[Anesthesia practice in Catalan hospitals and other health care facilities]. / Actividad anestésica en Cataluña según las características de los centros sanitarios.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. PATIENTS AND METHOD: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. RESULTS: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. CONCLUSIONS: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

Actividad anestésica en Cataluña según las características de los centros sanitarios / Anesthesia practice in Catalan hospitals and other health care facilities

Fundamento y objetivo: Conocer la actividad anestésica de Cataluña (España) en 2003 según los centros sanitarios. Pacientes y método: A partir de los datos ANESCAT 2003 estudiamos la actividad anestésica de los centros sanitarios clasificados según su fuente de financiación ­centros públicos del Institut Català de la Salut (ICS), centros públicos concertados (XHUP) o privados (CP)­, según su tamaño ­sin camas de hospitalización, con menos de 250 camas, con 251-500 camas y con más de 500 camas­ y su acreditación o no para la formación de médicos residentes (MIR). Resultados: Participaron 131 centros (11 del ICS, 47 XHUP y 73 CP; 26 sin camas de hospitalización, 78 con menos de 250 camas, 21 con 251-500 camas y 6 con más de 500 camas), de los cuales 17 impartían MIR. Los porcentajes de anestesias fueron: un 44,3% en XHUP, un 36,7% en CP y un 18,5% en ICS; un 5% en centros sin camas de hospitalización, un 42,9% en centros con menos de 250 camas, un 35% en centros con 251-500 camas y un 17,1% en centros con más de 500 camas, y un 35,5% en los MIR. La edad mediana de los pacientes de los CP, de los centros con menos de 250 camas y los no MIR fue menor. El estado físico de los pacientes fue peor en ICS, en los centros con más de 500 camas y en los MIR. Destacó la actividad de urgencias cercana al 25% en XHUP, ICS, centros con más de 250 camas y en los MIR. La anestesia ambulatoria en los CP supuso el 40% y en los otros, el 31%. La duración de la anestesia y de la recuperación postanestésica fue mayor en el ICS, en centros con más de 500 camas y en los MIR. El ingreso en unidades de cuidados críticos en el postoperatorio y la analgesia especializada fueron superiores en ICS, centros con más de 500 camas y MIR. Conclusiones: La complejidad de la actividad tanto anestésica como quirúrgica y la gravedad de los pacientes aumentaron con el número de camas del hospital y su titularidad pública

Background and objective: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. Patients and method: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. Results: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. Conclusions: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status