Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz / Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early.

INTRODUCTION: Pre-operative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA≤II were included for analysis and divided according to their post-operative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year post-operative mortality rates; 30-day post-operative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% versus 4.1%, p=.16) and 1-year post-operative (4.3% versus 16.3%, p=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% versus 16.3%, p=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year post-operative mortality indicators, as well as readmission for medical reasons.

Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz.

INTRODUCTION: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.

La aplicación informática «SCAE» en el diagnóstico precoz del cáncer musculoesquelético en el área sanitaria del Hospital Universitario 12 de Octubre. Análisis de su efectividad y propuestas de mejora / The computer application «SCAE» in the early diagnosis of musculoskeletal cancer in the healthcare area of the Hospital Universitario 12 de Octubre. Analysis of its effectiveness and proposals for improvement

Introducción: La aplicación informática SCAE-SM (Solicitud de Cita en Atención Especializada-Sospecha de Malignidad) es una herramienta informática de la que disponen los médicos de Atención Primaria (AP) para la derivación de pacientes que deban ser valorados por el especialista en un plazo máximo de 2 semanas, cuando se sospeche una patología maligna. El objetivo de nuestro trabajo fue analizar la utilidad de esta herramienta y proponer áreas de mejora en la gestión de los pacientes con sospecha de malignidad musculoesquelética. Material y métodos: Se realizó un estudio descriptivo transversal de las 235 derivaciones recibidas en los años 2012-2017. Se analizó su procedencia, la información contenida en las solicitudes y la respuesta proporcionada por evaluadores históricos (facultativos traumatólogos sin formación específica oncológica). Para este estudio, se ha realizado una nueva valoración ciega de todas las solicitudes por 13 traumatólogos con distinto nivel de formación específica en oncología musculoesquelética (reevaluadores). Resultados: De entre todas las SCAE-SM, solo el 8,23% de los pacientes presentaron enfermedad maligna o benigna agresiva. Los reevaluadores más acertados en la adecuación del adelanto de cita fueron aquellos con formación oncológica moderada (5-10 años de experiencia). Durante el periodo de tiempo del estudio, de todos los pacientes tratados en la Unidad de Tumores, solo el 18,81% accedieron por el circuito SCAE-SM, transcurriendo un tiempo medio de espera de 18,11 días desde la derivación de AP. Conclusiones: La aplicación informática SCAE-SM como herramienta de gestión y adelanto de la asistencia a los pacientes con patología tumoral musculoesquelética maligna es útil, si bien el uso del circuito es inadecuado. Es necesario difundirlo y generalizarlo, así como implementar programas de formación oncológica básica tanto en el ámbito de la AP como de la Hospitalaria.(AU)

Introduction: The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care (PC) physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. Material and methods: A descriptive cross-sectional study of 235 referrals received in the years 2012–2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). Results: Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5–10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. Conclusions: The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of PC and Hospital.(AU)

The computer application “SCAE” in the early diagnosis of musculoskeletal cancer in the healthcare area of the “Hospital Universitario 12 de Octubre”. Analysis of its effectiveness and proposals for improvement / La aplicación informática«SCAE» en el diagnóstico precoz del cáncer musculoesquelético en el área sanitaria del Hospital Universitario 12 de Octubre. Análisis de su efectividad y propuestas de mejora

Introduction: The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care (PC) physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. Material and methods: A descriptive cross-sectional study of 235 referrals received in the years 2012–2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). Results: Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5–10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. Conclusions: The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of PC and Hospital.(AU)

Introducción: La aplicación informática SCAE-SM (Solicitud de Cita en Atención Especializada-Sospecha de Malignidad) es una herramienta informática de la que disponen los médicos de Atención Primaria (AP) para la derivación de pacientes que deban ser valorados por el especialista en un plazo máximo de 2 semanas, cuando se sospeche una patología maligna. El objetivo de nuestro trabajo fue analizar la utilidad de esta herramienta y proponer áreas de mejora en la gestión de los pacientes con sospecha de malignidad musculoesquelética. Material y métodos: Se realizó un estudio descriptivo transversal de las 235 derivaciones recibidas en los años 2012-2017. Se analizó su procedencia, la información contenida en las solicitudes y la respuesta proporcionada por evaluadores históricos (facultativos traumatólogos sin formación específica oncológica). Para este estudio, se ha realizado una nueva valoración ciega de todas las solicitudes por 13 traumatólogos con distinto nivel de formación específica en oncología musculoesquelética (reevaluadores). Resultados: De entre todas las SCAE-SM, solo el 8,23% de los pacientes presentaron enfermedad maligna o benigna agresiva. Los reevaluadores más acertados en la adecuación del adelanto de cita fueron aquellos con formación oncológica moderada (5-10 años de experiencia). Durante el periodo de tiempo del estudio, de todos los pacientes tratados en la Unidad de Tumores, solo el 18,81% accedieron por el circuito SCAE-SM, transcurriendo un tiempo medio de espera de 18,11 días desde la derivación de AP. Conclusiones: La aplicación informática SCAE-SM como herramienta de gestión y adelanto de la asistencia a los pacientes con patología tumoral musculoesquelética maligna es útil, si bien el uso del circuito es inadecuado. Es necesario difundirlo y generalizarlo, así como implementar programas de formación oncológica básica tanto en el ámbito de la AP como de la Hospitalaria.(AU)

The computer application «SCAE¼ in the early diagnosis of musculoskeletal cancer in the healthcare area of the Hospital Universitario 12 de Octubre. Analysis of its effectiveness and proposals for improvement. / La aplicación informática «SCAE¼ en el diagnóstico precoz del cáncer musculoesquelético en el área sanitaria del Hospital Universitario 12 de Octubre. Análisis de su efectividad y propuestas de mejora.

INTRODUCTION: The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care (PC) physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. MATERIAL AND METHODS: A descriptive cross-sectional study of 235 referrals received in the years 2012-2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). RESULTS: Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5-10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. CONCLUSIONS: The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of PC and Hospital.