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HIGH COMPLEXITY
HIGH COMPLEXITY

HIGH COMPLEXITY
This is a set of extremely specialized services or which require a very high level of technology or professional expertise. Due to the low degree of prevalence, risk, interrelation to other processes or high cost, and in order to achieve the best results, these services are optimized by being concentrated into a low number of providers within the public health system.

1. THE NEUROSCIENCE TERTIARY AREA
    Neurosurgery
        Functional neurosurgery (movement surgery + pain surgery + psychosurgery).     
       
 
Neurology
  
    Endovascular treatment of acute ischemic stroke.  
    Diagnosis of Prodromal Alzheimer's Disease (using biomarkers).  
    Early onset dementia (<65 years).  
    Functional surgery program for Movement Disorders.  
    Comprehensive treatment program for Huntington's Disease and other hereditary choreas.  
    Brain mapping (cognitive) of patients undergoing awake brain surgery for a brain tumour.  
    Neuromuscular pathology (RCSU).  

 

2. TERTIARY CARDIOVASCULAR AREA
    Cardiology
        Structural cardiopathies TAVI, MITRACLIP, LEFT ATRIAL APPENDAGE (LAA).     
    Complex coronary lesions Occlusions (CTO) Rotational atherectomy (RTB).  
    MCP systems without electrode (MICRA).  
    Percutaneous extraction of electrodes.  
    Advanced navigation systems.  
       
 
Cardiac Surgery
  
    Ventricular assistance.  
    Heart transplantation.  

 

3. TERTIARY ONCOHAEMATOLOGICAL AREA
    General and Digestive Surgery
    

Uncommon oncological surgery for neoplasms of the oesophagus, stomach, rectum, liver, pancreas and other rare neoplasms.

     
       
 
Orthopaedic and Traumatology Surgery
  
    Endovascular treatment of acute ischemic stroke.  
       
  Plastic Surgery  
    Treatment of disseminated melanoma.  
    Genitourinary reconstruction (microsurgical reconstruction of the male genitalia).  
   
High-complexity reparative microsurgery: Supramicrosurgery = Microsurgical morphofunctional reconstruction and surgical treatment of lymphoedema.
  
       
 
Thoracic Surgery   
    Oncological surgery of low prevalence in accordance with CatSalut instruction 1/2012 (lung cancer surgery, complex oncological surgery of the thorax).  
    Surgery for patients with myasthenia.  
    Thoracic carcoma surgery.  
       
  Dermatology  
    Mohs surgery.  
       
   Clinical Haematology
    Allogeneic transplantation and referencing in accordance with CatSalut instruction 1/2012.  
    Precision therapy aimed at molecular targets and immunotherapy.  
       
  Medical Oncology
    Rare, germ cell and neuroendocrine sarcomas and tumours, in accordance with CatSalut instruction 1/2012.  
    Tumour pathology:  Skull base surgery, hypophysis tumour surgery, working jointly with otolaryngology and endocrinology, brain tumour surgery in eloquent areas (awake patient surgery) and neuro-oncology in general.  
       
  Otolaryngology-Oncology-Radiotherapy-Plastic Surgery   
    Cancer of the head and neck (complex reconstruction, protocols for function preservation, etc.).  
       
  Neurosurgery and Otolaryngology  
    Skull base tumour surgery and advanced endoscopic surgery.  
       
  Radiotherapeutyc Oncology / Radiophysics and Radioprotection  
   

 

Planning of external radiation therapy with PET-CT.		  
    Planning of external radiation therapy with 4D-CT.  
    Planning of external radiation therapy directly with magnetic resonance for pelvic/prostate tumours.  
    Intensity-modulated radiation therapy (IMRT, VMAT)  
    Stereotactic body radiation therapy.  
    Fractionated stereotactic brain radiation therapy.  
    Image-guided radiation therapy (IGRT) and with fiducial markers.  
    4D radiotherapy, taking into account respiratory motion control.  
    Adaptative radiotherapy.  
    Paediatric radiotherapy with anaesthesia.  
    Total body irradiation (TBI) for blood cancer tumours.  
    Motion control for interfraction patients with image guidance protocols for all patients.  
    In vivo dosimetry.  
    Prevention of cardiac damage from irradiation of left-breast carcinoma.  
    Personalized radiology discharge procedure for all patients in differentiated thyroid carcinoma treatments.  
    Brachytherapy:  
   
  •  Low dose-rate brachytherapy for treating prostate cancer with     iodine-125 seeds.
  
   
  •  High dose-rate brachytherapy for any location.
  
       
       
       
       
       
   Paediatrics
    TPH in haemato-oncological patients (RCSU). Oncology and haematology in the AIS Dreta healthcare area, in accordance with CatSalut instruction 1/2012.  
     
  Pneumology
    Cryo-broncoscopy.  

 

4. TERTIARY TRAUMATOLOGY AREA
    Various
        Reference in adult and paediatric multiple trauma patients, in accordance with CatSalut instruction 4/2011.     

 

5. TERTIARY GENETIC COUNSELLING AREA
    Various
        In oncological, haematological, neurological and cardiological pathology, etc.     

 

Tertiary single-service products (not specified in the above areas).
    Anaesthesiology, Reanimation and Pain Therapy
     Transthoracic echocardiography to guide valve implants in cardiovascular surgery.  
    ECMO cardio-circulatory treatment program for patients with advanced cardiopathy awaiting a heart transplant and/or cardiac function recovery.  
    Anaesthetic management of craniotomies in conscious patients with pathology in functional brain areas.  
       
  Angiology, Vascular and Endovascular Surgery  
    Aortic and carotid pathology and endovascular treatment of Peripheral Artery Disease, in accordance with CatSalut instruction 9/2014.  
       
  Pathological Anatomy 
   

Complex endoscopic techniques: treatment for Barrett's oesophagus, diagnostic choledocoscopy, and choledochal and intrahepatic lithotripsy with laser, submucosal resection of gastrointestinal lesions, therapeutic endoscopy.

  
   

Diagnostic and therapeutic hepatic haemodynamics.

  
       
  General and Digestive Surgery  
    Pelvic floor surgery (rectal incontinence, rectal prolapse).  
    Advanced laparoscopic surgery for uncommon pathology (achalasia, splenectomy, ultra-low rectum, hepatectomy, pancreatectomy, etc.).  
    Complex hepatic surgery (surgical lesion of the bile ducts, tumours, etc.).  
       
  Dermatology 
    Hansen’s disease .  
    Vascular lesions: Vascular laser treatment and medical surgical treatment of angiomas.  
       
  Imaging Diagnosis
    Interventional vascular, neurovascular and hepatobiliary procedures.  
    Percutaneous radiofrequency ablation of hepatic and pulmonary tumours.  
       
  Endocrinology 
    Intensified insulin therapy - Telemedical artificial pancreas   
    Endocrine neoplasias: poor prognosis endocrine carcinomas and MEN (1,2) and related entities.  
       
   Pharmacy  
    Clinical pharmacokinetics. Busulfan.  
    Significant participation in the CatSalut Technical Pharmacy Office.  
       
  Clinical Pharmacology  
    Phase I and II clinical testing unit: Drug Information Centre (CIM).  
    Pharmacovigilance Unit.  
       
  Gynaecology and Obstetrics
    Assisted Reproduction. Preimplantation genetic diagnosis (PGD).  
    Maternal and foetal immunohaematological and endocrinological abnormalities.  
    Maternal, family and foetal nephro-urological diseases.  
    High risk obstetrics: prematurity, intrauterine growth restriction and pre-eclampsia.  
    Deep pelvic endometriosis.  
    Ovarian cancer and multidisciplinary sarcoma programme.  
    Fertility preservation for cancer patients.  
       
  Immunology
    Immunodeficiency and autoimmune disease diagnostic and monitoring.  
    Biological therapy research and monitoring.  
       
  Laboratories (Biochemistry, Haematology, Microbiology, Immunology, Genetics and Pathological Anatomy) 
    Molecular techniques for the detection of microorganisms and their resistance mechanisms. Molecular epidemiology.  
    Viral isolation for cell cultures Flaccid paralysis surveillance.  
    Genotype diagnosis of hereditary pathology.  
    Antineoplastic treatment monitoring: busulfan, mitotane i asparaginase.  
    Caracterització immunogen típica de neoplàsies hematològiques  inclosa seqüenciació massiva.  
       
  Nuclear Medicine  
    Metabolic therapy with radiopharmaceuticals.  
       
  Ophthalmology
    Implantation of intraestomal corneal rings to correct keratoconus.  
    Crosslinking surgery for corneal ectatic disorders.  
    OCT-assisted surgical microscopy for the vitreoretinal interface, corneal layer transplantation and non-penetrating filtering surgery using deep sclerectomy.  
       
  Otolaryngology 
    Oncology and oncological surgery of the head and neck. Head and neck tumour Program and Committee (special collaboration with Medical Oncology, Radiotherapeutic Oncology and Plastic Surgery).  
    Severe sensorineural deafness and cochlear implants (adults and children). We are the reference centre for adults in Catalonia.  
    Otological BAHA surgery (bone-anchored hearing aid).  
    Otoneurosurgery with a special focus on tumours of the pontocerebellar angle.  
       
  Patologia Digestiva     
    Tècniques endoscòpiques complexes: tractament esòfag de Barret, coledocoscòpia diagnòstica i litrotícia coledocal i intrahepàtica amb làser, resecció submucosa de lesions gastrointestinals, endoscòpia terapèutica.  
    Hemodinàmica hepàtica diagnòstica i terapèutica.  
       
  Paediatrics
    Comprehensive treatment for extremely premature babies.  
    Hypothermia programmes in cases of neonatal asphyxia.  
    HPT programme, pioneering is Spain, for oncological pathologies, immunodeficiencies and metabolic disorders / RCSU.  
    Multidisciplinary treatment programme for multiple trauma paediatric patients with all of the medical, surgical and interventional radiology specialties on a 24/7 basis.    
    HPT in metabolic disorders / HPT in patients suffering from primary immunodeficiencies.  
       
  Pneumology    
    Mechanic ventilation and comprehensive ventilator rehabilitation. Hospital and home care.  
    Diagnosis and comprehensive treatment of severe asthma.  
    Pulmonary fibrosis and other rare interstitial  pneumopathies.  
       
  Psychiatry
    Treatment of resistant depression and schizophrenia and Neurosurgery (Deep brain stimulation).  
    Dialectic behaviour therapy for borderline personality disorder.  
       
 
Emergencies
  
    Heart attack code (protocol for emergency services and cardiology).  
    Stroke code (protocol for emergency services, neurology and radiology).  
    Non-invasive ventilation in ICC and IRCA (protocols for the emergency service and pulmonology).  
    Sepsis code (protocol for the emergency service and intensive medicine).  
    Trauma code (protocol for the emergency services, surgery, trauma and anaesthesia).