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Sanchez-Santos R.,Complejo Hospitalario Universitario Of Pontevedra | Corcelles Codina R.,Hospital Clinic de Barcelona | Vilallonga Puy R.,Hospital Universitario Valld Hebron | Delgado Rivilla S.,Hospital Clinic de Barcelona | And 26 more authors.
Obesity Surgery | Year: 2016

Background: Complications in sleeve gastrectomy (SG) can cast a shadow over the technique’s good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety. Methods: A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death. Results: The following data were collected for 2882 patients: age, 43.85 ± 11.6. 32.9 % male; BMI 47.22 ± 8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre ≥40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon’s experience < 20 patients, OR 1.72 (1.32–2.25); experience > 100 patients, OR 0.78 (0.69–0.87); DM2, OR1.48(1.12–1.95); probe > 40 F, OR 0.613 (0.429–0.876). Leak RFs were the following: smoking, OR1.93 (1.1–3.41); surgeon’s experience < 20 patients, OR 2.4 (1.46–4.16); experience of 20–50 patients, OR 2.5 (1.3–4.86); experience >100 patients, OR 0.265 (0.11–0.63); distance to pylorus > 4 cm, OR 0.510 (0.29–0.91). RFs for death were as follows: smoking, OR 8.64 (2.63–28.34); DM2, OR 3.25 (1.1–9.99); distance to pylorus < 5 cm, OR 6.62 (1.63–27.02). Conclusions: The safety of SG may be compromised by nonmodifiable factors such as age >65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size <40 F, distance to the pylorus <4 cm, and the surgeon’s experience (<50–100 cases). © 2016 Springer Science+Business Media New York Source


Amarillo E.,Hospital Universitario Of Fuenlabrada | Hernandez-Garcia E.,Hospital Universitario Of Fuenlabrada | Herrera M.,Hospital Universitario Of Fuenlabrada | Garcia Berrocal J.R.,Hospital Universitario Puerta Of Hierro Majadahonda | And 3 more authors.
Acta Otorrinolaringologica Espanola | Year: 2016

Introduction: The objective of our study was to identify the diagnostic and therapeutic approaches in the different ENT Departments of Spain with respect to sudden deafness. We wanted to establish a basis to help to create a new nation-wide consensus, unifying treatment, diagnostic and follow-up criteria for this disease. Methods: We carried out an anonymous Internet survey, addressing Spanish ENT doctors nation-wide (n = 2,029), gathering in 33 questions different aspects about diagnostic criteria, additional tests, treatment procedures and prognostic factors in sudden deafness, according to the different protocols and experience of the participants in the survey. Results: A total of 293 Spanish ENT doctors (14%) took part anonymously. In relation to diagnostic criteria, is the most noteworthy was the requisite of a confirmed neurosensorial loss (91.1%) followed by "initiated in less than three days" (75%) and 3 consecutive frequencies affected (76.4%). More than half of the participants requested an MRI of the IAC/CPA (68.7%) and 88.2% used gadolinium in this test. The prognostic factor most frequently considered was delay in commencement of treatment onset (84.8%).As far as treatment of primary cases, most of the responders agreed on the use of corticosteroids (99.7%). Oral administration was the most widely used (66%), followed by intravenous (29.6%) and intratympanic (1.4%) administration. Ninety-two percent had not had any major complications with systemic steroids. Intratympanic treatments were used by 70% of responders for rescue in failure. Conclusions: In Spain there is currently a significant disparity of concepts regarding the diagnosis of sudden deafness, and more agreement as to using steroids as their treatment. This highlights the need to implement measures to promote a better approach, which would be homogeneous and consensual, to this condition. © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. Source

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