The COVID-19 pandemic effect on the prehospital Madrid stroke code metrics and diagnostic accuracy.

BACKGROUND: Only very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year. METHODS: This was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality. RESULTS: SUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value = <0.01). Diagnostic accuracy, and the proportion of patients treated with reperfusion therapies remained stable. In-hospital mortality decreased by 4% (p = 0.05). CONCLUSIONS: During the first wave, a prolongation of the time "on the scene" of the management of the 112 calls, and of the hospital admission was observed. Prehospital diagnostic accuracy and the proportion of patients treated at the hospital level with intravenous thrombolysis or mechanical thrombectomy were not altered with respect to the previous year, showing the resilience of the stroke network and the emergency medical service.

Asistencia compartida con Medicina Interna en un Servicio de Cirugía Plástica. Valoración de su influencia en la calidad asistencial / Comanagement with Internal Medicine in a Plastic Surgery Service. Assessment of its influence on care quality

Introducción y objetivo: La edad y comorbilidad de los pacientes ingresados en Cirugía Plástica están aumentando, lo que a su vez incrementa las interconsultas a Medicina Interna que no alcanzan la efectividad requerida. Una alternativa es la asistencia compartida: responsabilidad y autoridad compartidas entre dos especialistas en el manejo de un paciente hospitalizado.Estudiamos el efecto de la asistencia compartida en Cirugía Plástica.Material y método.Estudio observacional retrospectivo de los pacientes ≥16 años ingresados desde el 17/10/2017 hasta el 31/12/2019 en el Servicio de Cirugía Plástica del Hospital Ramón y Cajal en Madrid, España, con asistencia compartida con Medicina Interna desde el 17/10/2018. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson, exitus, reingresos urgentes y estancia hospitalaria.Resultados.Los pacientes con asistencia compartida fueron de mayor edad (2.2 años, IC 95% 0.2 a 4.1), mayor Charlson (1.3; IC 95% 0.9 a 1.6), mayor número de diagnósticos (3.9; IC 95% 3.4 a 4.4) y mayor peso administrativo (0.17; IC 95% 0.08 a 0.27). Al ajustar, observamos que la asistencia compartida redujo un 24.1% la estancia en Cirugía Plástica, -1.3 días (IC 95% -2.6 a -0.1), el 60% los reingresos urgentes (OR 0,4; IC 95% 0.2 a 0.9) y el 30% la mortalidad, esta no significativa. El descenso de la estancia supuso una disminución de costes de, como mínimo, 489.731,11€.Conclusiones.Los enfermos ingresados en Cirugía Plástica están aumentando su edad y comorbilidad. La asistencia compartida, en la que un internista además del cirujano plástico atiende a los pacientes igual a como se hace en la planta de Medicina Interna, se asocia, en nuestra experiencia, a una disminución de la estancia, los reingresos urgentes y los costes, en línea con lo observado en otros servicios quirúrgicos. (AU)

Background and objective: The age and comorbidity of patients admitted to Plastic Surgery are increasing, leading to increased consultations/referrals to Internal Medicine which do not reach the required effectiveness. An alternative is comanagement: shared responsibility and authority between two specialists in the management of a hospitalized patient.We study the effect of comanagement on Plastic Surgery.Methods.Retrospective observational study of patients ≥16 years old admitted in Plastic Surgery 17/10/2017 and 31/12/2019, with comanagement with Internal Medicine since 17/10/2018. We analyze age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of diagnoses at discharge, Charlson comorbidity index, deaths, urgent readmissions and length of stay.Results.Patients with comanagement were older (2.2 years, 95% CI 0.2 to 4.1), higher Charlson (1.3; 95% CI 0.9 to 1.6), higher number of diagnoses (3.9; 95% CI 3.4 to 4.4) and higher administrative weight (0.17; 95% CI 0.08 to 0.27). On adjustment, comanagement reduced Plastic Surgery length of stay by 24.1%, -1.3 days (95% CI -2.6 to -0.1), 60% urgent readmissions (OR 0.4; 95% CI 0.2 to 0.9) and 30% mortality, not significant. The decrease in length of stay implies a Plastic Surgery savings of at least € 489.731,11.Conclusions.Patients admitted to Plastic Surgery are increasing in age and comorbidity. Comanagement in which an internist in addition to the plastic surgeon treats patients just as he does in the Internal Medicine ward, is associated, in our experience, with reduced length of stay and costs similar to those observed in other surgical services. (AU)

Resultados de la asistencia compartida con medicina interna en un servicio de cirugía oral y maxilofacial / Results of comanagement with internal medicine in oral and maxillofacial surgery department

ANTECEDENTES Y OBJETIVO: La edad de los pacientes ingresados para tratamiento por los servicios de cirugía oral y maxilofacial (COMF) es progresivamente más alta, con la comorbilidad asociada que eso conlleva, y supone un incremento sustancial de las interconsultas a los servicios de medicina interna (MI), que no alcanzan la efectividad requerida. Una alternativa para mejorar la atención a los pacientes es la colaboración entre ambos servicios mediante la asistencia compartida (AC). El objetivo de este artículo es estudiar la repercusión y el efecto del empleo de la AC en los pacientes de COMF. MÉTODOS: Estudio observacional retrospectivo de los pacientes ≥ 16 años ingresados desde el 12 de marzo de 2017 hasta el 12 de marzo de 2019 en COMF, con AC con MI desde el 12 de marzo de 2018. Las variables analizadas son edad, sexo, tipo de ingreso, si fue intervenido quirúrgicamente, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), exitus, reingresos urgentes y estancia hospitalaria. RESULTADOS: Los pacientes con AC fueron de menor edad (2,8 años, intervalo de confianza del 95 % [IC 95 %] 0,1 a 5,6), pero con mayor número de diagnósticos (0,8; IC 95 % 0,4 a 1,2) y una tendencia a mayor ICh (0,3; IC 95 % -0,1 a 0,6) y peso administrativo (0,04; IC 95 % -0,03 a 0,1). Al ajustar, observamos que la AC redujo el 22,7 % la estancia en CMF, 1 día (IC 95 % -1,8 a -0,3), el 40 % los reingresos urgentes y el 50 % la mortalidad, ambos no significativos. El descenso de la estancia supone una disminución de costes de, como mínimo, 231.816,7 €. CONCLUSIONES: La edad de los enfermos ingresados para tratamiento por los servicios de cirugía oral y maxilofacial es cada vez más alta, que se asocia con una mayor comorbilidad. El empleo de la asistencia compartida con medicina interna en el manejo de los pacientes ingresados en cirugía oral y maxilofacial se asocia a una disminución de la estancia y los costes, en línea con lo observado en otros servicios quirúrgicos

BACKGROUND AND OBJECTIVE: The age of patients admitted for treatment by Oral and Maxillofacial Surgery (OMFS) services is progressively higher, with the associated comorbidity that this entails, and supposes a substantial increase in referrals to the Internal Medicine (IM) services, which do not reach the required effectiveness. An alternative to improve patient care is collaboration between both services through shared care (SC). The objective of this article is to study the repercussion and effect of the use of shared care in Oral and Maxillofacial patients. METHODS: Retrospective observational study of patients aged ≥ 16 years admitted from 3/12/2017 to 3/12/2019 at OMFS, with SC with IM from 3/12/2018. The variables analyzed are age, sex, type of admission, whether the patient underwent surgery, administrative weight associated with DRG, total number of diagnoses at discharge, Charlson's comorbidity index (HCI), death, urgent readmissions and hospital stay. RESULTS: Patients with AC were younger (2.8 years, 95 % confidence interval [95 % CI] 0.1 to 5.6), but with a greater number of diagnoses (0.8, 95 % CI 0.4 to 1.2) and a trend towards higher CIh (0.3; 95 % CI -0.1 to 0.6) and administrative weight (0.04; 95 % CI -0.03 to 0.1 ). When adjusting, we observed that CA reduced the stay in the CMF by 22.7 %, 1 day (CI 95 % -1.8 to -0.3), 40 % the urgent readmissions and 50 % the mortality, both not significant. The decrease in the stay implies a reduction in costs of, at least, € 231,816.7. CONCLUSIONS: The age of patients admitted for treatment by Oral and Maxillofacial Surgery services is increasingly higher, which is associated with greater comorbidity. The use of shared care with Internal Medicine in the management of patients admitted to Oral and Maxillofacial Surgery is associated with a decrease in stay and costs, in line with what was observed in other surgical services

Respuesta a «Cómo limitar los sesgos en estudios cuasiexperimentales» / Reply to "How to limit bias in quasiexperimental studies"

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Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular / Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection

INTRODUCCIÓN: Existe un creciente aumento de las infecciones de prótesis articular (IPA) por bacterias resistentes a las cefalosporinas utilizadas en la profilaxis quirúrgica. La sustitución de estas por glucopéptidos no ha demostrado mejorar los resultados pero sí su asociación. MÉTODOS: Estudio comparativo de la asociación de teicoplanina y cefazolina antes de la cirugía de artroplastia frente a cefazolina sola de un grupo control previo. RESULTADOS: En el periodo control hubo 16 IPA de 585 cirugías, mientras que en el grupo de intervención fueron 6 de 579 (incidencia 2,7% vs. 1,03%; RR 0,4, p = 0,04). En el grupo control, 11 de las infecciones fueron causadas por bacterias grampositivas frente a 4 en el de intervención (1,8% vs. 0,7%, p = 0,08). CONCLUSIONES: La adición de teicoplanina a cefazolina en la profilaxis de la cirugía de artroplastia se asoció a una reducción de la incidencia de IPA, a expensas de un descenso de las causadas por grampositivos

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P = .04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P = .08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria

Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection. / Profilaxis dual con teicoplanina añadida a cefazolina en la prevención de la infección de prótesis articular.

INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P=.04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P=.08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria.

El problema de la fragmentación de la medicina hospitalaria / The problem of the fragmentation of hospital medicine

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Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología / Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology

Introducción y objetivos: Los pacientes ingresados en el Servicio de Otorrinolaringología (ORL) están aumentando en edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en ORL. Métodos: Estudio observacional retrospectivo de los pacientes ≥ 14 años ingresados desde el 1 de enero del 2009 hasta el 30 de junio del 2013 en ORL; desde mayo del 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), defunción, reingresos y estancia hospitalaria. Resultados: Los pacientes con AC fueron de mayor edad (4,5 años, intervalo de confianza del 95% [IC del 95%], 2,8 a 6,3), con más ingresos urgentes (odds ratio [OR] 1,4; IC del 95%, 1,1 a 1,8), mayor peso administrativo (0,3637; IC del 95%, 0,0710 a 0,6564), mayor número de diagnósticos (1,3; IC del 95%, 1 a 1,6), ICh (0,4; IC del 95%, 0,2 a 0,6) y también de defunción (OR 4,1; IC del 95%, 1,1 a 15,7). Al ajustar, observamos que la AC redujo el 28,6% la estancia en ORL, 0,8 días (IC del 95%, 0,1 a 1,6; p = 0,038). Este descenso supone un ahorro, al menos, de 165.893 Euros. Conclusiones: Los enfermos ingresados en ORL están aumentando su edad, comorbilidad y complejidad. La AC se asocia a una disminución de la estancia y los costes en ORL, similares a lo observado en otros servicios quirúrgicos (AU)

Introduction and objectives: Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. Methods: This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. Results: There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least Euros 165,893. Conclusions: Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-manage (AU)

Asistencia compartida (comanagement) con Medicina Interna en el Servicio de Ginecología / Comanagement with Internal Medicine in a Gynecology Department

Objetivo. Las pacientes hospitalizadas en Ginecología están aumentando su edad y complejidad, dificultando la labor de los ginecólogos. Estudiamos el efecto de la asistencia compartida (AC) con Medicina Interna (MI) sobre la estancia hospitalaria de las enfermas ingresadas en Ginecología. Material y método. Comparamos las pacientes ≥ 14 años dadas de alta de Ginecología en 2013, con AC con MI, con las del 2012, sin AC. Analizamos edad, ingreso urgente, cirugía sí/no, peso administrativo, número total de diagnósticos, índice de comorbilidad de Charlson (ICh), estancia hospitalaria, fallecimiento y reingresos. Resultados. En el año 2013 observamos incrementos del 20,6% en el número de diagnósticos y del 46,2% en el ICh. La estancia media ajustada se redujo en 0,5 días (IC 95% 0,2 a 0,7; p < 0,001). Conclusiones. La AC con MI se asocia a una disminución de la estancia media en Ginecología, en línea con lo observado en otros servicios quirúrgicos (AU)

Objective. There has been an increase in the age and complexity of patients hospitalized in gynecology departments, which has affected the work of gynecologists. We studied the effect of comanagement (CM) with Internal Medicine (IM) on hospital stay among gynecology inpatients. Material and methods. We compared patients aged ≥ 14 years old discharged from the gynecology department in 2013 who underwent CM with IM with patients who did not undergo CM and who were discharged in 2012. We analyzed age, emergency admission, surgery yes/no, administrative weight, number of diagnoses, the Charlson comorbidity index (CCI), hospital stay, fallecimiento, and readmissions. Results. In 2013, we observed increases of 20.6% in the number of diagnoses and of 46.2% in the CCI. The adjusted length of stay was reduced by 0.5 days (95% CI 0.2 to 0.7; p < 0.001). Conclusions. CM with IM is associated with a decrease in length of stay in gynecology, in line with that observed in other surgical departments (AU)

¿Tienen los cirujanos más dificultades en la atención de los pacientes hospitalizados no intervenidos respecto a los intervenidos? / Do surgeons have more difficulties in the hospital care of non-surgery patients than with surgery patients?

OBJETIVO: Un porcentaje variable de los enfermos ingresados en los servicios quirúrgicos no son operados por diversas razones. Nuestro objetivo es comprobar si los cirujanos tienen más dificultades en la atención de los pacientes ingresados no operados que en los operados. MATERIAL Y MÉTODOS: Hemos incluido a todos los pacientes de edad ≥ 14 años dados de alta el año 2010 de Cirugía General, Ginecología, Urología y Otorrinolaringología. Las variables principales fueron la estancia, mortalidad, reingresos y número de interconsultas solicitadas a servicios médicos. Las variables secundarias: edad, sexo, número de ingresos urgentes, número total de diagnósticos y el índice de comorbilidad de Charlson (ICh). RESULTADOS: Entre el 8,7 y el 22,8% de los pacientes ingresados en estos servicios no son operados. Los pacientes no operados tienen significativamente mayores estancia, mortalidad, reingresos y solicitudes de interconsultas que los operados, con significativamente mayores edad (excepto Urología), número de diagnósticos, ingresos urgentes e ICh (excepto Urología). CONCLUSIONES: Los pacientes ingresados en los servicios quirúrgicos que no son operados tienen mayor mortalidad, reingresos y solicitudes de interconsultas que los operados, probablemente por su mayor complejidad médica y urgencia del ingreso. Ello podría indicar una mayor dificultad en su manejo por parte de los cirujanos

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons

Resultados de una intervención de descolonización de Staphylococcus aureusen pacientes portadores a los que se indica una prótesis articular / Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty

INTRODUCCIÓN: La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus. MATERIAL Y MÉTODOS: Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010. RESULTADOS: En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de de IPA por S.aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04). CONCLUSIÓN: En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S.aureus consiguió un descenso significativo de la incidencia de IPA por S.aureus respecto a un control histórico

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S. aureuscarriers helps to reduce the incidence of PJI by S. aureus. MATERIAL AND METHODS: An S. aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S. aureuscompared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P = .04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group

[Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty]. / Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular.

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus. MATERIAL AND METHODS: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010. RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.

DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients?

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons.

Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.

INTRODUCTION AND OBJECTIVES: Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. METHODS: This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. RESULTS: There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893. CONCLUSIONS: Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services.

Respuesta: Acerca de la interconsulta médica / Reply: About medical interconsultation

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Pacientes quirúrgicos ingresados: asistencia compartida con Medicina Interna / Hospitalized surgical patients comanaged by Internal Medicine specialists

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