Romà Adroer - Academia.edu (original) (raw)
Papers by Romà Adroer
Cirugía Española (english Edition), 2009
To determine mortality risk factors in surgical patients. A cross-sectional study was carried out... more To determine mortality risk factors in surgical patients. A cross-sectional study was carried out on all surgical patients who died while in hospital, over a period of three years (2004-2006). Pre, intra and postoperative variables were analysed. Comparisons were made between patients operated on as emergencies and elective surgery patients. Multivariate analysis was performed on the pre, intra and postoperative variables, using chi(2) of Pearson correlation with a confidence interval of 95%. Surgery was performed on a total of 38 815 patients, of which 6 326 were emergency procedures and 32 489 as elective. There were 479 deaths registered: 36 occurred in the operating theatre and 443 died after the operation. Arterial hypertension, diabetes mellitus and cancer were significant causes of death. Intraoperative complications were associated with mortality during the surgical procedure. Emergency surgery was an independent risk factor (mortality, 5.5% vs. 0.4% for elective surgery). Sepsis, cardiac and respiratory related deaths were the main risk factors for postoperative death. Prevention and adequate treatment of perioperative risk factors should significantly reduce morbidity and mortality rates, mainly in those patient operated as emergencies.
European Journal of Anaesthesiology, 2008
Cirugía Española (english Edition), 2010
There is controversy over how to assess surgical mortality risks after different operations. The ... more There is controversy over how to assess surgical mortality risks after different operations. The purpose of this study was to assess the surgical factors that influenced surgical mortality and the ability of the Charlson Index and The Surgical Risk Scale (SRS) to determine low risk patients. All patients who died during the period 2004-2007 were included. The score of both indices (Charlson and SRS) were recorded. A score of «0» for the Charlson Index and «8» for the SRS were chosen as the cut-off point between a low and high probability of death. Three risk groups were established: Low when the Charlson was =0 and SRS was <8; Intermediate when the Charlson was >0 and the SRS <8 or Charlson=0 and SRS ≥8; and high when the Charlson was>0 and the SRS ≥8. The risks factors before, during and after surgery were compared between the groups. A total of 72,771 patients were surgically intervened, of which 7011 were urgent. One in every 1455 patients died during surgery and 1 in every 112 died during their hospital stay. Thirteen (2%) patients who died belonged to the low risk group, 199 (30.7%) to the intermediate risk group, and 434 (67.2%) to the high risk group. Heart disease was associated with the high risk group. The urgency of the operation was a determining factor associated with surgical complexity. Re-intervention and sepsis predominated as a cause of death in the low risk group, and in the rest of the groups a cardiac cause was the predominant factor. The combination of the Charlson Index and SRS detected those patients with a low risk of death, thus making it a useful tool to audit surgical results.
Cirugia Espanola, Apr 1, 2009
Revista española de anestesiología y reanimación, 2010
Revista española de anestesiología y reanimación, 2010
Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. A... more Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient's cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who di...
Cirugia Espanola, 2010
IntroductionThere is controversy over how to assess surgical mortality risks after different oper... more IntroductionThere is controversy over how to assess surgical mortality risks after different operations. The purpose of this study was to assess the surgical factors that influenced surgical mortality and the ability of the Charlson Index and The Surgical Risk Scale (SRS) to determine low risk patients.
Revista Española de Anestesiología y Reanimación, 2010
ABSTRACT Objetive Retrospective analysis of all surgical, early postoperative, and 1-week to dete... more ABSTRACT Objetive Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. Material and methods A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient’s cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. Results From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who died during surgery; that pattern was similar but less marked in patients dying within 48 hours. The patients who died within 48 hours had a higher rate of postoperative hemodynamic complications; the patients who died during the week following surgery had higher rates of septic, neurologic, and respiratory complications. Conclusions Emergency surgery stands out as an important predictor of death during or after surgery; other significant risk factors are postoperative complications.
European Journal of Anaesthesiology, 2007
Bipolar Disorders, 2013
The study was designed to test an audit-based quality improvement programme (QIP) addressing lith... more The study was designed to test an audit-based quality improvement programme (QIP) addressing lithium prescribing and monitoring in UK mental health services. A baseline clinical audit was conducted against the following standards: (i) measurement of renal and thyroid function before initiating treatment with lithium and (ii) recommended monitoring of serum lithium and renal and thyroid function during maintenance treatment. A re-audit was conducted at 18 months and a supplementary audit at three years. Data were submitted for patients at baseline (n = 3,373), re-audit (n = 3,647), and supplementary audit (n = 5,683), 57% of whom had bipolar disorder. The baseline findings prompted a patient safety alert issued by the National Patient Safety Agency. By supplementary audit, the proportion of patients having four serum lithium tests over the previous year had increased from 30% at baseline to 48%, and the respective proportions that had two tests of renal function from 55% to 70% and thyroid function from 49% to 66%. Elderly patients and those prescribed a drug known to interact with lithium were not more likely to be monitored in line with the audit standards. Between baseline and supplementary audit, the proportion of patients with a diagnosis of bipolar disorder prescribed an antidepressant increased from 36% to 41%. Improvements in biochemical monitoring of lithium treatment were achieved over time with participation in a QIP that included benchmarking of performance against clinical standards and customized change interventions. Nevertheless, gaps remain between the standard and current practice. Antidepressants are frequently prescribed in patients with bipolar disorder despite a paucity of evidence supporting their efficacy.
Cirugía Española
Objective To determine mortality risk factors in surgical patients.
Cirugía Española (english Edition), 2009
To determine mortality risk factors in surgical patients. A cross-sectional study was carried out... more To determine mortality risk factors in surgical patients. A cross-sectional study was carried out on all surgical patients who died while in hospital, over a period of three years (2004-2006). Pre, intra and postoperative variables were analysed. Comparisons were made between patients operated on as emergencies and elective surgery patients. Multivariate analysis was performed on the pre, intra and postoperative variables, using chi(2) of Pearson correlation with a confidence interval of 95%. Surgery was performed on a total of 38 815 patients, of which 6 326 were emergency procedures and 32 489 as elective. There were 479 deaths registered: 36 occurred in the operating theatre and 443 died after the operation. Arterial hypertension, diabetes mellitus and cancer were significant causes of death. Intraoperative complications were associated with mortality during the surgical procedure. Emergency surgery was an independent risk factor (mortality, 5.5% vs. 0.4% for elective surgery). Sepsis, cardiac and respiratory related deaths were the main risk factors for postoperative death. Prevention and adequate treatment of perioperative risk factors should significantly reduce morbidity and mortality rates, mainly in those patient operated as emergencies.
European Journal of Anaesthesiology, 2008
Cirugía Española (english Edition), 2010
There is controversy over how to assess surgical mortality risks after different operations. The ... more There is controversy over how to assess surgical mortality risks after different operations. The purpose of this study was to assess the surgical factors that influenced surgical mortality and the ability of the Charlson Index and The Surgical Risk Scale (SRS) to determine low risk patients. All patients who died during the period 2004-2007 were included. The score of both indices (Charlson and SRS) were recorded. A score of «0» for the Charlson Index and «8» for the SRS were chosen as the cut-off point between a low and high probability of death. Three risk groups were established: Low when the Charlson was =0 and SRS was <8; Intermediate when the Charlson was >0 and the SRS <8 or Charlson=0 and SRS ≥8; and high when the Charlson was>0 and the SRS ≥8. The risks factors before, during and after surgery were compared between the groups. A total of 72,771 patients were surgically intervened, of which 7011 were urgent. One in every 1455 patients died during surgery and 1 in every 112 died during their hospital stay. Thirteen (2%) patients who died belonged to the low risk group, 199 (30.7%) to the intermediate risk group, and 434 (67.2%) to the high risk group. Heart disease was associated with the high risk group. The urgency of the operation was a determining factor associated with surgical complexity. Re-intervention and sepsis predominated as a cause of death in the low risk group, and in the rest of the groups a cardiac cause was the predominant factor. The combination of the Charlson Index and SRS detected those patients with a low risk of death, thus making it a useful tool to audit surgical results.
Cirugia Espanola, Apr 1, 2009
Revista española de anestesiología y reanimación, 2010
Revista española de anestesiología y reanimación, 2010
Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. A... more Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient's cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who di...
Cirugia Espanola, 2010
IntroductionThere is controversy over how to assess surgical mortality risks after different oper... more IntroductionThere is controversy over how to assess surgical mortality risks after different operations. The purpose of this study was to assess the surgical factors that influenced surgical mortality and the ability of the Charlson Index and The Surgical Risk Scale (SRS) to determine low risk patients.
Revista Española de Anestesiología y Reanimación, 2010
ABSTRACT Objetive Retrospective analysis of all surgical, early postoperative, and 1-week to dete... more ABSTRACT Objetive Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. Material and methods A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient’s cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. Results From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who died during surgery; that pattern was similar but less marked in patients dying within 48 hours. The patients who died within 48 hours had a higher rate of postoperative hemodynamic complications; the patients who died during the week following surgery had higher rates of septic, neurologic, and respiratory complications. Conclusions Emergency surgery stands out as an important predictor of death during or after surgery; other significant risk factors are postoperative complications.
European Journal of Anaesthesiology, 2007
Bipolar Disorders, 2013
The study was designed to test an audit-based quality improvement programme (QIP) addressing lith... more The study was designed to test an audit-based quality improvement programme (QIP) addressing lithium prescribing and monitoring in UK mental health services. A baseline clinical audit was conducted against the following standards: (i) measurement of renal and thyroid function before initiating treatment with lithium and (ii) recommended monitoring of serum lithium and renal and thyroid function during maintenance treatment. A re-audit was conducted at 18 months and a supplementary audit at three years. Data were submitted for patients at baseline (n = 3,373), re-audit (n = 3,647), and supplementary audit (n = 5,683), 57% of whom had bipolar disorder. The baseline findings prompted a patient safety alert issued by the National Patient Safety Agency. By supplementary audit, the proportion of patients having four serum lithium tests over the previous year had increased from 30% at baseline to 48%, and the respective proportions that had two tests of renal function from 55% to 70% and thyroid function from 49% to 66%. Elderly patients and those prescribed a drug known to interact with lithium were not more likely to be monitored in line with the audit standards. Between baseline and supplementary audit, the proportion of patients with a diagnosis of bipolar disorder prescribed an antidepressant increased from 36% to 41%. Improvements in biochemical monitoring of lithium treatment were achieved over time with participation in a QIP that included benchmarking of performance against clinical standards and customized change interventions. Nevertheless, gaps remain between the standard and current practice. Antidepressants are frequently prescribed in patients with bipolar disorder despite a paucity of evidence supporting their efficacy.
Cirugía Española
Objective To determine mortality risk factors in surgical patients.