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Inicio Cirugía Española (English Edition) Reply to the Letter “Discrepancies in Analysis of Frequency, Type of Complicat...
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Vol. 97. Issue 7.
Pages 422-423 (August - September 2019)
Vol. 97. Issue 7.
Pages 422-423 (August - September 2019)
Letter to the Editor
DOI: 10.1016/j.cireng.2019.05.018
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Reply to the Letter “Discrepancies in Analysis of Frequency, Type of Complications and Economic Costs of Outlying Patients in General and Digestive Surgery”
Réplica a la carta al director «Discrepancias en el análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva»
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Juan-Carlos Gomez-Rosadoa,
Corresponding author
dr.gomez.rosado@gmail.com

Corresponding author.
, Yun-Hao Lib, Javier Valdés-Hernándeza, Luis-Cristobal Capitán-Moralesb
a Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
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To the Editor:

In reference to the controversy raised by our article,1 we would like to thank Dr. De la Plaza's group for their interest and respond to their comments.2

It may not be clear in the methodology, but the minimum basic data set (MBDS) was used exclusively for a randomized sampling of all the non-outlying patients who, meeting the inclusion criterion, had the same DRG as the outlying patients, thereby balancing the samples in complexity, number and date. Each episode was evaluated individually, however, analyzing all clinical records and classifying the complications according to the internationally accepted Clavien-Dindo classification,3 as shown in Table 3, in addition to the categories proposed in the article (infectious, hemorrhagic, etc.). Precisely that is the reason why there are differences in complications between some patients and others, although they were not statistically significant. Therefore, we disagree on the interpretation that is made of the method. In any case, we should mention that, in our unit, we monitor the prospective recording of complications, as recommended,4 in a database prepared for this purpose with more than 17000 record entries, which has been very helpful for the development of the study. However, due to its design we have had to retrospectively review the digital files, so it is not cited in the methodology.

As for the calculation of costs, we agree, and this is reflected in the discussion in the article about cost calculation5; there are other models such as direct imputation, which is more precise but also more expensive and complex to obtain in a public healthcare system. There is also the proposed model that uses the economic validation of the Comprehensive Complication Index,6,7 although this had not been published when we submitted our manuscript. Our proposal for adjustment according to the hospital stay rate for each DRG attempts to adjust the cost so that it is closer to reality, although the calculations are somewhat generic and clearly limited when analyzing the cases individually. However, the main objective of the study is to analyze not the costs of complications but those of outlying patients, even though the complications certainly determine the cost of the episode, whether or not patients are outlying. Undoubtedly, this question is more commonly discussed “in the corridors” than in the scientific literature, and we believe that it should be analyzed in a more precise manner. However, as we have already said, it is tremendously difficult to design a prospective, randomized study due to the limitations of the admissions management system itself, hospital administration and, logically, the ever-changing availability of hospital beds.

Funding

The authors have received no funding for the development or publication of this project.

References
[1]
J.C. Gómez-Rosado, Y.H. Li, J. Valdés-Hernández, F. Oliva-Mompean, L.C. Capitán Morales.
Análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva.
[2]
R. De la Plaza Llamas, I.A. Gemio del Rey, J.M. Ramia.
Discrepancias en el Análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva.
[3]
D. Dindo, N. Demartines, P.A. Clavien.
Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
[4]
la Plaza Llamas de R, Ramia Ángel JM, García Gil JM, Arteaga Peralta V, García Amador C, Lopez Marcano AJ, et al. Registro prospectivo de todas las complicaciones postoperatorias en un servicio de cirugía general. ¿Como hacerlo? Cir Esp. 2018;96:Espec Congr 7.
[5]
J.C. Gómez-Rosado, J. Salas-Turrens, A. Olry-de-Labry-Lima.
Análisis de los costes económicos asociados a las complicaciones en cirugía general y digestiva.
[6]
R. De la Plaza Llamas, J.M. Ramia Ángel, J.M. Bellón, V. Arteaga Peralta, C. García Amador, A.J. López Marcano, et al.
Clinical validation of the comprehensive complication index as a measure of postoperative morbidity at a surgical department: a prospective study.
Ann Surg, 268 (2018), pp. 838-844
[7]
De la Plaza LlamasF R., Á. Hidalgo Vega, R.A. Latorre Fragua, A.J. López Marcano, A.A. Medina Velasco, D.A. Díaz Candelas, et al.
The cost of postoperative complications and economic validation of the comprehensive complication index.

Please cite this article as: Gomez-Rosado J-C, Li Y-H, Valdés-Hernández J, Capitán-Morales L-C. Réplica a la carta al director «Discrepancias en el análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva». Cir Esp. 2019;97:422–423.

Copyright © 2019. AEC
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