Are there important differences in comorbidity between surgical and medical inpatients?

BACKGROUND AND OBJECTIVE: Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care. Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients. MATERIALS AND METHODS: Retrospective, observational, descriptive study in patients aged ≥16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis. RESULTS: The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups. CONCLUSIONS: Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.

¿Hay diferencias importantes en la comorbilidad entre los pacientes ingresados en servicios quirúrgicos y los ingresados en servicios médicos? / Are there important differences in comorbidity between surgical and medical inpatients?

Antecedentes y objetivo: El desarrollo científico y tecnológico está cambiando la práctica médica y transformando los hospitales, seleccionando los pacientes que permanecen hospitalizados, los cuales están aumentando su edad y comorbilidad. Son cada vez más complejos médicamente y con menos diferencias clínicas entre los pacientes médicos y quirúrgicos, lo que puede implicar cambios organizativos y asistenciales hospitalarios. Nuestro objetivo es valorar las diferencias en la edad y comorbilidad existentes entre los pacientes hospitalizados en las áreas médica y quirúrgica. Materiales y métodos: Estudio descriptivo observacional retrospectivo que ha incluido a los pacientes de edad ≥16 años dados de alta durante el año 2019 de todos los servicios médicos y quirúrgicos, excluidos Obstetricia y Cuidados Intensivos. Los datos se obtuvieron del CMBD del hospital y fueron analizados mediante análisis univariante. Resultados: Se incluyeron 31.264 pacientes, 16.397 del área médica y 14.867 del área quirúrgica. Los del área quirúrgica son 8 años más jóvenes (62,69 años [IC 95% 62,4-62,98]), con mayor proporción de mujeres (OR 1,12 [IC 95% 1,07-1,17]) y menos ingresos urgentes (OR 0,11 [IC 95% 0,10-0,12]). En las variables relacionadas con la carga de comorbilidad los resultados entre ambos grupos de pacientes son similares en todas ellas y sin diferencias significativas. Conclusiones: Los enfermos del área quirúrgica tienen una alta carga de comorbilidad médica, similar a los del área médica. Conocer este dato es importante para cirujanos y anestesistas y abre la puerta para planear alternativas a la organización hospitalaria actual.(AU)

Background and objective: Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care.Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients. Materials and methods: Retrospective, observational, descriptive study in patients aged ≥ 16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis. Results: The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups. Conclusions: Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.(AU)

A brief history of medical cross-consultations.

Physicians have long needed and sought out the support and advice of experienced colleagues. This practice, endorse by Hippocrates and Galen, remaining unchanged until the Enlightenment. During that age, cross-consultations boomed. Monographic works were written, the characteristics and qualities that consulting physician had to possess were studied the problems that it could cause were examined, and rules and guidelines to follow during a cross-consultation were established. It remained unchanged until the end of the 19th century, when the emergence of various medical specialties offered the possibility of seeking specialized assistance. This specialization gave rise to a fragmentation of medical care which favored the emergence of the internist as a "universal consultant." In the last quarter of the 20th century, in light of the importance of and problems arising from cross-consultation, it began to be studied on its own, specialized services were created to attend to them, and, finally, comanagement appeared.

¿Qué pacientes quirúrgicos necesitan asistencia compartida? / Which surgical patients require shared care?

La mayoría de los pacientes quirúrgicos hospitalizados tiene mucha comorbilidad médica y recibe un gran número de medicaciones, o sufre complicaciones importantes, o ambos. La asistencia compartida (AC) es la responsabilidad y autoridad compartidas en el manejo de un paciente hospitalizado. Se discute si se deben seleccionar o no pacientes para la AC. Los diferentes criterios de selección no son seguros o fáciles de aplicar, y dejan fuera a muchos pacientes subsidiarios de AC. El manejo perioperatorio es fundamental para la mortalidad postoperatoria. El fallo del rescate (mortalidad hospitalaria secundaria a complicaciones posquirúrgicas) es el principal factor sobre la mortalidad quirúrgica hospitalaria. Afecta a cualquier paciente, independientemente de su edad, comorbilidad o tipo de cirugía. El componente que reduce más el fallo de rescate es la presencia de internistas en las salas quirúrgicas. Consideramos que todos los enfermos hospitalizados en los servicios quirúrgicos deberían recibir AC

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC

Which surgical patients require shared care? / ¿Qué pacientes quirúrgicos necesitan asistencia compartida?

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.

Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos / Characteristics and temporal pattern of readmissions of patients with atrial fibrillation hospitalized in medical departments

Objetivo. Conocer las características de los pacientes con fibrilación auricular (FA) en el ámbito hospitalario y sus sucesivos ingresos. Método. Estudio retrospectivo de cohortes con la totalidad de los ingresos hospitalarios en el área médica del hospital de Lugo entre el 1 de enero de 2000 y el 31 de diciembre de 2013. La fuente de información fue el conjunto mínimo básico de datos del centro. Resultados. Se registraron 149.271 ingresos hospitalarios correspondientes a 66.286 pacientes. Con respecto al total, el porcentaje de ingresos y pacientes con FA fue del 17,3% (25.870) y 18,9% (12.512), respectivamente. Los pacientes con FA se caracterizaron por una mayor proporción de mujeres (49,7 frente a 44,3%; p<0,0001), mayor edad (78,3 [DE 10,2] frente a 67,1 años [DE 17,9]; p<0,0001), más enfermedades crónicas (4,2 [DE 2,1] frente a 2,9 [DE 1,9]; p<0,001), estancia hospitalaria más prolongada (12,5 [DE 12,5] frente a 10,6 días [DE 19,9]; p<0,0001) y una elevada tasa de reingresos (3,0 [DE 2,75] frente a 2,1 [DE 2,28]; p<0,001), con un acortamiento progresivo del tiempo entre ingresos. El servicio de Medicina Interna asumió la atención de más de la mitad de los enfermos con FA. Los diagnósticos secundarios asociados más frecuentes fueron: enfermedad pulmonar obstructiva crónica, ictus, insuficiencia cardiaca, cardiopatía isquémica, otras enfermedades del aparato respiratorio e hipertensión arterial. Conclusiones. La FA se presenta en pacientes de alta complejidad, ingresados mayoritariamente en servicios de Medicina Interna, y se asocia a una elevada tasa de reingresos. Es preciso considerar las enfermedades asociadas a la FA que permitan un enfoque global de estos pacientes (AU)

Objective. To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. Method. A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. Results. A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; P<.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; P<.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; P<.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; P<.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; P<.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension. Conclusions. AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients (AU)

Characteristics and temporal pattern of readmissions of patients with atrial fibrillation hospitalized in medical departments. / Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos.

OBJECTIVE: To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. METHOD: A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. RESULTS: A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; P<.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; P<.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; P<.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; P<.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; P<.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension. CONCLUSIONS: AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients.