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Effect of Comanagement With Internal Medicine on Hospital Stay of Patients Admitted to the Service of Otolaryngology
Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología
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class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Improvements in anaesthesiological and surgical techniques and procedures are leading to an increased amount of surgical interventions being performed on patients of greater age and with comorbidities.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Furthermore, the development of outpatient surgery and short hospital stays means that many patients are not admitted to hospital for operations or are only admitted for a short period. As a result, the patients who are being hospitalised in surgical departments are increasing in age, comorbidity and complexity making the surgeons’ job more difficult, particularly on the ward, due to medical pathologies and polymedication, among other factors. This difficulty makes greater cooperation necessary between medical departments in the care of patients who have undergone surgery and this in turn leads to an increase in requests for medical consultations/referrals, in particular to Internal Medicine<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> (IM); this is not an efficient way of functioning.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although there is very little available information on these issues with regards to the Otorhinolaryngology Department (ENT), this department is also experiencing increasing difficulties in managing its patients and making more requests for IM consultations/referrals. Up to 17.4% of consultations/referrals received by IM are from the area of ENT surgery.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> According to the literature, alcohol y and tobacco are implicated in 75% of patients with head and neck cancer, with a high percentage of disease processes related to them.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> 60%–75% of these patients have concomitant diseases,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5,6</span></a> 20% with serious comorbidity; these diseases increase with age<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> and are most commonly cardio-respiratory and metabolic.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> Comorbidity is a clear prognostic factor of mortality in these patients<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–6</span></a>; the number of complications also increases, as does their severity, and hospital stay.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">An alternative to consultations/referrals is co-management (CM). This is gradually expanding, particularly in large surgical departments and has proven to be highly effective in our environment.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> This health care model was recently proposed for patients with head and neck cancer.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> In May 2011 we started to collaborate in this way with ENT, which is very different to other surgical departments in terms of characteristics and patient type. We have not been able to find any type of collaboration between IM and ENT comparable with that described in this article.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim is to study the effect of CM with IM on the hospital stay of patients admitted to ENT departments.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">There are currently 452 beds available in our hospital and we treat an almost exclusively urban population of 250<span class="elsevierStyleHsp" style=""></span>000 inhabitants. We teach at pre and post graduate level and the hospital is authorised to train medical and surgical resident doctors. The observational retrospective study included all patients ≥14 years of age, whether they had been operated on or not, who were admitted from 1st January 2009 until 30th June 2013 to the ENT ward, and these were divided into 2 groups for comparison: one without CM and the second with CM with IM. During this period, this department's activity did not significantly vary in organisation, with the only exception of CM with MI initiated on 18th May 2011.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The ENT department has been increasing the number of surgical procedures performed using major outpatient surgery; to be specific, most otological, rhinological, pharyngeal procedures and oncological pharyngolaryngeal surgery using CO<span class="elsevierStyleInf">2</span> laser are carried out in this way. The result is that at present it is mainly patients with head and neck pathologies who are hospitalised, the majority of whom require oncological procedures with external approaches to remove tumours, with or without reconstructive surgery. Furthermore, in recent years protocols have been put in place for the preservation of organs in oncological processes with the result that at present only those patients requiring rescue surgery are operated on, or those for whom chemo or radiotherapy is contraindicated. Due to the above, the complexity of hospitalised patients in the ENT department has increased. Patients hospitalised in the ENT department during the period analysed between 2009 and 2013 met with all the above-mentioned characteristics.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To sum up, CM requires all patients<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> to be cared for by internists for the their entire period of hospitalisation in the ENT department, exactly as occurs in IM wards: taking the patient's clinical history and physical examination, requesting complementary tests and prescribing treatment, which the internists can do freely but in coordination with ENT surgeons. Internists never participate in decisions on hospital admission decisions or indication for surgery; these are exclusively the domain of the ENT surgeons.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The variables analysed were: age, sex, emergency hospital admission, whether the patient had been operated on or not, the administrative weight associated with the DRG, total number of diagnoses, the Charlson comorbidity index (CCI), which is validated for use with administrative databases,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> adjusted by updated ages and weights,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> hospital stay, deaths and re-admissions in under 15 days for any reason and in any unit. The data were obtained from our hospital's minimum basic data set, which accepts up to 13 diagnoses coded according to the ICD-9-CM code. In 2010 the total average cost per day of stay in our hospital was 1490€ for ENT and 323€ for IM.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">We describe the age, stay, administrative weight, number of diagnoses and CCI with the mean and confidence interval of 95% (CI of 95%). The other variables, which are all qualitative, are described using percentages and their 95% confidence interval. Control variables were all those gathered from the study, with the exception of stay (study variable). We considered a precision of ±5 hundredths as sufficient for the type of work and the clinical nature of the findings, which we rounded down to a decimal, with the exception of the administrative weight which we kept at 4 decimals. The mean deviation between both groups was studied with the Student's “<span class="elsevierStyleItalic">t</span>” Test. The other variables were analysed using the odds ratio (OR). We adjusted stay with a multiple linear regression model. The variables were included in the model using the step-wise regression method. The inclusion and exclusion criteria of the variables in the model were fixed at <span class="elsevierStyleItalic">P</span><.05 for inclusion and <span class="elsevierStyleItalic">P</span>>.10 for exclusion. The final model was selected using the criterion of the square of the multiple adjusted correlation coefficient. The value of statistical significance was established at <span class="elsevierStyleItalic">P</span><.05. Statistical analysis was performed using the SPSS 15.0 (SPSS Inc. Chicago, U.S.A.) statistical package.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the study period, the ENT unit admitted a total of 1629 patients ≥14years of age. In the group with CM we observed an increase of 9.9% in age, 14.7% in emergency hospital admission, 27.9% in administrative weight, 48.1% in number of diagnoses and 33.3% in CCI (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Mortality increased in this group, although hospital stay did not decrease, as this was 15.6 days for the patients who died. When statistical adjustment was made with the significant variables in the univariate analysis, the mean stay, which in the data without adjustment was 0.7 days higher in the group with CM, reduced to 0.8 days (CI of 95%, 0.1 to 1.6; <span class="elsevierStyleItalic">P</span>=.038), a reduction of 28.6%.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Using the cost of a stay in IM, which is the most economical, as the benchmark, the reduction in mean stay achieved with CM relates to a reduction in costs: 642 patients×0.8 stays avoided×323€=165<span class="elsevierStyleHsp" style=""></span>893€, during the study period with CM, a little more than 25 months.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Our results show that patients admitted into ENT are increasing in age, comorbidity and complexity, and that CM with IM relates to a reduction in hospital stay, which leads to a major drop in costs. The hospital stay study is of interest since, among other things, it is a good indicator of adverse events<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> and health care costs.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">There are several reasons to explain these findings. CM with IM reduces stay, mortality and readmission, among other health care parameters, in surgical patients,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> probably because their clinical history is one of the most likely factors to lead to complications in surgical patients.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Moreover, failure to rescue (delay in diagnosis and/or treatment of a postoperative complication once it has occurred) is fundamental to results<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> and mortality.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> In this regard, the daily work of internists may be of vital importance. At least 88% of patients admitted to surgical wards could benefit from CM with IM.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Mortality and readmission, partly conditioned by premature discharge, may have an impact on hospital stay. Although there is an increase in mortality in the group with CM, it did not affect hospital stay, since these were patients whose stay was longer than the mean. By contrast, readmissions did not increase. Internist intervention helps the patient to leave hospital in a better condition and with fewer probabilities of being readmitted. We must bear in mind that 72.6% of surgical patients were readmitted for medical reasons.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">This study has its limitations. The type of design using historic controls implies a risk of bias due to the extensive period of study (period effect), amongst others. In our case, it meant that the patients with CM with IM were more complex and had greater comorbidity. Another limitation is that the study refers to a single hospital; therefore our results must be confirmed in other hospitals and under other conditions. An additional disadvantage is that we have not found any documented references with which to compare our results.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">CM with IM is associated with reduced mean stay and costs in relation to ENT, in line with what has already been observed in other surgical departments. CM with IM is a health care organisation model with good results in ENT.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres562525" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec579107" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres562524" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec579108" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-30" "fechaAceptado" => "2014-09-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec579107" "palabras" => array:4 [ 0 => "Referral and consultation" 1 => "Co-management" 2 => "Otolaryngology" 3 => "Internal medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec579108" "palabras" => array:4 [ 0 => "Remisión y consulta" 1 => "Asistencia compartida" 2 => "Otorrinolaringología" 3 => "Medicina Interna" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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%; <span class="elsevierStyleItalic">P</span>=.038). This reduction represents an ENT savings of at least €165<span class="elsevierStyleHsp" style=""></span>893.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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 <span class="elsevierStyleItalic">(odds ratio</span> [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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,038). Este descenso supone un ahorro, al menos, de 165.893 €.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Montero Ruiz E, Rebollar Merino Á, Rivera Rodríguez T, García Sánchez M, Agudo Alonso R, Barbero Allende JM. Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología. Acta Otorrinolaringol Esp. 2015;66:264–268.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CM: co-management; Dif: difference; 95% CI: confidence interval of 95%; CCI: Charlson comorbidity index; n.s: not significant; OR: odds ratio; SS: statistical significance.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Without CM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">With CM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dif/OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SE \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1629 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">642 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.1 (46.3–48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.3 (44.2–46.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.9 (48.5–51.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 (2.8–6.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Woman (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.8 (39.4–44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.4 (38.4–44.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.4 (38.5–46.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">OR 1 (0.8–1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n.s. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emergency hospital admission (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.5 (13.7–17.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 (11.6–15.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.1 (15.1–21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">OR 1.4 (1.1–1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Operated (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.1 (84.4–87.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.2 (83–87.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.4 (84.8–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">OR 1.2 (0.9–1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n.s. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Administrative weight (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4470 (1.3037–1.5902) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3037 (1.1337–1.4736) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6674 (1.4150–1.9197) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3637 (0.0710–0.6564) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. diagnosed (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 (3.1–3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (2.6–2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3.8–4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (1–1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CCI (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 (1.3–1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (1.1–1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 (1.5–1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 (0.2–0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Death (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 (0.3–1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 (0–0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (0.4–2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">OR 4.1 (1.1–15.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Re-admission (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 (2.1–3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 (1.8–3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.6–4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">OR 1 (0.6–1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n.s. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stay (days; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (2.6––3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 (2.2–3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (2.8–4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 (−0.2 to 1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n.s. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911654.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Results.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores que influyen en la solicitud de interconsultas a medicina interna por los servicios quirúrgicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Montero Ruiz" 1 => "L. Pérez Sánchez" 2 => "C. Gómez Ayerbe" 3 => "J.M. Barbero Allende" 4 => "M. García Sánchez" 5 => "J. López Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2010.12.008" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2011" "volumen" => "89" "paginaInicial" => "106" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21277571" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0100" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La interconsulta médica: problemas y soluciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Montero Ruiz" 1 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2021 March | 0 | 6 | 6 |
| 2021 January | 0 | 7 | 7 |
| 2020 December | 0 | 2 | 2 |
| 2020 November | 0 | 2 | 2 |
| 2020 September | 0 | 2 | 2 |
| 2020 August | 0 | 2 | 2 |
| 2020 July | 0 | 1 | 1 |
| 2020 June | 0 | 1 | 1 |
| 2020 March | 11 | 2 | 13 |
| 2020 February | 12 | 6 | 18 |
| 2020 January | 25 | 5 | 30 |
| 2019 December | 28 | 6 | 34 |
| 2019 November | 7 | 3 | 10 |
| 2019 October | 21 | 10 | 31 |
| 2019 September | 10 | 10 | 20 |
| 2019 August | 14 | 3 | 17 |
| 2019 July | 15 | 14 | 29 |
| 2019 June | 46 | 19 | 65 |
| 2019 May | 92 | 50 | 142 |
| 2019 April | 26 | 20 | 46 |
| 2019 March | 6 | 8 | 14 |
| 2019 February | 11 | 3 | 14 |
| 2019 January | 4 | 2 | 6 |
| 2018 December | 9 | 2 | 11 |
| 2018 November | 12 | 5 | 17 |
| 2018 October | 12 | 2 | 14 |
| 2018 April | 1 | 0 | 1 |
| 2018 March | 5 | 3 | 8 |
| 2018 February | 5 | 3 | 8 |
| 2018 January | 3 | 1 | 4 |
| 2017 December | 9 | 2 | 11 |
| 2017 November | 8 | 2 | 10 |
| 2017 October | 14 | 1 | 15 |
| 2017 September | 4 | 2 | 6 |
| 2017 August | 12 | 2 | 14 |
| 2017 July | 28 | 5 | 33 |
| 2017 June | 7 | 3 | 10 |
| 2017 May | 27 | 2 | 29 |
| 2017 April | 16 | 3 | 19 |
| 2017 March | 39 | 5 | 44 |
| 2017 February | 22 | 2 | 24 |
| 2017 January | 15 | 0 | 15 |
| 2016 December | 12 | 3 | 15 |
| 2016 November | 8 | 2 | 10 |
| 2016 October | 14 | 7 | 21 |
| 2016 September | 12 | 6 | 18 |
| 2016 August | 12 | 1 | 13 |
| 2016 July | 8 | 1 | 9 |
| 2016 June | 20 | 6 | 26 |
| 2016 May | 26 | 20 | 46 |
| 2016 April | 24 | 8 | 32 |
| 2016 March | 24 | 8 | 32 |
| 2016 February | 31 | 14 | 45 |
| 2016 January | 30 | 15 | 45 |
| 2015 December | 38 | 16 | 54 |
| 2015 November | 36 | 15 | 51 |
| 2015 October | 59 | 25 | 84 |
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