arnoldo Riquelme, Antonio Ramos-De la Medina, C Urteaga Casares, Helena Martinez, Laura Guberna Blanco, Daniel Useros Brañas, José María Remes-Troche, Ignasi Olivas, Guillem Iborra Muñoz, Guillermo García-Rayado, María José Domper Arnal, Diego Casas Deza, Katarzyna M. Pawlak, L Melcarne, Katarzyna Kozlowska-Petriczko, Francisco Navarro Romero, Enrique de-Madaria, Rubén Pastor Mateu, Karina Cárdenas-Jaén, Irati Gorroño Zamalloa, Micaela Riat Castro Zocchi, B Lapeña Muñoz, Inmaculada Ortiz Polo, Alicia Calero, Elena Isabel Esteban Cabello, Edgar E. Lozada Hernández, Alicia Vaillo-Rocamora, and Ibán Caravaca-García

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Hepatology, Coronavirus disease 2019 (COVID-19), Hospitalized patients, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Internal medicine, Gastroenterology, medicine, business, Prospective cohort study, AGA Abstracts
Published
2021
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