Reingreso no planificado tras cirugía de resección pulmonar: revisión sistemática / Unplanned readmission after lung resection surgery: A systematic review

Los reingresos urgentes suponen un impacto importante sobre los resultados en la salud de los pacientes y los costes sanitarios. Los factores de riesgo asociados a reingreso tras cirugía de resección pulmonar han sido poco estudiados. El principal objetivo del presente trabajo es la identificación de factores pre- y perioperatorios determinantes de reingreso; secundariamente, determinación de tasa de reingresos, identificación de diagnósticos de reingreso, e impacto de los reingresos sobre las tasas de supervivencia en los estudios que lo analizaban. La revisión se realizó mediante búsqueda sistemática en las principales bases de datos bibliográficas. Finalmente, 19 trabajos cumplieron los criterios de selección. Los principales factores de riesgo fueron: variables sociodemográficas de los pacientes; comorbilidades; tipo de resección; complicaciones postoperatorias; estancia prolongada. A pesar de la gran variabilidad en los estudios publicados, todos destacan la importancia de reducir los índices de reingreso por su significativo impacto sobre pacientes y sistema sanitario

Urgent readmissions have a major impact on outcomes in patient health and healthcare costs. The associated risk factors have generally been infrequently studied. The main objective of the present work is to identify pre- and perioperative determinants of readmission; the secondary aim was to determine readmission rate, identification of readmission diagnoses, and impact of readmissions on survival rates in related analytical studies. The review was performed through a systematic search in the main bibliographic databases. In the end, 19 papers met the selection criteria. The main risk factors were: sociodemographic patient variables; comorbidities; type of resection; postoperative complications; long stay. Despite the great variability in the published studies, all highlight the importance of reducing readmission rates because of the significant impact on patients and the healthcare system

Unplanned readmission after lung resection surgery: A systematic review. / Reingreso no planificado tras cirugía de resección pulmonar: revisión sistemática.

Urgent readmissions have a major impact on outcomes in patient health and healthcare costs. The associated risk factors have generally been infrequently studied. The main objective of the present work is to identify pre- and perioperative determinants of readmission; the secondary aim was to determine readmission rate, identification of readmission diagnoses, and impact of readmissions on survival rates in related analytical studies. The review was performed through a systematic search in the main bibliographic databases. In the end, 19 papers met the selection criteria. The main risk factors were: sociodemographic patient variables; comorbidities; type of resection; postoperative complications; long stay. Despite the great variability in the published studies, all highlight the importance of reducing readmission rates because of the significant impact on patients and the healthcare system.

Incidencia de efectos adversos en un servicio de cirugía general / Incidence of adverse events in a general surgery unit

Objetivo La práctica clínica es una actividad acompañada de riesgos e incertidumbre. Los objetivos son estimar la incidencia de pacientes quirúrgicos con efectos adversos (EA), analizar los factores asociados y estimar su impacto e identificar las posibilidades de prevención. Pacientes y método Estudio ambispectivo de los pacientes atendidos en una unidad de un servicio de cirugía general de un hospital de tercer nivel. La revisión de todos los ingresos se realizó de forma prospectiva con una guía de cribado, examinándose de manera retrospectiva con un cuestionario modular todas las historias clínicas que cumplieron criterios de cribado. Resultados Se revisaron 989 historias con un valor predictivo positivo (VPP) para EA de la guía de cribado de 53%. La incidencia acumulada de pacientes con EA fue del 17,8% y la densidad de incidencia de EA de 1,92/100 días de hospitalización. Los factores intrínsecos y extrínsecos se asociaron a mayor riesgo de EA; los eventos más frecuentes fueron las infecciones nosocomiales (54,4%) y los problemas quirúrgicos (31,8%) y los de medicación (7,4%). El 66,8% de los EA fueron considerados moderados (el 53,5% de todos los EA evitables).Conclusiones El cuestionario de cribado ha sido útil para la valoración de EA. Los EA son frecuentes en pacientes quirúrgicos y repercuten en la utilización de los recursos hospitalarios. Los factores asociados más relevantes fueron la estancia, la intervención quirúrgica y los factores extrínsecos. De los EA, destacó la infección de herida quirúrgica. Por su impacto, dos tercios fueron moderados y se consideró evitables la mitad de todos los EA (AU)

Objective Clinical practice is an activity accompanied by risks and uncertainties. The objectives are: to determine the incidence of patients with adverse events (AE) in a general surgery unit; to analyse the associated factors; to consider their impact and to identify the prevention possibilities. Patients and method Ambispective study in patients taken care of in a general surgery unit in a tertiary hospital. Every admission was prospectively reviewed using a screening guide, with all the clinical histories that fulfilled screening criteria being examined retrospectively using a modular questionnaire. Results A total of 989 histories were reviewed, the positive predictive value (PPV) of the screening guide for AE was 53%. The accumulated incidence of patients with AE was 17.8% and the incidence density of AE was 1.92 for every 100 days of hospitalisation. Intrinsic and extrinsic risk factors were associated to greater risk of EA, the most frequent events being: nosocomial infections (54.4%), surgical problems (31.8%) and problems associated with medication (7.4%). A total of 66.8% of the AE were considered moderate, with 53.5% of all AE being preventable. Conclusions The screening questionnaire was useful for the valuation of adverse events. AE are common in surgical patients which has an effect on the use of other hospital resources. The most important associated factors were: length of stay, surgical and extrinsic factors and surgical wound infection as the main AE. Two thirds of AE were considered moderate and half of all AE were considered avoidable (AU)

[Incidence of adverse events in a general surgery unit]. / Incidencia de efectos adversos en un servicio de cirugía general.

OBJECTIVE: Clinical practice is an activity accompanied by risks and uncertainties. The objectives are: to determine the incidence of patients with adverse events (AE) in a general surgery unit; to analyse the associated factors; to consider their impact and to identify the prevention possibilities. PATIENTS AND METHOD: Ambispective study in patients taken care of in a general surgery unit in a tertiary hospital. Every admission was prospectively reviewed using a screening guide, with all the clinical histories that fulfilled screening criteria being examined retrospectively using a modular questionnaire. RESULTS: A total of 989 histories were reviewed, the positive predictive value (PPV) of the screening guide for AE was 53%. The accumulated incidence of patients with AE was 17.8% and the incidence density of AE was 1.92 for every 100 days of hospitalisation. Intrinsic and extrinsic risk factors were associated to greater risk of EA, the most frequent events being: nosocomial infections (54.4%), surgical problems (31.8%) and problems associated with medication (7.4%). A total of 66.8% of the AE were considered moderate, with 53.5% of all AE being preventable. CONCLUSIONS: The screening questionnaire was useful for the valuation of adverse events. AE are common in surgical patients which has an effect on the use of other hospital resources. The most important associated factors were: length of stay, surgical and extrinsic factors and surgical wound infection as the main AE. Two thirds of AE were considered moderate and half of all AE were considered avoidable.

Perfil de los usuarios y motivos de demanda del Servicio de Urgencias extrahospitalario 061 / User profile and reasons to demand 061 emergency medical services

Objetivos: La demanda a los servicios de urgencias extrahospitalarios (SUE) ha aumentado en los últimos años. Los objetivos de este estudio son caracterizar a las personas usuarias del SUE 061 y valorar si su satisfacción con Atención Primaria (AP), estar esperando visita en atención especializada, su situación laboral y el conocimiento de otros servicios de urgencias, influyen en la demanda del 061. Método: Estudio de una muestra de los pacientes atendidos durante dos meses por el SUE 061. Sus características sociodemográficas y motivos de demanda se obtuvieron mediante un cuestionario telefónico de elaboración propia. Resultados: La tasa de respuesta fue del 32,3%. El perfil más frecuente de usuario del 061 fue el de una persona mayor y mujer que lo demandó por problemas respiratorios (36 sujetos, 27,9%). El domingo (27 usuarios, 20,9%) y el horario entre las 15 y 22 horas (59 personas, 45,7%) fueron los momentos de mayor frecuentación. La asistencia prestada por AP fue valorada positivamente; estaban esperando visita por un especialista 24 (18,6%); a ninguno le suponía un problema ausentarse del trabajo para ir al médico; y 68 (52,7%) entrevistados conocían otros servicios de urgencias. Conclusiones: Los usuarios del SUE 061 no utilizaron éste como puerta de entrada al sistema sanitario. Además de la gravedad de la patología, en su demanda existen otros factores (AU)

Background: Demand of out-of-hospital emergency medical services (EMS) has increased in the last few years. The objectives of the present study were to describe the profile of 061 EMS users, and to evaluate whether the degree of satisfaction with Primary Healthcare (PH), the fact of having to wait for specialized healthcare, the labour situation and the knowledge of other EMS could have any impact on the demand of 061. Methods: Study of a sample of 061 EMS users in a 2-month period. Socio-demographic factors and reasons for using this service were obtained using a specific telephone questionnaire. Results: The response rate was 32,3%. Users were most frequently elderly people and females, and the most common reason for calling was related to respiratory problems (36 users, 27,9%). The demand was greater on Sundays (27 users, 20,9%) and between 15 and 22 hours (59 users, 45,7%). The users positively valued the medical assistance by PH; 24 individuals (18,6%) were waiting to be seen by a specialist physician; being absent from work to visit a doctor was not a problem for any of the users; and 68 (52,7%) users had knowledge about other EMS. Conclusions: 061 was not used as a first option to get into the health care system. In addition to the severity of the disease, several external factors play a role in the demand of this medical service (AU)

[Adverse events in general and digestive surgery departments in Spanish hospitals]. / Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles.

OBJECTIVE: To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. MATERIAL AND METHOD: We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. RESULTS: The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P< .001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P< .001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. CONCLUSIONS: Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority.

Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles / Adverse events in general and digestive surgery departments in Spanish hospitals

Objetivo. Determinar la incidencia de pacientes con efectos adversos (EA) en los servicios de cirugía general, describir las causas inmediatas del EA, definir los evitables y conocer su impacto. Material y método. Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499 camas) y 5 de tamaño grande (500 camas o más). Pacientes ingresados, cuya hospitalización fuera superior a 24 h, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y los que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados. La incidencia de pacientes con EA fue del 10,5% (76/735), con un intervalo de confianza (IC) del 95%, 8,1%-12,5%. La presencia de factores de riesgo intrínsecos aumenta el riesgo de EA (el 14,8 frente al 7,2%; p = 0,001), y también lo hace la presencia de factores de riesgo extrínseco (el 16,2 frente al 7,0%; p < 0,001). La comorbilidad influyó en la aparición de EA (el 33,7 de EA frente al 2,2% sin comorbilidad; p < 0,001). La gravedad del EA se relacionó con el riesgo ASA (p = 0,036). El 41,7% de los EA se relacionó con la infección nosocomial; el 27,1%, con procedimientos, y el 24%, con la medicación. El 31,3% de los EA se consideraron leves; el 39,6%, moderados, y el 29,2%, graves. Un 36,5% se valoraron como evitables. El total de estancias adicionales provocadas por EA fueron de 527 (6,3 estancias adicionales por paciente), de las cuales 216 correspondieron a EA evitables. Conclusiones. Los pacientes de cirugía general y aparato digestivo tienen más riesgo de EA. Existen factores de vulnerabilidad, como son la edad, la comorbilidad y la aplicación de dispositivos externos. Una parte importante de los EA se relacionan con la infección nosocomial (especialmente infección de la herida quirúrgica) y también con el propio procedimiento. Finalmente, los EA tienen un impacto notable en el paciente y en una proporción considerable de casos pueden evitarse. El impacto sanitario, social y económico de los EA, hasta hace poco una epidemia silenciosa en nuestro país, convierte la necesidad de su estudio en una prioridad de salud pública (AU)

Objective. To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. Material and method. We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. Results. The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P<.001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P<.001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. Conclusions. Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority (AU)