Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis.

BACKGROUND: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. OBJECTIVES: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. METHODS: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients' arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals' structural costs for each patient (each hospital's tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). RESULTS: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals' structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. CONCLUSIONS: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.

[Influence of Clinical Practice Guidelines on the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis. Data from the Registry of the Spanish Society of Pulmonology and Thoracic Surgery]. / Influencia de las guías de práctica clínica en el diagnóstico y tratamiento de la fibrosis pulmonar idiopática. Datos del Registro de la Sociedad Española de Neumología y Cirugía Torácica.

Objective: The objective of the study was to analyze the diagnostic process and the time until the start of treatment of patients with idiopathic pulmonary fibrosis in relation to the publication of successive clinical practice guide. Material and methods: Multicenter, observational, ambispective study, in which patients includes in the idiopathic pulmonary fibrosis registry of the Spanish Society of Pulmonologist and Thoracic Surgery were analyzed. An electronic data collection notebook was enabled on the society's website. Sociodemographic and clinical variables were collected at diagnosis and follow-up of the patients. Results: From January 2012 to december 2019, 1064 patients were included in the registry, with 929 finally analyzed. The diagnosis process varied depending on the year in which it was performed, and the radiological pattern observed in the high-resolution computed tomography. Up to 26.3% of the cases (244) were diagnosed with chest high-resolution computed tomography and clinical evaluation. Surgical biopsy was used up to 50.2% of cases diagnosed before 2011, while it has been used in 14.2% since 2018. The median time from the onset of symptoms to diagnosis was 360 days (IQR 120-720), taking more than 2 years in the 21.0% of patients. A percentage of 79.4 of patients received antifibrotic treatment. The average time from diagnosis to the antifibrotic treatment has been 309 ± 596.5 days, with a median of 49 (IQR 0-307). Conclusions: The diagnostic process, including the time until diagnosis and the type of test used, has changed from 2011 to 2019, probably due to advances in clinical research and the publication of diagnostic-therapeutic consensus guidelines.

Analysis of solitary pulmonary nodule after surgical resection in patients with 18F-FDG positron emission tomography integrated computed tomography in the preoperative work-up. / Análisis del nódulo pulmonar solitario tras su resección quirúrgica en pacientes con 18F-FDG PET-TC integrado en el estudio preoperatorio.

INTRODUCTION: To analyse clinicopathological characteristics of patients operated for pulmonary solitary nodule (PSN) and 18F-FDG integrated PET-CT scan after surgical resection. METHODOLOGY: Retrospective study on a prospective database of patients operated from January 2007 to October 2017 for PSN without preoperative diagnosis. Dependent variable was anatomopathological result (benign vs malignant) of PSN. Variables of the study were: age, sex, PET-CT uptake, SUVmax, smoking history, COPD, previous history of malignant disease, tumoral location, and tumour size on CT-scan. RESULTS: A total of 305 patients were included in this study, 225 (73.8%) men, 80 (26.2%) women, mean age = 63.9 (range 29-86 years), mean size PSN = 1.68 (s.d. .65 cm), benign = 46 (15.1%), malignant = 258 (84.6%), type of resection: pulmonary wedge = 151 (49.5%), lobectomy = 141 (46.2%), segmentectomy = 12 (3.9%), exploratory intervention = 1 (0.3%). Postoperative mortality was 1.9%. COPD = 50.8% cases, previous cancer disease = 172 cases (56.4%), smoking history = 250 cases (82.0%), positive PET = 280 cases (91.8%), PSN in upper pulmonary fields = 204 cases (66.9%), median SUVmax = 3.4 (range 0-20.7). Backward stepwise binary logistic regression model showed that age, SUVmax, previous malignant disease and female sex were independent risk factors with statistical significance (p < .05). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94.6%, 23.4%, 87.1%, 44.0%, and 83.6% respectively. There were 14 false negative cases (4.6%) and 36 false positive cases (11.8%). CONCLUSIONS: Age, SUVmax, previous malignant disease, and female sex were independent risk factors in our study. Each case should be individually evaluated in a multidisciplinary committee, and the patient's preferences or concerns should be kept in mind in decision-making. Surgical resection of PSN is not exempt from morbidity and mortality, even in sublobar or pulmonary wedge resection.

[Obstructive sleep apnoea syndrome]. / Síndrome de apneas-hipopneas durante el sueño.

INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. PATIENTS AND METHODS: Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. RESULTS: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. CONCLUSIONS: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight.