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Resumen Introduccion El tromboembolismo venoso (TEV) representa una complicacion postoperatoria grave, pero evitable con una profilaxis adecuada. Las encuestas aportan informacion util acerca de las actitudes y preferencias respecto a la prevencion del TEV. Metodos Estudio transversal descriptivo, basado en una encuesta, remitida a los cirujanos generales miembros de la Asociacion Espanola de Cirujanos (AEC), y que incluye 31 preguntas acerca del TEV postoperatorio y su prevencion, asi como 3 casos clinicos. Resultados La encuesta fue contestada por 530 cirujanos, lo que representa el 21,8% de los 2.429 miembros invitados a participar por correo electronico. La mayoria de los cirujanos participantes trabajan en hospitales docentes grandes, siendo el 28,5% medicos residentes. Para el 28% el TEV representa un problema importante. Aunque el 81% considera que tiene un conocimiento adecuado sobre la prevencion del TEV postoperatorio, un porcentaje similar reconoce necesitar mas formacion. La mayoria (98,7%) utiliza las heparinas de bajo peso molecular, consideradas la modalidad mas eficaz y segura, seguida de los metodos mecanicos. El metodo de estratificacion de riesgo mas utilizado es el de Caprini (81%). La mayoria comienza la profilaxis farmacologica preoperatoriamente, pero existe bastante variacion en las dosis utilizadas, asi como en las pautas de inicio y duracion, sobre todo en cirugia no oncologica. Conclusiones Existe interes y, en general, un adecuado conocimiento acerca de la prevencion del TEV entre los cirujanos espanoles. Sin embargo, creemos necesaria mayor formacion sobre aspectos practicos de la profilaxis, adaptando las recomendaciones de las guias recientes a protocolos locales.

BACKGROUND: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single- and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population. METHODS: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%. CONCLUSIONS: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

Hypocalcaemia is the most frequent complication after total thyroidectomy. Finding a method for its early detection has become a priority. A single-center prospective cohort study was conducted to identify risk factors for postoperative hypocalcaemia, develop an early detection model, and test its validity in a different group of patients. The sample was composed of patients who underwent a total thyroidectomy between May 2012 and September 2015. Demographic, clinical, laboratory, and surgical data were collected. The incidence of hypocalcaemia and permanent hypoparathyroidism was calculated. Bivariate and multivariate analysis identified several independent predictors of hypocalcaemia, which were used to design a predictive model. The validity of the model was subsequently tested in a different cohort. Area under the ROC curve (AUROC) was calculated to determine its predictive power. The study and validation groups included 352 and 118 patients, respectively. Seventy-three patients developed laboratory-confirmed hypocalcaemia (20.7%), and symptomatic in 43 (12.2%). Multivariate analysis confirmed as independent predictors of hypocalcaemia the higher number of parathyroid glands identified [OR 1.41(0.98, 2.02); p = 0.063] and pre-to-postoperative gradient of parathormone decline [OR 1.06(1.04, 1.08); p < 0.001]. Based on these variables, the NuGra (Number of parathyroid glands identified-Gradient of decline) model was developed for predicting laboratory-confirmed hypocalcaemia. Its predictive power was high (AUROC 0.902, CI 0.857–0.947) for the study and the validation group (AUROC 0.956, CI 0.919–0.993). A higher number of parathyroid glands identified and a higher gradient of parathormone decline are risk factors for post-thyroidectomy hypocalcaemia. The NuGra model is useful for early prediction of individual risk for hypocalcaemia.

Introduction Venous thromboembolism (VTE) represents a serious postoperative complication that can be prevented by adequate thromboprophylaxis. Surveys provide relevant information about clinician’s attitudes and preferences regarding VTE prophylaxis. Methods Transversal, descriptive study based on a survey sent to general surgeons members of the Spanish Association of Surgeons (AEC), that included 31 questions regarding postoperative VTE and its prevention, as well as three clinical scenarios. Results 530 surgeons, 21.8% of the 2429 invited by electronic mail to participate, completed the survey. Most of the answering clinicians work on in big teaching hospitals, and 28.5% are residents. VTE represents a serious problem for 28% of participants. Although 81% consider that their knowledge on the prevention of postoperative VTE is adequate, a similar percentage recognizes the need for further education. The vast majority (98.7%) use low molecular weight heparins, which are considered the most effective and safe modality, followed by mechanical methods. The Caprini risk assessment score is used by 81% of surgeons, who usually start pharmacological prophylaxis preoperatively. However, there are remarkable differences in the dosing of heparins, timing of initiation, and duration, especially in non-oncologic surgical patients. Conclusions Most Spanish surgeons are interested in the prevention of postoperative VTE. Overall, the level of knowledge on thromboprophylaxis is adequate. However, our results indicate that there is a need for better education on relevant practical aspects of prophylaxis that could be achieved by incorporating recommendations from recent guidelines to local hospital-based protocols.

Introduction Venous thromboembolism (VTE) represents a serious complication after oncologic surgery. Recent studies have shown that the risk of VTE persists several weeks after surgery. This study assesses the form of presentation and time course of VTE after abdominal and pelvic cancer surgery. Methods Prospective, multicenter, observational study that analyzes data from an international registry (RIETE) that includes consecutive patients with symptomatic VTE. Our study assesses the form and time of presentation of postoperative VTE, as well as main outcomes, in patients operated for abdominopelvic cancer 8 weeks prior to VTE diagnosis. Variables related to the presentation of VTE after hospital discharge are identified. Results Out of the 766 analyzed patients with VTE, 395 (52%) presented pulmonary embolism (PE). Most VTE cases (84%) were detected after the first postoperative week, and 38% after one month. Among patients with VTE in the first postoperative week, 70% presented PE. VTE presented after hospital discharge in 54% of cases. Colorectal, urologic, and gynecologic tumors, the use of radiotherapy, and blood hemoglobin levels were independently associated with VTE diagnosis after hospital discharge. Complications (thrombosis recurrence, bleeding, and death) occurred in 34% of patients with VTE detected before hospital discharge, compared to 24% in VTE after hospital discharge (P Conclusions VTE occurs after hospital discharge in most patients, particularly in those operated for colorectal, urologic, and gynecologic cancer. Pulmonary embolism is more frequent in patients who develop early VTE, who also have worse prognosis.

Resumen Introduccion La enfermedad tromboembolica venosa (ETV) representa una grave complicacion tras la cirugia oncologica. Recientes estudios revelan que el riesgo de ETV postoperatoria se extiende durante varias semanas. Este estudio analiza la forma y momento de presentacion de la ETV tras cirugia oncologica abdominal. Metodos Estudio observacional, prospectivo y multicentrico, que analiza los datos de un registro internacional (RIETE) que incluye pacientes consecutivos con ETV sintomatica. Se evalua la forma y momento de presentacion de la ETV, asi como su pronostico, en pacientes operados por cancer abdominopelvico en las 8 semanas previas a la ETV. Se identifican las variables que se asocian con la presentacion de la ETV tras el alta. Resultados Entre los 766 pacientes analizados, 396 (52%) presentaron embolia pulmonar (EP). La mayoria (84%) de los casos de ETV se presentaron despues de la primera semana de la intervencion y un 38% pasado un mes. El 70% de los pacientes con ETV precoz presentaron EP. El 54% de los casos desarrollaron ETV tras el alta. Los tumores colorrectales y genitourinarios, el uso de radioterapia y los niveles de hemoglobina resultaron variables independientes de ETV tras el alta. El 34% de los pacientes con ETV antes del alta tuvieron complicaciones (recidiva, hemorragia y defuncion), frente al 24% con ETV tras el alta (p Conclusiones La ETV se presenta tras el alta en la mayoria de los pacientes, especialmente en aquellos con cancer colorrectal y genitourinario. La EP es mas frecuente en los pacientes con ETV precoz que, ademas, tienen peor pronostico.

Venous thromboembolism (VTE) represents a serious complication after oncologic surgery. Recent studies have shown that the risk of VTE persists several weeks after surgery. This study assesses the form of presentation and time course of VTE after abdominal and pelvic cancer surgery.Prospective, multicenter, observational study that analyzes data from an international registry (RIETE) that includes consecutive patients with symptomatic VTE. Our study assesses the form and time of presentation of postoperative VTE, as well as main outcomes, in patients operated for abdominopelvic cancer 8 weeks prior to VTE diagnosis. Variables related to the presentation of VTE after hospital discharge are identified.Out of the 766 analyzed patients with VTE, 395 (52%) presented pulmonary embolism (PE). Most VTE cases (84%) were detected after the first postoperative week, and 38% after one month. Among patients with VTE in the first postoperative week, 70% presented PE. VTE presented after hospital discharge in 54% of cases. Colorectal, urologic, and gynecologic tumors, the use of radiotherapy, and blood hemoglobin levels were independently associated with VTE diagnosis after hospital discharge. Complications (thrombosis recurrence, bleeding, and death) occurred in 34% of patients with VTE detected before hospital discharge, compared to 24% in VTE after hospital discharge (P0.01).VTE occurs after hospital discharge in most patients, particularly in those operated for colorectal, urologic, and gynecologic cancer. Pulmonary embolism is more frequent in patients who develop early VTE, who also have worse prognosis.

Aproximadamente en 1 de cada 4 pacientes que se someten a cirugia general y no reciben profilaxis antitrombotica se desarrolla enfermedad tromboembolica venosa (ETV), que incluye la trombosis venosa profunda (TVP) —localizada en los miembros inferiores en mas del 90% de los casos— y la embolia pulmonar (EP). Ademas de la EP fatal, que llega a afectar al 0,8% de los pacientes operados, hasta en un tercio de los pacientes que sufren una TVP sintomatica pueden desarrollarse complicaciones a largo plazo, como el sindrome postrombotico, o sufrir recidivas tromboembolicas. La mejor estrategia para reducir la elevada morbimortalidad asociada a la ETV postoperatoria es su prevencion, y para ello se utiliza alguno de los metodos profilacticos disponibles y de demostradas eficacia y seguridad. Los metodos mas investigados y mas habituales en nuestro medio son los farmacologicos, entre los que destacan la heparina y sus fracciones de bajo peso molecular, y los metodos mecanicos, como las medias elasticas y la compresion neumatica intermitente. Dependiendo del riesgo de potencial ETV de cada paciente, que esta en funcion de sus caracteristicas y de la intervencion que se va a realizar, se instauraran las medidas profilacticas adecuadas.

espanolObjetivo: el objetivo de este estudio es evaluar la resecabilidad y efectividad de las rehepatectomias en metastasis hepaticas de origen colorrectal recidivadas en terminos de morbimortalidad, supervivencia global y libre de enfermedad. Metodos: se realizo un estudio retrospectivo de una cohorte prospectiva de pacientes con metastasis hepaticas de origen colorrectal con cirugia de repeticion en el Hospital Universitario San Cecilio de Granada de marzo de 2003 hasta junio de 2013. Las variables principales de resultado fueron la supervivencia y la morbilidad antes de los 30 dias del postoperatorio. Resultados: un total de 147 pacientes con metastasis hepaticas de origen colorrectal se sometieron a la extirpacion quirurgica durante el periodo de estudio; 61 pacientes presentaron una recidiva hepatica de los cuales 34 se sometieron a una cirugia de repeticion. La tasa global de supervivencia a 5 y 10 anos para los pacientes resecados fue del 48 y el 48%. La estancia media hospitalaria fue de 8,9 ± 3,5 dias, la morbilidad del 9% y la mortalidad del 0%. Conclusion: las resecciones hepaticas repetidas para las metastasis hepaticas de origen colorrectal constituyen una operacion segura y eficaz, con resultados similares a los obtenidos tras una primera reseccion hepatica. EnglishObjective: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. Methods: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. Results: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n = 27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. Conclusion: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection.