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Background We evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program. Methods We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated. Results Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048). Conclusions Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.

Introduction: obesity has become a worldwide health problem due to its relationship with cardiovascular morbimortality, thus bariatric surgery is considered as one of the main solutions for the correction of excess weight and, consequently, the improvement of its associated heart diseases. Objective: to compare vertical gastrectomy (VG) and biliopancreatic diversion (BPD) by observing echocardiographic characteristics both before and after surgery, as well as to evaluate surgical outcome in terms of the BAROS scale. Methods: results were collected from the echocardiographic testing requested for the preoperative study of patients who underwent surgery over the course of 24 months (from January 2014 to December 2015), as well as their anthropometric data. These were compared with postoperative parameters measured at 3 years after surgery. Results: finally, 26 patients were selected (13 VG and 13 BPD) with a mean age of 42 yrs. VG: initial BMI: 44.6 ± 7.1; final BMI: 31.8 ± 11.3 (p0.01); BPD: initial BMI: 48.1 ± 14.2; final BMI: 32.7 ± 10.4 (p0.01). Echocardiography: normal systolic function: 100% vs 92%; normal diastolic function: 88.5% vs 69.2%; no valvulopathy: 80% vs 69%; normal left atrium: 76.9% vs 73.1% (p0.05); HTA: 38.5% vs 19.2% (p0.05), preoperatively and postoperatively, respectively. Conclusions: no significant differences were found between the two groups studied with different techniques, although a slight deterioration in diastolic function was found in both groups. The comorbidities associated with obesity improved in both groups, and the surgery was scored as positive. The scant variation revealed by echocardiography prompts to reconsider its systematic preoperative use in these patients given the low cost-benefit ratio.Introducción: la obesidad se ha convertido en un problema de salud a nivel mundial por su relación con la morbimortalidad cardiovascular. La cirugía bariátrica se plantea como una de las soluciones para la corrección del exceso de peso y mejoría de las cardiopatías asociadas. Objetivo: comparar la gastrectomía vertical con la derivación biliopancreática de tipo Scopinaro para observar la repercusión de los cambios que se producen en la estructura cardiaca tras la cirugía. Además, evaluar el resultado quirúrgico en función de la escala BAROS. Material y métodos: se recogieron los resultados de la ecocardiografía incluida en el estudio preoperatorio de los pacientes candidatos a cirugía bariátrica de nuestro hospital, intervenidos en un periodo de 2 años, junto a los datos antropométricos y de comorbilidad. Estos se compararon con los resultados postoperatorios medidos a los 3 años de la cirugía. Resultados: finalmente se seleccionaron 26 pacientes (13 GV y 13 DBP), con una edad media de 42 años. GV: IMC inicial de 44,6 ± 7,1; IMC final de 31,8 ± 11,3 (p0,01). DBP: IMC inicial de 48,1 ± 14,2; IMC final de 32,7 ± 10,4 (p0,01). Ecocardiografía: función sistólica normal: 100% vs. 92%; función diastólica normal: 88,5% vs. 69,2%; sin valvulopatía: 80% vs. 69%; aurícula izquierda normal: 76,9% vs. 73,1% (p0,05); HTA: 38% vs. 19% (p0,05), en el preoperatorio y postoperatorio, respectivamente. Conclusiones: no se encontraron diferencias significativas entre los dos grupos estudiados con técnicas diferentes, si bien pudo encontrarse un ligero deterioro de la función diastólica en ambos grupos. Las comorbilidades asociadas a la obesidad mejoraron en ambos grupos y el grado de evaluación de la cirugía fue positivo. La escasa variación de la ecocardiografía hace replantearse su uso sistemático en el preoperatorio de estos pacientes por el bajo índice coste-beneficio.

Importance: enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective: to determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, setting, and participants: the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures: colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main outcomes and measures: the primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results: between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P¿=¿.01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P¿

Resumen Objetivo Estudiar el impacto en la mortalidad y morbilidad en pacientes criticos de las bacteriemias primarias (BP) y relacionadas con cateteres intravasculares (BRC) causadas por Staphylococcus coagulasa negativo (SCN). Diseno Doble analisis con datos del registro ENVIN-HELICS (1997 a 2008): 1) analizar las caracteristicas clinicas de pacientes con BP/BRC causadas por SCN, comparandolas con las de los pacientes con BP/BRC causadas por otros patogenos; y 2) analizar mediante un estudio casos-controles (1:4) el impacto de BP/BRC por SCN en pacientes sin otras infecciones nosocomiales frente a pacientes sin ninguna infeccion nosocomial. Ambito Ciento sesenta y siete UCI espanolas. Pacientes Pacientes ingresados en UCI mas de 24 horas. Intervencion Ninguna. Variables de interes Estancia en UCI y mortalidad. Resultados Dos mil doscientos cincuenta y dos pacientes presentaron BP/BRC de los que 1.133 casos fueron por SCN. La mortalidad de los pacientes con BP/BRC causadas por patogenos distintos de SCN fue superior (29,8% vs. 25,9%; p = 0,039), debido exclusivamente a la mortalidad de pacientes con candidemia (mortalidad: 45,9%). En pacientes sin otras infecciones nosocomiales, la BP/BRC por SCN (414 pacientes) es un factor independiente de riesgo de tener una estancia superior a la media (OR 5,81; IC 95%: 4,31-7,82; p Conclusion La mortalidad cruda de los pacientes que padecieron BP/BRC causada por SCN es similar a la de los pacientes con BP/BRC causada por otras bacterias, pero inferior a la de los pacientes con candidemia. Comparandolo con la estancia en UCI de pacientes sin infecciones nosocomiales, la BP/BRC por SCN es un factor apreciable de prolongacion de estancia.