Proyecto DUCMA 2.0. Puesta al día sobre la situación actual de las unidades de Cirugía Mayor Ambulatoria en España

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datos lejos de los aportados por otros pa&#237;ses de nuestro entorno<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Este porcentaje se denomina &#237;ndice de ambulatorizaci&#243;n &#40;IA&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> y mide la proporci&#243;n de los procedimientos quir&#250;rgicos realizados en CMA sobre el total de procedimientos quir&#250;rgicos &#40;ambulatorios y con ingreso&#41;&#44; permitiendo conocer el impacto de la actividad de la CMA sobre la actividad quir&#250;rgica total del hospital&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Para incrementar el IA es necesario conocer las caracter&#237;sticas y el funcionamiento de las unidades de Cirug&#237;a Mayor Ambulatoria &#40;UCMA&#41;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;7</span></a>&#46; Hay pocos datos reales sobre la situaci&#243;n actual de la CMA en Espa&#241;a y en las distintas comunidades aut&#243;nomas &#40;<span class="elsevierStyleSmallCaps">CC</span>&#46; AA&#46;&#41;&#44; a pesar de las cifras publicadas por el Ministerio<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;8&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La Asociaci&#243;n Espa&#241;ola de Cirug&#237;a Mayor Ambulatoria &#40;ASECMA&#41; puso en marcha el proyecto Directorio de Unidades de Cirug&#237;a Mayor Ambulatoria &#40;DUCMA&#41; en 2013&#44; estudio piloto para conocer la realidad de las UCMA en Espa&#241;a&#46; Participaron 38 UCMA&#44; una muestra poco representativa de la CMA de nuestro pa&#237;s&#46; Las conclusiones del estudio apuntaron que ser&#237;a recomendable redefinir las preguntas de la encuesta y seguir recopilando informaci&#243;n para ampliar la muestra<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ante la necesidad de una puesta al d&#237;a real sobre la situaci&#243;n actual de la CMA en nuestro pa&#237;s&#44; ASECMA impuls&#243; la iniciativa del proyecto DUCMA 2&#46;0&#44; cuyos objetivos fueron describir la estructura&#44; las caracter&#237;sticas y el funcionamiento de las UCMA en Espa&#241;a y&#44; de forma secundaria&#44; identificar diferencias en la actividad de CMA entre las distintas CC&#46; AA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se trata de un estudio observacional transversal multic&#233;ntrico basado en una encuesta electr&#243;nica&#46; Participaron todas las UCMA de Espa&#241;a que formalizaron su inscripci&#243;n en un registro&#46; Se envi&#243; una invitaci&#243;n por correo electr&#243;nico a todos los hospitales del Sistema Nacional de Salud censados en el Ministerio de Sanidad y en la base de datos de ASECMA&#46; Cada UCMA design&#243; un &#250;nico representante para cumplimentar la encuesta y no se establecieron criterios de exclusi&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La encuesta estuvo disponible para cumplimentar desde abril hasta septiembre de 2022 en la web del proyecto<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> Las respuestas de los participantes se volcaron a un cuaderno de recogida de datos electr&#243;nico&#46; En caso de haber respuestas incompletas o valores an&#243;malos&#44; se contact&#243; con el representante de la UCMA para resolver las discrepancias&#46; Se cerr&#243; la base de datos el 10 de octubre de 2022&#46; La encuesta comprendi&#243; 29 preguntas divididas en cinco bloques que se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se hizo con el programa SAS&#174; &#40;versi&#243;n 9&#44;4&#59; SAS Institute Inc&#46;&#44; Cary&#44; NC&#44; EE&#46; UU&#46;&#41;&#46; Las variables cualitativas se describieron mediante frecuencias absolutas y relativas&#44; y las variables cuantitativas&#44; mediante la media&#44; desviaci&#243;n t&#237;pica&#44; intervalo de confianza asociado a la media de 95&#37;&#44; mediana&#44; percentil 25&#44; percentil 75&#44; valor m&#237;nimo y valor m&#225;ximo&#46; Los datos ausentes &#40;<span class="elsevierStyleItalic">missing data</span>&#41; se consideraron perdidos&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Un total de 133 UCMA se registraron en la web del proyecto DUCMA y 90 cumplimentaron la encuesta &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Las CC&#46; AA&#46; con mayor representaci&#243;n fueron Catalu&#241;a &#40;n &#61; 22&#59; 24&#37;&#41;&#44; la Comunidad de Madrid &#40;n &#61; 14&#59; 16&#37;&#41; y Andaluc&#237;a &#40;n &#61; 12&#59; 13&#37;&#41;&#46; El resto de las comunidades que registraron al menos una UCMA ten&#237;an una representaci&#243;n menor de 6&#37; y ninguna UCMA de Murcia&#44; La Rioja&#44; Ceuta y Melilla registraron datos en el estudio&#46; Las UCMA participantes por CC&#46; AA&#46; se muestran en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Coordinaci&#243;n y organizaci&#243;n de la unidad</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a> muestran respectivamente los resultados de las variables cualitativas y cuantitativas utilizadas para evaluar la coordinaci&#243;n y la organizaci&#243;n de las UC&#59; 22 UCMA indicaron que reciben pacientes de atenci&#243;n primaria &#40;media de 29&#37;&#41;&#44; 89 que atienden pacientes derivados de especialistas quir&#250;rgicos &#40;media de 88&#37;&#41; y 29 que atienden pacientes derivados de especialidades no quir&#250;rgicas &#40;media de 15&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">El IA global de Espa&#241;a se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y las diferencias observadas entre las CC&#46; AA&#46; se exponen en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Valoraci&#243;n preoperatoria</span><p id="par0060" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra los resultados de las variables cuantitativas utilizadas para evaluar la valoraci&#243;n preoperatoria realizada en las UCMA&#44; as&#237; como las distintas especialidades integradas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Control del dolor</span><p id="par0065" class="elsevierStylePara elsevierViewall">Un total de 80&#37; pacientes indicaron que cuentan con protocolos de analgesia adaptados a los procedimientos quir&#250;rgicos&#46; Por otro lado&#44; todas las UCMA consideran la estabilidad hemodin&#225;mica un criterio necesario para el alta&#46; Otros de los criterios m&#225;s valorados son la hemorragia quir&#250;rgica m&#237;nima y la orientaci&#243;n t&#233;mporo-espacial &#40;98&#37; encuestados&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Calidad y formaci&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">De las 85 UCMA que contestaron las preguntas sobre la formaci&#243;n y los indicadores de calidad utilizados&#44; 51&#37; informaron que en su unidad se imparte formaci&#243;n espec&#237;fica para m&#233;dicos y 55&#37; la imparten para el personal de enfermer&#237;a&#46; En cuanto a los indicadores de calidad m&#225;s utilizados&#44; 87&#37; emplean la tasa de suspensiones&#47;cancelaciones&#44; 80&#37; la tasa de ingresos no previstos&#44; 78&#37; la llamada telef&#243;nica posoperatoria&#44; 69&#37; el &#237;ndice de sustituci&#243;n y 67&#37; la encuesta de calidad percibida por el paciente&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Seguimiento domiciliario</span><p id="par0075" class="elsevierStylePara elsevierViewall">De las 84 UCMA que respondieron estas preguntas&#44; 91&#37; indicaron que hacen seguimiento posoperatorio&#46; Entre ellas&#44; 93&#37; llaman al paciente por tel&#233;fono a las 24 horas&#44; y 12&#37; acuden personalmente a su domicilio&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los resultados del estudio DUCMA 2&#46;0 aportan una visi&#243;n general del estado actual de la CMA en Espa&#241;a&#44; definida por la Asociaci&#243;n Internacional de Cirug&#237;a Ambulatoria &#40;IAAS&#41; como aquella cirug&#237;a cuya alta tiene lugar el mismo d&#237;a laborable de la intervenci&#243;n&#44; quedando excluida la posibilidad de pernocta<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46; Incluir la posibilidad de pernocta falsea el concepto de CMA en los datos estad&#237;sticos<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> y esta circunstancia puede verse favorecida cuando se realiza cirug&#237;a de corta estancia &#40;con pernocta&#41;&#44; como sucede en 38&#37; de las UCMA del presente estudio&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La mayor&#237;a de UCMA participantes pertenecen a Hospitales Generales Universitarios de financiaci&#243;n p&#250;blica&#44; con una mediana de 5&#46;000 pacientes intervenidos y &#225;reas poblacionales de 300&#46;000 habitantes&#44; aunque la desviaci&#243;n t&#237;pica es amplia y se incluyen centros con &#225;reas de referencia entre 5&#46;000 y 1&#46;000&#44;000 de habitantes&#46; CC&#46; AA&#46;&#44; como Catalu&#241;a&#44; Madrid y Andaluc&#237;a&#44; est&#225;n ampliamente representadas&#44; pero no todas participaron en el estudio&#44; lo que genera un sesgo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La IAAS recomienda promocionar las unidades aut&#243;nomas o sat&#233;lites por ser m&#225;s coste-efectivas que las unidades integradas<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46; Sin embargo&#44; en nuestro pa&#237;s predominan las UCMA de tipo integrado &#40;52&#37;&#41;&#44; que comparten quir&#243;fanos en el bloque quir&#250;rgico central y con la cirug&#237;a en r&#233;gimen de hospitalizaci&#243;n convencional&#44; lo que incrementa las cancelaciones y puede desvirtuar el circuito&#44; punto importante a mejorar en el futuro&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Dos de cada tres coordinadores son anestesistas&#44; pero en 4&#37; de las UCMA la coordinaci&#243;n recae en el personal de enfermer&#237;a&#46; Este dato ya se constat&#243; en el estudio de 2013&#44; representando un aspecto innovador en la gesti&#243;n de las UCMA&#44; ya que&#44; en 18&#37; de las unidades evaluadas&#44; el personal de enfermer&#237;a era el encargado de autorizar el alta de los pacientes<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; Llama tambi&#233;n la atenci&#243;n la ausencia de autonom&#237;a de gesti&#243;n en cuanto a confecci&#243;n de la programaci&#243;n quir&#250;rgica &#40;67&#37;&#41;&#44; recursos humanos &#40;73&#37;&#41; y recursos materiales &#40;66&#37;&#41;&#44; lo que posiblemente derive del hecho de ser UCMA integradas&#46; Sin embargo&#44; 85&#37; de las UCMA se sienten apoyadas por la direcci&#243;n del centro&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Seg&#250;n la actividad global predomina Oftalmolog&#237;a &#40;36&#37;&#41;&#44; seguida de Cirug&#237;a General y del Aparato Digestivo &#40;18&#37;&#41;&#44; lo que coincide con la literatura<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;11</span></a>&#46; La derivaci&#243;n de pacientes se realiza mayoritariamente desde especialistas quir&#250;rgicos &#40;88&#37;&#41;&#44; aunque cabe destacar una derivaci&#243;n de 22&#37; desde primaria&#46; Este hecho puede deberse a experiencias de colaboraci&#243;n con esta&#44; como el Proyecto Kirubide<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a>&#46; De las UCMA analizadas&#44; 66&#37; realizan una llamada 24 horas antes de la intervenci&#243;n con fines de comprobaci&#243;n y dar indicaciones al paciente&#44; en l&#237;nea con los resultados de nuestro estudio previo<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Como aspecto fundamental&#44; nuestro IA fue de 63&#37;&#44; en contraste con 47&#44;6&#37; reportado por el Ministerio en 2021<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; Aunque es evidente que el IA denota c&#243;mo funciona un centro hospitalario y el sistema sanitario en general<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#44;6&#44;7</span></a>&#44; los datos divergen&#46; Esto puede deberse a c&#243;mo las distintas CC&#46; AA&#46; reportan los datos que luego procesa el Ministerio<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&#46; A pesar de un aumento progresivo de las cifras del Ministerio<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;8&#44;9&#44;13</span></a>&#44; seguimos lejos de otros pa&#237;ses de nuestro entorno&#44; como Dinamarca &#40;91&#37;&#41; o Noruega &#40;64&#37;&#41;&#44; aunque otros pa&#237;ses&#44; como Italia o Portugal&#44; s&#237; tienen IA pr&#243;ximos a 50&#160;&#37;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Estas diferencias son multifactoriales&#44; como los incentivos de los sistemas de financiaci&#243;n&#44; la organizaci&#243;n del sistema sanitario&#44; el entusiasmo de los equipos&#44; la satisfacci&#243;n de los pacientes y la propia recogida de datos<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#44;14&#44;15</span></a>&#46; Las razones de las divergencias entre el estudio DUCMA 2&#46;0 y las cifras del Ministerio deben buscarse en la forma de recogida de datos y el concepto real de CMA&#44; como ya se ha comentado&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Existe gran heterogeneidad entre las distintas CC&#46; AA&#46;&#44; tanto en nuestro estudio como en los datos oficiales&#46; Aceptando el posible sesgo del presente estudio&#44; las de mayor IA son Extremadura &#40;aunque &#250;nicamente incluy&#243; una UCMA&#41;&#44; el Pa&#237;s Vasco&#44; la Comunidad de Madrid y Andaluc&#237;a&#44; todas con valores superiores a 70&#37;&#44; mientras que las de menor IA son Navarra&#44; Arag&#243;n y Canarias&#44; esta &#250;ltima con 37&#37;&#46; Por su parte&#44; los datos del Ministerio de 2021<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> colocan IA m&#225;s altos a Catalu&#241;a&#44; la Comunidad de Madrid y La Rioja &#40;54&#44;4&#44; 52&#44;5 y 49&#44;8&#37;&#44; respectivamente&#41;&#44; y m&#225;s bajos a Castilla y Le&#243;n&#44; Extremadura y Arag&#243;n &#40;37&#44;9&#44; 36&#44;3 y 36&#44;0&#37;&#44; respectivamente&#41;&#44; de modo que las discordancias tambi&#233;n son evidentes&#46; En la pandemia por COVID-19 en 2020&#44; el IA fue menor que en 2019 &#40;disminuci&#243;n de la actividad quir&#250;rgica total de 25&#37; en hospitales p&#250;blicos y 17&#37; en privados&#41;&#44; pero la potenciaci&#243;n de la CMA con medidas estrictas de protecci&#243;n de pacientes y personal sanitario contribuy&#243; de forma esencial a paliar este descenso<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los criterios de alta utilizados se basan en escalas derivadas de la de Aldrete<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#46; En nuestro estudio&#44; 80&#37; de las UCMA dispone de protocolos de dolor&#44; y cuatro de cada cinco UCMA cuentan con protocolos de analgesia adaptados al tipo de intervenci&#243;n quir&#250;rgica&#46; Una atenci&#243;n insuficiente a este s&#237;ntoma puede condicionar efectos adversos importantes y un nivel bajo de satisfacci&#243;n de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;7</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La mitad de las UCMA imparten formaci&#243;n espec&#237;fica para m&#233;dicos o personal de enfermer&#237;a&#46; Estos datos confirman las observaciones del estudio de 2013 y muestran el margen de mejora<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; Es fundamental la formaci&#243;n de los facultativos y del personal de enfermer&#237;a&#44; para una mayor calidad asistencial<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El seguimiento domiciliario se realiza mediante llamada posoperatoria desde la unidad &#40;91&#37;&#41;&#44; pero solo 57&#37; ofrecen posibilidad de contactar con el facultativo responsable&#44; lo que orienta a que el futuro del seguimiento de los pacientes est&#233; probablemente relacionado con la telemedicina<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La IAAS considera fundamental el uso de indicadores cl&#237;nicos para garantizar un entorno seguro y eficiente en CMA<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a>&#46; En nuestro pa&#237;s se han dedicado esfuerzos en este sentido<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#44;15&#44;16&#44;21&#44;22</span></a>&#44; pero&#44; al igual que en el estudio de 2013<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#44; no se utilizan de forma generalizada&#46; Sobresalen en nuestro estudio indicadores de calidad cient&#237;fico-t&#233;cnica como las suspensiones y la tasa de ingresos no previstos&#44; y solo dos de cada tres UCMA recogen la calidad percibida&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n del estudio es que se basa en una encuesta voluntaria y algunas preguntas son de car&#225;cter subjetivo&#46; La estructura hospitalaria en nuestro pa&#237;s en 2019 contaba con 308 UCMA en centros p&#250;blicos y 234 en centros privados<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; este estudio muestra diversos aspectos de la situaci&#243;n actual de la CMA en Espa&#241;a&#46; Parece claro que se necesita mayor coordinaci&#243;n entre administraciones para obtener datos fiables y promover un incremento real y efectivo del IA&#46; Todo ello hace imprescindible favorecer la existencia de sistemas de gesti&#243;n de la calidad en las UCMA y la formaci&#243;n de los profesionales implicados&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">No hay conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "identificador" => "xack751727"
          "titulo" => "Agradecimientos"
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          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-09-14"
    "fechaAceptado" => "2023-10-22"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1836978"
          "palabras" => array:4 [
            0 => "Cirug&#237;a mayor ambulatoria"
            1 => "&#205;ndice de ambulatorizaci&#243;n"
            2 => "Unidades de cirug&#237;a mayor ambulatoria"
            3 => "Control de calidad"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1836979"
          "palabras" => array:4 [
            0 => "Ambulatory surgery"
            1 => "Ambulatory index"
            2 => "Ambulatory surgery units"
            3 => "Quality control"
          ]
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      ]
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a mayor ambulatoria &#40;CMA&#41; es un sistema de gesti&#243;n seguro y eficiente para resolver los problemas quir&#250;rgicos&#44; pero su implantaci&#243;n y desarrollo ha sido variable&#46; El objetivo de este estudio es describir las caracter&#237;sticas&#44; la estructura y el funcionamiento de las unidades de Cirug&#237;a Mayor Ambulatoria &#40;UCMA&#41; en Espa&#241;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal&#44; multic&#233;ntrico basado en una encuesta electr&#243;nica&#44; con recogida de datos entre abril y septiembre de 2022&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En total&#44; 90 UCMA completaron la encuesta&#46; La media del &#237;ndice de ambulatorizaci&#243;n &#40;IA&#41; global es de 63&#37;&#46; M&#225;s de la mitad de las UCMA &#40;52&#37;&#41; son de tipo integrado&#46; La mitad las unidades imparte formaci&#243;n para m&#233;dicos &#40;51&#37;&#41; y personal de enfermer&#237;a &#40;55&#37;&#41;&#46; Los indicadores de calidad m&#225;s utilizados son la tasa de suspensiones &#40;87&#37;&#41; y de ingresos no previstos &#40;80&#37;&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se necesita mayor coordinaci&#243;n entre administraciones para obtener datos fiables&#46; Asimismo&#44; se deben implementar sistemas de gesti&#243;n de calidad en las unidades y desarrollar herramientas para la formaci&#243;n adecuada de los profesionales implicados&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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            "identificador" => "abst0025"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Ambulatory surgery is a safe and efficient management system to solve surgical problems&#44; but its implementation and development has been variable&#46; The aim of this study is to describe the characteristics&#44; structure and functioning of ambulatory surgery units &#40;ASU&#41; in Spain&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Multicenter&#44; cross-sectional&#44; observational study based on an electronic survey&#44; with data collection between April and September 2022&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 90 ASUs completed the survey&#46; The mean overall ambulatory index is 63&#37;&#46; More than half of the ASUs &#40;52&#37;&#41; are integrated units&#46; Around half of the units provide training for physicians &#40;51&#37;&#41; and for nurses &#40;55&#37;&#41;&#46; The most frequently used quality indicators are suspension rate &#40;87&#37;&#41; and the rate of unplanned admissions &#40;80&#37;&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Greater coordination between administrations is needed to obtain reliable data&#46; It is also necessary to implement quality management systems in the different units&#44; as well as to develop tools for the adequate training of the professionals involved&#46;</p></span>"
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            "identificador" => "abst0040"
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            "identificador" => "abst0045"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo de las Unidades de Cirug&#237;a Mayor Ambulatoria que participaron en el estudio&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">UCMA&#58; Unidad de Cirug&#237;a Mayor Ambulatoria&#46;</p>"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Unidades de Cirug&#237;a Mayor Ambulatoria que cumplimentaron la encuesta por comunidad aut&#243;noma&#46;</p>"
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      ]
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CMA&#58; cirug&#237;a mayor ambulatoria&#59; UCMA&#58; Unidad de Cirug&#237;a Mayor Ambulatoria&#46;</p>"
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              "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bloque&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pregunta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coordinaci&#243;n y organizaci&#243;n de la unidad</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Tipo de hospital al que pertenece la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; &#191;Cu&#225;ntos pacientes estima que fueron intervenidos en su unidad en 2019&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; Tipo de unidad&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46; Horario de la unidad y de las sesiones quir&#250;rgicas&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46; &#193;rea poblacional a la que atiende la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46; Tipo de financiaci&#243;n de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46; Tipo de actividad que se lleva a cabo en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46; Servicios desde los que se derivan los pacientes&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46; Categor&#237;a profesional del coordinador de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46; Autonom&#237;a del coordinador de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46; Especialidad del coordinador de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46; &#191;Cree que la direcci&#243;n de su centro apoya el desarrollo de la CMA&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46; &#205;ndice de ambulatorizaci&#243;n de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valoraci&#243;n preoperatoria</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46; Especialidades integradas en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46; Porcentaje de intervenciones quir&#250;rgicas realizadas por especialidad&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46; &#191;En su UCMA se confirma la intervenci&#243;n por llamada telef&#243;nica 24 horas antes&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Control del dolor</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46; En relaci&#243;n con los protocolos de analgesia&#44; &#191;qu&#233; condiciones se dan en su UCMA&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46; &#191;Qu&#233; analg&#233;sicos domiciliarios incluye su protocolo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46; Criterios de alta de la UCMA al domicilio&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calidad y formaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46; Formaci&#243;n realizada en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46; Indicadores de calidad utilizados en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seguimiento domiciliario</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46; &#191;Realiza un seguimiento posoperatorio de los pacientes&#63; En caso afirmativo&#44; &#191;cu&#225;l&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46; Evaluaci&#243;n peri&#243;dica del dolor en el domicilio por parte del paciente&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46; Seguimiento posoperatorio del dolor por parte de la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46; Adherencia de los servicios quir&#250;rgicos a los protocolos de analgesia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46; Figura encargada de elaborar los protocolos de analgesia en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46; Periodicidad de las revisiones de los protocolos de analgesia en la UCMA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46; &#191;Considerar&#237;a &#250;til una <span class="elsevierStyleItalic">app</span> con la que el paciente pueda hacer el seguimiento del dolor posoperatorio en el domicilio y que integre la informaci&#243;n en la historia cl&#237;nica&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46; &#191;Cree que el uso de una <span class="elsevierStyleItalic">app</span> mejorar&#237;a el control del dolor de los pacientes&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Preguntas de la encuesta para evaluar el estado actual de las unidades de Cirug&#237;a Mayor Ambulatoria de Espa&#241;a</p>"
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          0 => array:3 [
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ARTD&#58; anestesia&#44; reanimaci&#243;n y terap&#233;utica del dolor&#59; CMA&#58; cirug&#237;a mayor ambulatoria&#59; NS&#47;NC&#47;NA&#58; no sabe&#47;no contesta&#47;no aplica&#59; UCMA&#58; unidad de cirug&#237;a mayor ambulatoria&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General Universitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>De referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Integrada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aut&#243;noma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sat&#233;lite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Independiente o <span class="elsevierStyleItalic">free</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Standing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Horario de la UCMA y sesiones quir&#250;rgicas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ma&#241;ana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tarde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ma&#241;ana y tarde&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">b</span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de financiaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Privada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cirug&#237;a menor ambulatoria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CMA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cirug&#237;a de corta estancia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Categor&#237;a del coordinador de la UCMA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Jefe de servicio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Jefe de secci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adjunto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Autonom&#237;a del coordinador de la UCMA</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Para hacer la programaci&#243;n quir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Para gestionar recursos humanos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Para gestionar recursos materiales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Especialidad del coordinador</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ARTD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a general y del aparato digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oftalmolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermer&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ginecolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traumatolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No hay coordinador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Apoyo de la CMA por parte del centro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&#44; en absoluto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#44; pero de forma insuficiente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#44; es uno de sus objetivos prioritarios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NS&#47;NC&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Resultados de las variables cualitativas utilizadas para evaluar la coordinaci&#243;n y organizaci&#243;n de las UCMA &#40;n &#61; 90&#41;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DT&#58; desviaci&#243;n t&#237;pica&#59; IC 95&#37;&#58; intervalo de confianza de 95&#37;&#59; IQ&#58; intervenci&#243;n quir&#250;rgica&#59; M&#237;n&#58; valor m&#237;nimo&#59; M&#225;x&#58; valor m&#225;ximo&#59; P&#58; percentil&#59; UCMA&#58; unidad de cirug&#237;a mayor ambulatoria&#46;</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COORDINACI&#211;N Y ORGANIZACI&#211;N DE LA UNIDAD</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#237;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#225;x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n v&#225;lida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">N&#250;m&#46; pacientes intervenidos en 2019</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;974&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;322&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de ambulatorizaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">VALORACI&#211;N PREOPERATORIA</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Porcentaje de IQ realizadas por especialidad</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Cirug&#237;a general&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Coloproctolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cirug&#237;a vascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cirug&#237;a pl&#225;stica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cirug&#237;a maxilofacial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Comunidad aut&#243;noma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">&#205;ndice de ambulatorizaci&#243;n &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Extremadura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pa&#237;s Vasco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&#44;39 &#177; 26&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#44;94 &#177; 18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Andaluc&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#44;96 &#177; 24&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Asturias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;23 &#177; 25&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Castilla y Le&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;00 &#177; 24&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Comunidad Valenciana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#44;89 &#177; 17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Baleares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#44;50 &#177; 24&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#44;00 &#177; 14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cantabria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;67 &#177; 34&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Catalu&#241;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;28 &#177; 23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55&#44;00 &#177; 14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#44;75 &#177; 11&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Arag&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&#44;40 &#177; 14&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Canarias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#44;58 &#177; 9&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ceuta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">La Rioja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Melilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Murcia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Porrero"
                            1 => "B&#46; Porrero"
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                      "Libro" => array:3 [
                        "fecha" => "2015"
                        "editorial" => "Win2Win Worldwide S&#46;L&#46;"
                        "editorialLocalizacion" => "Madrid"
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                    0 => array:2 [
                      "titulo" => "Day Surgery Units Data Upgrade"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Bustos Molina"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir May Amb&#46;"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "141"
                        "paginaFinal" => "154"
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                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Sanidad&#46; Intervenciones quir&#250;rgicas realizadas en hospitales del Sistema Nacional de Salud &#40;SNS&#41;&#44; frecuentaci&#243;n por 1&#46;000 habitantes&#44; porcentaje de intervenciones de Cirug&#237;a Mayor Ambulatoria &#40;CMA&#41; sobre el total de intervenciones y d&#237;as de espera para intervenciones no urgentes seg&#250;n comunidad aut&#243;noma&#46; 2021&#46; &#91;consultado 5 Sept de 2023&#93;&#46; Disponible en&#58; <a target="_blank" href="https://www.sanidad.gob.es/estadEstudios/sanidadDatos/tablas/tabla26.htm">https&#58;&#47;&#47;www&#46;sanidad&#46;gob&#46;es&#47;estadEstudios&#47;sanidadDatos&#47;tablas&#47;tabla26&#46;htm</a>"
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                    0 => array:2 [
                      "titulo" => "Organitzaci&#243; i funcionament de la cirurgia major ambulat&#242;ria a Catalunya&#58; resultats del projecte europeu DAYSAFE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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