Esclerosis múltiple y trastornos asociados al consumo de alcohol: mortalidad atribuible, prolongación de estancias y exceso de costes hospitalarios / Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures

INTRODUCCIÓN: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en los pacientes con esclerosis múltiple (EM), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes ingresados con EM recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Se calculó la mortalidad, la prolongación de estancias y los sobrecostes atribuibles a los TCA controlando mediante análisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, el tipo de ingreso, otros trastornos adictivos y las comorbilidades. RESULTADOS: Se estudiaron 10.249 ingresos por EM de 18 a 74 años de edad, entre los cuales hubo 215 pacientes con TCA. Los ingresos con EM y TCA fueron predominantemente varones, mayor frecuencia de ingresos urgentes, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con EM y TCA presentaron importantes excesos de mortalidad (94,1%), prolongación indebida de estancias (2,4 días) y sobrecostes por alta (1.116,9 euros). CONCLUSIONES: De acuerdo a los resultados de este estudio, los TCA en pacientes con EM aumentaron significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes

INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures

Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures. / Esclerosis múltiple y trastornos asociados al consumo de alcohol: mortalidad atribuible, prolongación de estancias y exceso de costes hospitalarios.

INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.

Minimum requirements in infection control.

Infection control (IC) activities are facing new challenges, but the resources dedicated to IC are too frequently insufficient. Heterogeneity of resources among centres and countries is huge, a fact that at least partly explains the differences in the results obtained. In this article, we review and discuss the available recommendations for minimum requirements in IC related to organizational aspects, IC staffing and the training of these staff, ward staffing, structural issues, and microbiological support. A professional-based consensus on the minimum requirements for IC in European centres based on present challenges and societal demands is needed.

Infecciones de localización quirúrgica en los pacientes tratados con cistectomía radical: exceso de mortalidad, prolongación de estancias y sobrecostes hospitalarios / Surgical site infections in patients who undergo radical cystectomy: Excess mortality, stay prolongation and hospital cost overruns

Introducción: El objetivo de este estudio es el análisis del impacto de las infecciones de localización quirúrgica (ILQ) en los pacientes tratados con cistectomía radical, en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes tratados con cistectomía radical recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Resultados: Se estudió a 4.377 pacientes tratados con cistectomía radical, 3.904 varones y 473 mujeres, de los cuales 849 (19,4%) experimentaron una ILQ. Los pacientes con ILQ fueron predominantemente varones, de mayor edad, con mayor prevalencia de trastornos asociados al consumo de alcohol y con más comorbilidades. Los pacientes con ILQ presentaron importantes excesos de mortalidad (125,6%), prolongación indebida de estancias (17,8 días) y sobrecostes (14.875,7 euros). Conclusiones: Controlando mediante el emparejamiento multivariado las variables demográficas, el tipo de hospital, los trastornos adictivos y las comorbilidades, la aparición de ILQ en pacientes tratados con cistectomía radical aumenta significativamente la mortalidad, la duración de la estancia y su coste. Ciertas medidas preventivas ya consagradas en estudios previos podrían disminuir su incidencia y su impacto sanitario y económico

Background: The aim of this study was to analyze the impact of surgical site infections (SSI) in patients who underwent radical cystectomy, in terms of excess hospital mortality, stay prolongation and cost overruns. Material and methods: A retrospective observational study was conducted on a sample of patients who underwent radical cystectomy as recorded in the basic minimum data sets of 87 Spanish hospitals from 2008-2010. Results: We studied 4377 patients who underwent radical cystectomy (3904 men and 473 women) of whom 849 (19.4%) experienced an SSI. The patients with SSI were predominantly men, elderly and had a higher prevalence of alcohol-related disorders and more comorbidities. The patients with SSI had significant excess mortality (125.6%), undue stay prolongation (17.8 days) and cost overruns (14,875.70 euros). Conclusions: After controlling for demographic variables, hospital type, addiction disorders and comorbidities using multivariate pairing, the onset of SSI in patients who underwent radical cystectomy significantly increased the mortality, stay and cost. Certain preventive measures already established in previous studies could reduce the incidence of SSI and its healthcare and financial impact

Surgical site infections in patients who undergo radical cystectomy: Excess mortality, stay prolongation and hospital cost overruns.

BACKGROUND: The aim of this study was to analyze the impact of surgical site infections (SSI) in patients who underwent radical cystectomy, in terms of excess hospital mortality, stay prolongation and cost overruns. MATERIAL AND METHODS: A retrospective observational study was conducted on a sample of patients who underwent radical cystectomy as recorded in the basic minimum data sets of 87 Spanish hospitals from 2008-2010. RESULTS: We studied 4377 patients who underwent radical cystectomy (3904 men and 473 women) of whom 849 (19.4%) experienced an SSI. The patients with SSI were predominantly men, elderly and had a higher prevalence of alcohol-related disorders and more comorbidities. The patients with SSI had significant excess mortality (125.6%), undue stay prolongation (17.8 days) and cost overruns (14,875.70 euros). CONCLUSIONS: After controlling for demographic variables, hospital type, addiction disorders and comorbidities using multivariate pairing, the onset of SSI in patients who underwent radical cystectomy significantly increased the mortality, stay and cost. Certain preventive measures already established in previous studies could reduce the incidence of SSI and its healthcare and financial impact.

[Exposure to Mycobacterium tuberculosis during a bus travel]. / Exposición a Mycobacterium tuberculosis durante un viaje en autobús.

BACKGROUND: In an outbreak of tuberculosis that occurred in a school, we evaluated the possible transmission during a trip in a school bus as the cause of infection. SUBJECTS, PATIENTS AND METHODS: Contact tracing of the driver, 3 teachers and 49 students from different grades who were travelling from Málaga to Sierra Nevada (Spain) in March 1998. All the students from the ten grades where any case of tuberculosis appeared from April to December 1998 and all the teachers of the school were included. RESULTS: At the school, 232 students were studied. The prevalence of the infection was 35%. A total of 12 new cases among the students were found. No teachers out of the 127 examined became ill. Out of the people who travelled by school bus, 2 teachers and 19 students were infected, prevalence among students 46%; five of those become ill. The odds ratio of infection for those having a class mate with positive smears was 5,5. On the other hand, the trip by bus (compared with those who did not take it) meant a odds ratio of 3,4. Most of the infected travellers were sitting in the bus close to the index case. CONCLUSIONS: In this tuberculosis outbreak some of the students who became ill or infected were not near the index case nor friendly with him at class. Therefore is possible that in some cases tuberculosis was transmitted inside the bus.

[Borderline between emergencies and hospitalization in the analysis of hospital mortality]. / La frontera entre urgencias y hospitalización en el análisis de la mortalidad hospitalaria.

BACKGROUND: The analysis of hospital mortality rate as a measure of care quality is usually restricted to death occurred at hospital wards, and no consideration is given to deaths occurred at the Emergency Department. Therefore, the information from a fundamental hospital area goes without analysis. METHODS: The following characteristics of decreased individuals at the Emergency Department (n = 79) and hospital wards (n = 280) in the Costa del Sol Hospital (Marbella, Málaga, Spain) during 1997 were compared: age, sex, main diagnosis at admission, main diagnosis specificity, and number of secondary diagnoses. A reevaluation of hospital mortality rates was made after data from ED deaths had been added. RESULTS: The addition of deaths occurred at the ED meant a relevant increase in hospital mortality rates: 57% for heart failure, 30% for stroke, and 25% for myocardial infarction. Twenty percent of deaths at the ED had non-specific diagnosis versus 5% at wards (p < 0.0001; 95%CI: 6.03; 24.15). Deaths at the ED had 2.9 +/- 1.3 secondary diagnoses versus 4.9 +/- 2.0 in deaths at hospital wards (p < 0.0001; 95%CI: 1.6; 2.4). CONCLUSIONS: Deaths at the ED make up a relevant proportion of the total deaths and should be incorporated to the hospital mortality analysis. Deficiencies in the collection of clinical information were observed in this ED. Therefore, adjustments for severity--an essential issue for comparing mortality rates between centers--might be precluded.