Trastornos por consumo de alcohol y neumonía neumocócica adquirida en la comunidad: mortalidad atribuible, prolongación de estancias y sobrecostes hospitalarios / Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending

Introducción: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en las neumonías neumocócicas adquiridas en la comunidad (NNAC), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes que presentaron NNAC 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, los trastornos adictivos y las comorbilidades. Resultados: Se estudiaron 16.202 ingresos urgentes por NNAC de 18 a 74años de edad, entre los cuales hubo 2.685 pacientes con TCA. Los ingresos con NNAC y TCA fueron predominantemente varones, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con NNAC y TCA presentaron importantes excesos de mortalidad (50,8%; IC95%: 44,3-54,3%), prolongación indebida de estancias (2,3 días; IC 95%: 2,0-2,7 días) y sobrecostes (1.869,2 Euros; IC95%: 1.498,6-2.239,8 Euros). Conclusiones: De acuerdo con los resultados de este estudio, los TCA en pacientes con NNAC aumentan significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes

Introduction: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Methods: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Results: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3 days; CI95%: 2.0-2.7 days) and increased costs (1,869.2 Euros; CI95%: 1,498.6-2,239.8 Euros). Conclusions: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending

Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending.

INTRODUCTION: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. METHODS: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. RESULTS: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). CONCLUSIONS: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino / Analysis of two strategies for the management of threatened preterm labor

Objetivo. Comparar dos formas de abordar el trabajo prematuro de parto. La primera basándonos exclusivamente en criterios clínicos y la segunda empleando como herramientas auxiliares la prueba de la fibronectina y la longitud cervical por ecografía vaginal. Material y métodos. Estudio comparativo de ambas estrategias, enfatizando en costes hospitalarios y resultados perinatales. Para el grupo de estudio, en el que empleábamos ambos marcadores para seleccionar a las mujeres de mayor riesgo, empleamos un grupo prospectivo de 122 gestantes que acudieron de urgencia por amenaza de parto pretérmino (APP), y el grupo control (n=112) formado con una cohorte histórica de gestantes ingresadas por APP. Las gestantes catalogadas como de riesgo bajo para tener un parto prematuro eran dadas de alta en urgencias y controladas de forma ambulatoria. Se estimaron los valores predictivos de ambas pruebas y los resultados medidos fueron la tasa de prematuridad, las complicaciones neonatales, los días de hospitalización y los costes hospitalarios resultantes de la hospitalización, la medicación y las visitas posteriores. Resultados. Los resultados perinatales y las tasas de prematuridad en ambos grupos eran comparables. El uso de los tocolíticos y corticoides se redujo al emplear ambos marcadores. La estancia hospitalaria mediana fue 0 en el grupo de estudio (2,6 días cuando eran hospitalizadas), frente a 5 días en el grupo control. Los costes hospitalarios por paciente fueron de 446.24 € en el grupo de estudio (rango intercuartílico (IQ) 1.390,08) y de 1.634,04 € (IQ 1.092,65) en el grupo control. Conclusiones. Empleando estas técnicas para el diagnóstico del verdadero trabajo prematuro de parto, y obteniendo resultados perinatales comparables, no está justificado el tratamiento universal de aquellas gestantes que consultan de urgencia por APP. Esta estrategia puede conducirnos a un ahorro aproximado de 1.200 € por gestante (AU)

Objective. To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound. Material and methods. We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n=112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits. Results. Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group. Conclusions. Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient (AU)