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Fernandez-Fairen M.,Institute Cirugia Ortopedica Y Traumatologia Of Barcelona | Hernandez-Vaquero D.,Hospital de San Agustin | Murcia A.,Hospital de Cabuenes | Torres A.,Hospital Universitario Santa Lucia | Llopis R.,Hospital Universitario Santa Cristina
Clinical Orthopaedics and Related Research | Year: 2013

Background: Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup. Questions/purposes: We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant. Methods: We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied. Results: At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was -4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups. Conclusions: Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance. Level of Evidence: Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.


De Miguel-Diez J.,Hospital General Universitario Gregorio Maranon | Jimenez-Garcia R.,Rey Juan Carlos University | Jimenez D.,Ramon y Cajal Hospital | Monreal M.,Hospital Universitari Germans Trias i Pujol | And 6 more authors.
European Respiratory Journal | Year: 2014

The aim of our study was to analyse changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay, costs and in-hospital mortality of patients hospitalised for pulmonary embolism in Spain over a 10-year period. We included all patients who were hospitalised for pulmonary embolism (ICD-9-CM codes 415.11 and 415.19) as the primary diagnosis between 2002 and 2011. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population. 115 671 patients were admitted. The overall crude incidence increased from 20.44 per 100 000 inhabitants in 2002 to 32.69 in 2011 (p,<.05). In 2002, 13.3% of patients had a Charlson comorbidity index .> 2, and in 2011 the prevalence increased to 20.8% (p, <.05). Mean length of hospital stay was 12.7 days in 2002 and decreased to 9.99 in 2011 (p, <.05). During the study period, mean cost per patient increased from ε3915 to ε4372 (p, <.05). In-hospital mortality decreased from 12.9% in 2002 to 8.32% in 2011 (p, <.05). The increase in the use of computed tomographic pulmonary angiography over time was associated with increased incidence and lower mortality. Our results revealed an increase in the incidence of hospitalised pulmonary embolism patients from 2002 to 2011 with concomitant increase in comorbidities and cost. However, length of hospital stay and inhospital mortality decreased. Copyright © 2014 ERS.


Knorr J.,Toulouse University Hospital Center | Soldado F.,Autonomous University of Barcelona | Pham T.T.,Toulouse University Hospital Center | Torres A.,Hospital Universitario Santa Lucia | And 2 more authors.
Journal of Pediatric Orthopaedics | Year: 2014

BACKGROUND: Percutaneous techniques for the correction of foot deformities are gaining popularity in the adult population, but remain poorly explored in children. Of the several surgical techniques described to treat persistent severe metatarsus adductus (MA) deformity in children, neither was percutaneous. The purpose of the study was to describe a percutaneous technique for MA correction in children, to report the outcomes, and to discuss the advantages it offers. METHODS: We designed a prospective study on 34 consecutive feet with MA deformity from 26 children undergoing percutaneous correction. All operated feet had severe, rigid MA deformities, most of which were components of residual/recurrent clubfoot deformities. The mean age at surgery was 5.7 years and the mean follow-up was 55.2 months. For clinical evaluation, we used the bisector method; the first cuneometatarsal angle and metatarsal-metaphyseal angle measured in weight-bearing radiographs and AOFASf score were determined preoperatively and postoperatively. In unilateral cases, we used the contralateral foot measurements as control. The operating time and the hospitalization time were also recorded. The surgical technique consisted of performing the Cahuzac procedure for MA correction with a percutaneous approach. RESULTS: At the final follow-up all feet presented a normal heel bisector line. Radiologic parameters were normalized when compared with control feet. The mean surgical and hospitalization time was 14 minutes and 6 hours, respectively. Mean AOFAS score improved from 78 to 98. CONCLUSIONS: A minimally invasive percutaneous technique allowed a successful correction of MA deformity in children and resulted in a substantive decrease in both surgical and hospitalization time and better cosmetic results. LEVEL OF EVIDENCE: Level II. Copyright © 2013 by Lippincott Williams &Wilkins.


Ramos R.,Fresenius Medical Care | Molina M.,Hospital Universitario Santa Lucia
Nefrologia | Year: 2013

Chronic kidney disease (CKD) associated to an increase of cardiovascular morbidity and mortality in these patients is becoming a worldwide major public health problem that is rapidly approaching epidemic proportions. Early detection and prevention may have an impact in both, slowing the progression of CKD and reducing the cardiovascular morbi-mortality. CKD prevention programs can be more cost efficient over time without negative impact in quality of care. Until now, reimbursement in CKD has been segmented and usually focused on the end of the process (dialysis) when cost is higher, therefore new models focused on provider integration, while balancing quality and costs, are needed to respond to today's challenges. Traditionally "pay for services" has been used in dialysis concerted centers but this model has the risk of inducting to increase the demand. Integral management would respond to this challenge with integrated solutions that will manage renal disease at all levels of healthcare risk. It is based in a comprehensive model that typically includes several products and services and, usually, the renal drugs inclusion. The rate of reimbursement directly depends on the achievement of quality control parameters previously defined. The third model is based in a "capitation" that consists when the provider receive a set amount per population for a particular time regardless of the volume of services provided. The complexity and the progressive stage of CKD along with the associated morbidity in these patients force us to consider a global approach rather as a sum of different services. In our opinion, the first method of reimbursement in CKD that should be regarded is a bundle rate and when this model has been consolidated, tending toward a global capitation model. © 2013 Revista Nefrología. Órgano Oficial de la Sociedad Española de Nefrología.


Hernandez-Vaquero D.,Hospital Universitario San Agustin | Fernandez-Fairen M.,Institute Cirugia Ortopedica y Traumatologia | Torres-Perez A.,Hospital Universitario Santa Lucia | Santamaria A.,Institute Cirugia Ortopedica y Traumatologia
Revista Espanola de Cirugia Ortopedica y Traumatologia | Year: 2012

The concept that small incisions lead to a better outcome in many procedures has extended into most surgical areas, orthopaedic surgery among them. However, in some cases there is not enough scientific evidence to recommend these procedures. This article attempts to provide an updated review of the works published with sufficient scientific evidence on the advantages of minimally invasive surgery (MIS) compared to conventional access approaches. The published articles, meta-analyses and systematic literature reviews with level I or II evidence are reviewed in topographic order. Wherever possible, the information available on the costs-benefits of this type of surgery is also reviewed. © 2012 SECOT.

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