Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014 / Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014

Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de "score" de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos "bajo riesgo", 7 a 12 puntos "mediano riesgo", 13 a 18 puntos "alto riesgo", desde 19 puntos como "máximo riesgo". Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Impacto de los programas de salud ERA y GES en la mortalidad por neumonía adquirida en la comunidad en personas de 65 años o más en Chile

[RESUMEN]. Objetivo. Evaluar el impacto del Programa de Enfermedades Respiratorias del Adulto (ERA) y el Régimen General de Garantías Explícitas en Salud (GES) en la mortalidad por neumonía adquirida en la comunidad (NAC) en personas de 65 años o más en Chile. Métodos. En este estudio ecológico se calcularon las tasas anuales y trimestrales de mortalidad por NAC en personas de 65 a 79 años y de 80 años o más entre 1990 y 2014. Las fuentes de información fueron las bases de datos del Departamento de Estadística e Información de Salud y del Instituto Nacional de Estadística de Chile. Como intervenciones se evaluó el Programa ERA (puesto en marcha en el 2001) y la inclusión de la NAC en el GES (a partir del 2005). Los datos se analizaron mediante el método de series de tiempo interrumpidas, según el modelo de Prais-Winsten. Se consideró un nivel de significación del 5%. Resultados. El análisis mostró que después del inicio del programa ERA se observaron disminuciones significativas de la tasa de mortalidad por NAC en los dos grupos de edad estudiados, mientras que a partir de la incorporación de la NAC al programa GES no se encontraron cambios estadísticamente significativos en esas tasas. Conclusiones. La implementación del programa ERA contribuyó a reducir las tasas de mortalidad por NAC en personas de 65 años o más en Chile, no así la incorporación de la NAC al GES.

[ABSTRACT]. Objective. Evaluate the impact of the Adult Respiratory Diseases (ERA) Program and the General System of Explicit Health Guarantees (GES) on mortality from community-acquired pneumonia (CAP) in persons aged ≥65 years in Chile. Methods. In this ecological study, annual and quarterly mortality rates from CAP were calculated in persons aged 65 to 79 years and ≥80 years from 1990 to 2014. Information was gathered from the databases of Chile’s Department of Health Statistics and Information and its National Statistics Institute. The ERA Program (implemented in 2001) and the inclusion of CAP in the GES (starting in 2005) were evaluated as interventions. Data were analyzed using the interrupted time-series method, following the Prais-Winsten model, with a 5% significance level. Results. The analysis showed that after the ERA Program began, significant reductions in CAP mortality were observed in the two age groups studied, whereas after CAP was added to the GES program, no statistically significant changes were found in those rates. Conclusions. Implementation of the ERA Program helped to reduce CAP mortality in persons aged ≥65 years in Chile, whereas inclusion of CAP in the GES program did not.

[RESUMO]. Objetivo. Avaliar o efeito do Programa Enfermidades Respiratorias del Adulto (doenças respiratórias do adulto, ERA) e do Régimen General de Garantías Explícitas en Salud (regime geral de garantias explícitas em Saúde, GES) na mortalidade por pneumonia adquirida na comunidade (PAC) em indivíduos acima de 65 anos no Chile. Métodos. Estudo ecológico em que foram calculadas as taxas anuais e trimestrais de mortalidade por PAC em indivíduos de 65 a 79 anos e acima de 80 anos no período entre 1990 e 2014. Os dados foram obtidos dos bancos de dados do Departamento de Estatística e Informação em Saúde e do Instituto Nacional de Estatística do Chile. As intervenções avaliadas foram o Programa ERA (implantado em 2001) e a inclusão da PAC no GES (a partir de 2005). Os dados foram analisados com o método de séries temporais interrompidas segundo o modelo de Prais-Winsten. O nível de significância foi de 5%. Resultados. A análise demonstrou que, após a implantação do Programa ERA, houve uma redução significativa na taxa de mortalidade por PAC nas duas faixas etárias consideradas. Por outro lado, a inclusão da PAC no GES não teve efeito estatisticamente significativo na taxa de mortalidade. Conclusões. A implantação do Programa ERA contribuiu para reduzir a taxa de mortalidade por PAC em indivíduos acima de 65 anos no Chile, porém o mesmo não ocorreu com a inclusão da PAC no GES.

Cáncer de cabeza y cuello: validación de cuestionario QLQ-H& N35 / Head and neck cancer: validation of the QLQ-H& N35 quality of life questionnaire

Background: Head and neck cancer affects esthetic and anatomical parameters, causing pain and functional impotence, affecting vital functions such as eating and breathing, hampering the quality of life of patients. EORTCQLQ-C30 questionnaire with its supplementary module QLQ-H & N35 evaluates the quality of life of these patients. Aim: To statistically validate the QLQ-H & N35 questionnaire in patients with head and neck cancer. Material and Methods: In a cross-sectional study, we studied patients with head and neck cancer who attended a rehabilitation unit. Reliability was measured using Cronbach's α and validity was determined by the diagnostic efficiency of the QLQ-H & N35 scale as compared with the SF-36 quality of life survey. A Receiver Operational Characteristic (ROC) curve was generated. Results: The Cronbach's α global internal consistency of the questionnaire was > 0.70 and its discrimination capacity was 74.2%, which are considered acceptable. Conclusions: These results confirm the statistical validity of the QLQ-H & N35 questionnaire, specifically for patients with head and neck cancer in Chile.

Caracterización de pacientes hospitalizados con neoplasia activa y diagnóstico de enfermedad tromboembólica venosa mediante la puntuación de Khorana en el Instituto Nacional del Cáncer / Khorama score as a predictive tool for thromboembolic events in high risk patients

Background: There is an established relation between cancer and the development of thromboembolic venous disease. Khorana et al developed a predictive score using clinical characteristics and laboratory values to stratify patients according to their risk. Aim: To characterize using Khorana score, patients with active cancer and a diagnosis of thromboembolic disease during hospitalization in an oncology hospital. Material and Methods: Review of records of the pharmacy of the hospital, selecting patients who received heparin in therapeutic doses during their hospitalization. Using laboratory values available in the medical records, the Khorama score was calculated. Results: Twenty seven patients with thromboembolic events, aged 60 ± 2 years (56% males) were selected for the study. Eighty percent of them were catalogued in the intermediate and high risk group according to Khorana score. Conclusions: Khorana score is a simple scale that might be useful to establish early prophylactic measures in patients with high risk for thromboembolic events, especially those with cancer.

Quimiorradioterapia adyuvante en el cáncer gástrico resecado con intención curativa: análisis de supervivencia y toxicidad de pacientes tratados entre 1995 y 2003 en el Instituto Nacional del Cáncer, Chile / Results of adjuvant chemoradiation after curative surgery for gastric cancer: a retrospective study

Background: Survival rates after curative surgery for gastric cancer are disappointing. Therefore adjuvant therapeutic strategies are required. Aim: To analyze survival and side effects of treatment among gastric cancer patients treated with adjuvant chemo radiotherapy after curative resection of gastric adenocarcinoma. Material and methods: Retrospective review of medical records of 74 patients aged 20 to 74 years, treated with complete resection of gastric adenocarcinoma followed by adjuvant chemo radiation. Survival analysis was based on the records and information from the National Mortality Registry. Results: Five years survival fluctuated from 50 percent among patients in stage IB to 25 percent among those is stage IV. Significant acute toxicity was observed in 23 patients (31 percent). No patients died due to acute toxicity. Eleven patients (16.4 percent) developed significant late toxicity, with two possible deaths related to treatment. Conclusions: Postoperative chemo radiotherapy is feasible in our experience. Continues infusion of 5-fluoruracil is recommended to reduce toxicity.