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  1. Article ; Online: External Prospective Validation of the Modified CriSTAL Score for 30- and 90-day Mortality in Geriatric Urgent Surgical Patients.

    Eguaras Córdoba, Inés / Sánchez Acedo, Pablo / Herrera Cabezon, Javier / Galbete, Arkaitz / Cardona, Magnolia

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2020  Volume 25, Issue 8, Page(s) 2083–2090

    Abstract: Objective: This study aimed to determine the predictive accuracy of the modified clinical prognostic tool Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) to predict 30-day and 90-day mortality in older patients undergoing ... ...

    Abstract Objective: This study aimed to determine the predictive accuracy of the modified clinical prognostic tool Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) to predict 30-day and 90-day mortality in older patients undergoing urgent abdominal surgery.
    Background: Anticipating the mid-term mortality of older patients undergoing urgent surgery is complex and flawed with uncertainty.
    Methods: A prospective study of consecutive ≥ 65 years old presenting at the emergency department who subsequently underwent urgent abdominal surgery. The modified CriSTAL score was calculated in the sample using the FRAIL scale instead of the Clinical Frailty Scale. Discrimination (area under the receiver-operating characteristic (AUROC)) and model calibration were used to test the predictive accuracy of the modified CriSTAL score for death within 30-day mortality as the primary outcome.
    Results: A total of 500 patients (median age 78 years) were enrolled. The observed 30-day and 90-day mortality rate were 11.6% and 13.6%. The modified CriSTAL tool AUROC curve to predict 30-day and 90-day mortality was 0.78 and 0.77. The model was well calibrated according to the Hosmer-Lemeshow test (p: 0.302) and the calibration plots to predict 30-day and 90-day mortality.
    Conclusions: The modified CriSTAL tool (with FRAIL scale as frailty instrument) had good discriminant power and was well calibrated to predict 30-day and 90-day mortality in elderly patients undergoing urgent abdominal surgery. The modified CriSTAL tool is an easy preoperative tool that could assist in the prognosis of postoperative outcomes and decision-making discussions with patients before for urgent abdominal surgery.
    MeSH term(s) Aged ; Emergency Service, Hospital ; Frail Elderly ; Frailty/diagnosis ; Geriatric Assessment ; Humans ; Prospective Studies ; Risk Assessment ; Risk Factors ; Triage
    Language English
    Publishing date 2020-10-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-020-04822-0
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  2. Article: Sclerosing angiomatoid nodular transformation (SANT) of the spleen: review of the literature.

    Maya Senosiain, Irene / Sánchez Acedo, Pablo / Mercado Gutiérrez, María Rosario / Ruiz Marzo, Rocío / Ariceta López, Aitor / Tarifa Castilla, Antonio / Zazpe Ripa, Cruz / Herrera Cabezón, Javier

    Revista espanola de enfermedades digestivas

    2023  Volume 115, Issue 12, Page(s) 720–721

    Abstract: We present a sclerosing angiomatoid nodular transformation (SANT) case report in a 60 year-old-woman. SANT is an extremely rare benign disease of the spleen that it is radiologically similar to malignant tumors, and clinically difficult to differentiate ... ...

    Abstract We present a sclerosing angiomatoid nodular transformation (SANT) case report in a 60 year-old-woman. SANT is an extremely rare benign disease of the spleen that it is radiologically similar to malignant tumors, and clinically difficult to differentiate from other splenic diseases. Splenectomy is both diagnostic and therapeutic in symptomatic cases. The analysis of the resected spleen is necessary to achieve the final diagnosis of SANT.
    MeSH term(s) Female ; Humans ; Middle Aged ; Histiocytoma, Benign Fibrous/diagnostic imaging ; Histiocytoma, Benign Fibrous/surgery ; Splenectomy ; Splenic Diseases/diagnostic imaging ; Splenic Diseases/surgery
    Language English
    Publishing date 2023-03-14
    Publishing country Spain
    Document type Review ; Case Reports ; Journal Article
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2023.9520/2023
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  3. Article: Intraductal papillary mucinous neoplasm of the main duct in a patient with pancreas divisum.

    Sánchez Acedo, Pablo / Viteri Ramírez, Guillermo / Herrera Cabezón, Javier / Tarifa Castilla, Antonio

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2019  Volume 111, Issue 4, Page(s) 322

    Abstract: Pancreas divisum is a congenital anomaly present in 5-10% of the population and is usually asymptomatic. Pancreatic intraductal papillary mucinous neoplasms (IPMN) are mucinous cystic tumors that have malignant potential and are classified according to ... ...

    Abstract Pancreas divisum is a congenital anomaly present in 5-10% of the population and is usually asymptomatic. Pancreatic intraductal papillary mucinous neoplasms (IPMN) are mucinous cystic tumors that have malignant potential and are classified according to their location as IPMN of the main duct, branch duct or mixed type. Larger lesions and those originating in the main duct have an increased risk of malignancy. The real incidence is unknown as most lesions are asymptomatic.
    MeSH term(s) Adenocarcinoma, Mucinous/diagnostic imaging ; Aged ; Carcinoma, Pancreatic Ductal/diagnostic imaging ; Common Bile Duct/abnormalities ; Humans ; Incidental Findings ; Magnetic Resonance Imaging ; Male ; Pancreas/abnormalities ; Pancreas/diagnostic imaging ; Pancreatic Neoplasms/diagnostic imaging
    Language English
    Publishing date 2019-02-11
    Publishing country Spain
    Document type Case Reports
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2019.5959/2018
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  4. Article: Survival, morbidity and mortality of pancreatic adenocarcinoma after pancreaticoduodenectomy with a total mesopancreas excision.

    Sánchez Acedo, Pablo / Herrera Cabezón, Javier / Zazpe Ripa, Cruz / Tarifa Castilla, Antonio

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2019  Volume 111, Issue 8, Page(s) 609–614

    Abstract: Introduction: pancreatic adenocarcinoma is the most common malignancy in the periampullary region, with a five-year survival rate around 20%.: Objective: the goal of our study was to determine the survival and safety data of a number of patients that ...

    Abstract Introduction: pancreatic adenocarcinoma is the most common malignancy in the periampullary region, with a five-year survival rate around 20%.
    Objective: the goal of our study was to determine the survival and safety data of a number of patients that underwent a cephalic duodenopancreatectomy (CDP) with total mesopancreas excision (TMPE).
    Material and methods: a prospective observational study was performed of 114 patients with pancreatic adenocarcinoma who underwent duodenopancreatectomy and TMPE over the period 2008-2017. Demographic variables, tumor stage, number of lymph nodes excised, lymph node ratio, R classification, the prognostic factor disease-free interval and survival were all assessed in a multivariate analysis.
    Results: complications were reported for 54 (47.3%) patients, of which 22 (19.3%) were categorized as serious. The mortality rate was 4.3% and the mean follow-up was 26.2 months. During this period, 73 (64%) patients relapsed after a mean interval of 40.9 months. The relapse pattern was mainly hepatic (26.3%), followed by local relapse (20%). Mean survival was 40.38 and actuarial survival was 26.6% at five years. Relapse-related factors included stage T3 or higher (RR 8.1 [1.1-61]) and an R1 resection (RR 13.4 [2.7-66.5]) and survival-related factors included an R1 resection (RR 10.7 [2.5-46.2]).
    Conclusion: TMPE ensures an adequate lymphadenectomy and lymph node ratio according to reported standards. The survival of patients that have undergone surgery for pancreatic adenocarcinoma in our institution is 68.4% at one year and 26.6% at five years. An R1 resection is the primary factor for both relapse and survival.
    MeSH term(s) Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Humans ; Lymph Node Excision/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Pancreas/surgery ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Pancreaticoduodenectomy/mortality ; Prospective Studies
    Language English
    Publishing date 2019-07-17
    Publishing country Spain
    Document type Journal Article ; Observational Study
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2019.6139/2018
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  5. Article ; Online: Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery.

    Sánchez Acedo, Pablo / Eguaras Córdoba, Inés / Zazpe Ripa, Cruz / Herrera Cabezón, Javier / Tarifa Castilla, Antonio

    Cirugia espanola

    2020  Volume 98, Issue 8, Page(s) 450–455

    Abstract: Introduction: Delirium is a frequent complication in elderly patients after urgent abdominal surgery.: Methods: Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables ...

    Title translation Estudio prospectivo de los factores asociados al delirium en el postoperatorio de la cirugía abdominal urgente.
    Abstract Introduction: Delirium is a frequent complication in elderly patients after urgent abdominal surgery.
    Methods: Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium.
    Results: The study includes 446 patients with a median age of 78years, 63.6% were ASA ≥III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P<.001; OR: 1,08; 95%CI: 1,038-1,139), ASA (P=.026; OR: 3.15; 95%CI: 1.149-8.668), physiological state (P<.001; OR: 5.8; 95%CI: 2.176-15.457), diagnosis (P=.006) and cognitive impairment (P<.001; OR: 5.8; 95%CI: 2.391-14.069).
    Conclusion: The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.
    MeSH term(s) Abdomen/surgery ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cognitive Dysfunction/complications ; Cognitive Dysfunction/epidemiology ; Delirium/diagnosis ; Delirium/etiology ; Early Diagnosis ; Emergency Treatment/adverse effects ; Female ; Frailty/complications ; Frailty/epidemiology ; Functional Status ; Humans ; Male ; Nutritional Status/physiology ; Postoperative Complications/psychology ; Prospective Studies ; Quality of Life/psychology ; Risk Factors
    Language Spanish
    Publishing date 2020-04-03
    Publishing country Spain
    Document type Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.ciresp.2020.01.011
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  6. Article ; Online: Prospective validation of the Urgent Surgery Elderly Mortality risk score (USEM).

    Eguaras Córdoba, Inés / Sánchez Acedo, Pablo / Herrera Cabezon, Javier / Galbete Jiménez, Arkaitz / Guillen-Grima, Francisco

    American journal of surgery

    2020  Volume 220, Issue 4, Page(s) 1071–1075

    Abstract: Introduction: We aimed to test the predictive ability and to compare the predictive ability of the USEM to SRS, SORT and ASA in a prospective sample.: Patients and methods: A Prospective cohort of >65-year-old patients undergoing urgent abdominal ... ...

    Abstract Introduction: We aimed to test the predictive ability and to compare the predictive ability of the USEM to SRS, SORT and ASA in a prospective sample.
    Patients and methods: A Prospective cohort of >65-year-old patients undergoing urgent abdominal surgery in a Hospital. Models calibration and discrimination were evaluated using the receiver operating characteristics curves and the Hosmer-Lemeshow test.
    Results: A total of 500 patients with a median age of 78 years were included. The AUROC in the validation cohort was 0.824. The USEM overestimated mortality (Test Hosmer-Lemeshow p < 0.001), after recalibration the USEM provided an accurate prediction of postoperative mortality.
    Conclusions: After the recalibration, the USEM had good discriminant power to estimate the risk of mortality in elderly patients after urgent abdominal surgery.
    MeSH term(s) Aged ; Aged, 80 and over ; Emergencies/epidemiology ; Female ; Follow-Up Studies ; Geriatric Assessment/methods ; Hospital Mortality/trends ; Humans ; Male ; Postoperative Complications/mortality ; Prospective Studies ; Risk Assessment/methods ; Risk Factors ; Spain/epidemiology ; Surgical Procedures, Operative/adverse effects ; Survival Rate/trends
    Language English
    Publishing date 2020-05-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2020.04.020
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  7. Article: Delayed gastric emptying following pancreatoduodenectomy: a Roux-en-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study.

    Herrera Cabezón, Javier / Sánchez Acedo, Pablo / Tarifa Castilla, Antonio / Zazpe Ripa, Cruz

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2018  Volume 111, Issue 1, Page(s) 34–39

    Abstract: Introduction: delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy (PD) and it occurs in 50% of cases.: Objectives: the endpoint was to determine if there were any differences in the incidence of DGE between ... ...

    Abstract Introduction: delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy (PD) and it occurs in 50% of cases.
    Objectives: the endpoint was to determine if there were any differences in the incidence of DGE between Roux-en-Y gastrojejunostomy (ReY) and Billroth II gastrojejunostomy (BII) in PD with pancreaticogastrostomy (PG).
    Methods: this was a case-control prospective randomized study of all PD cases between 2013 and 2016. Sixty-four patients were included, 32 in each group. An intention-to-treat statistical analysis was performed.
    Results: no significant differences were found with regard to morbidity and mortality or hospital stay. DGE was present in 25% of the patients in the BII group in comparison to 15.6% in the ReY group, which was not statistically significant (p = 0.35). There was a higher percentage of patients with primary DGE in the BII group, 12.5% versus 6.2%, but this was not statistically significant (p = 0.53). No difference in DGE severity was observed. Male gender (OR 8.38 [1.1; 129]), abdominal complications (OR 15 [1.7; 396.9]), pre-operative malnutrition (OR 99.7 [3.3, 11,126]) and hemorrhage (OR 9.4 [1.37, 107.94]) were the main risk factors for DGE according to the multivariate analysis.
    Conclusions: there were no significant differences in the incidence or severity of DGE between BII or ReY after PD with PG.
    MeSH term(s) Adenocarcinoma/surgery ; Aged ; Aged, 80 and over ; Anastomosis, Roux-en-Y/adverse effects ; Case-Control Studies ; Female ; Gastric Bypass/adverse effects ; Gastric Emptying ; Gastroenterostomy/adverse effects ; Gastroparesis/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/statistics & numerical data ; Postoperative Care ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Risk Factors ; Sex Factors
    Language English
    Publishing date 2018-10-04
    Publishing country Spain
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2018.5744/2018
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  8. Article: Hepatoblastoma del adulto. Presentación de un caso.

    Goikoetxea Urdiain, A / Sánchez Acedo, P / Mateo Retuerta, J / Tarifa Castilla, A / Zazpe Ripa, C / Herrera Cabezón, J

    Anales del sistema sanitario de Navarra

    2016  Volume 39, Issue 2, Page(s) 301–304

    Abstract: Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We pre-sent a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right ... ...

    Title translation Adult hepatoblastoma. A case report.
    Abstract Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We pre-sent a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient recei-ved a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any trans-plant experience.
    Language Spanish
    Publishing date 2016-05
    Publishing country Spain
    Document type English Abstract ; Journal Article
    ZDB-ID 2141772-6
    ISSN 1137-6627
    ISSN 1137-6627
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  9. Article: Angiosarcoma epitelioide de vesícula.

    Sánchez Acedo, P / Herrera Cabezón, J / Tarifa Castilla, A / Zazpe Ripa, C / Lera Tricas, J M

    Anales del sistema sanitario de Navarra

    2015  Volume 38, Issue 2, Page(s) 333–337

    Abstract: Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 ... ...

    Title translation Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature.
    Abstract Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment.
    MeSH term(s) Aged, 80 and over ; Gallbladder Neoplasms/diagnosis ; Gallbladder Neoplasms/surgery ; Hemangiosarcoma/diagnosis ; Hemangiosarcoma/surgery ; Humans ; Male ; Prognosis
    Language Spanish
    Publishing date 2015-05
    Publishing country Spain
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2141772-6
    ISSN 1137-6627
    ISSN 1137-6627
    DOI 10.23938/ASSN.0085
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  10. Article: The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy.

    Sánchez Acedo, Pablo / Zazpe Ripa, Cruz / Eguaras Córdoba, Inés / Herrera Cabezón, Javier / Tarifa Castilla, Antonio / Camarero Triana, Bruno

    Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

    2019  Volume 111, Issue 11, Page(s) 817–822

    Abstract: Introduction: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to ...

    Abstract Introduction: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD.
    Methods: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed.
    Results: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity.
    Conclusions: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay.
    MeSH term(s) Aged ; Aged, 80 and over ; Antibiotic Prophylaxis ; Bacterial Infections/epidemiology ; Bacterial Infections/etiology ; Bacterial Infections/prevention & control ; Bile Ducts/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Preoperative Care ; Prostheses and Implants ; Prosthesis Design ; Retrospective Studies
    Language English
    Publishing date 2019-10-10
    Publishing country Spain
    Document type Journal Article ; Observational Study
    ZDB-ID 1070381-0
    ISSN 1130-0108 ; 0212-7512
    ISSN 1130-0108 ; 0212-7512
    DOI 10.17235/reed.2019.6228/2019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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