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Incidencia de infección de sitio operatorio en pacientes con cirugía de columna y uso de vancomicina tópica: Estudio de cohorte retrospectiva
Incidence of surgical site infection in patients with spinal surgery and use of topical vancomycin: A cohort study
Madeline Rossana Bilbao Rodasa,
Autor para correspondencia
madelin1487@gmail.com

Autor para correspondencia.
, Frank Mario Herrerab
a Residente de Ortopedia y Traumatología, Fundación Universitaria Sanitas, Bogotá, D.C, Colombia
b Ortopedista Especialista en Cirugía de Columna, Clínica Colsanitas, Bogotá, D.C, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Seg&#250;n el Centers for Disease Control &#40;CDC&#41;&#44; las Infecciones de Sitio Operatorio &#40;ISO&#41; se definen como la infecci&#243;n que ocurre en la incisi&#243;n quir&#250;rgica o cerca de ella durante los primeros 30 d&#237;as&#44; o hasta un a&#241;o&#44; si se ha dejado un implante<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; Las ISO son tema importante de salud&#44; ya que complican cerca del 2 al 5&#37; de todas las cirug&#237;as y representan un alto costo para el sistema&#59; en 1996 se estimaba un costo de &#36;100&#46;000 d&#243;lares&#44; y cada episodio de infecci&#243;n aumentaba el costo en salud en &#36;4&#46;067 comparado con los casos no complicados<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a>&#46; Adem&#225;s&#44; la presencia de infecciones interfiere con la recuperaci&#243;n del paciente as&#237; como con el resultado final de la cirug&#237;a&#46; Cahill et al&#44; en un estudio en poblaci&#243;n pedi&#225;trica report&#243; que los pacientes infectados presentaban una incidencia del 25&#37; de pseudoatrosis&#44; secuelas neurol&#243;gicas y posteriores deformidades&#44; as&#237; como un aumento en la mortalidad<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; En cirug&#237;a de columna la tasa de infecci&#243;n var&#237;a del 0&#46;7&#37; al 11&#46;9&#37; y esto var&#237;a de acuerdo con el tipo de procedimiento&#44; indicaci&#243;n&#44; as&#237; como el uso de instrumentaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; As&#237; mismo&#44; se han descrito algunos factores de riesgo para ISO en cirug&#237;a de columna&#44; como la edad mayor de 65 a&#241;os&#44; diabetes mellitus &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;22&#44; CI 95&#37; 1&#46;38&#44; 3&#46;60&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; tabaquismo y obesidad mayor a IMC de 35 &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;36&#44; IC 95&#37;&#58;1&#46;47&#44; 3&#46;80&#58;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#44; as&#237; como el tiempo quir&#250;rgico prolongado &#40;&#62;5 horas&#41; &#40;OR 2&#46;8 IC 95&#37;&#58;1&#46;296-6&#46;268&#41;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Varias estrategias se han prouesto para diminuir el riesgo de infecci&#243;n de sitio operatorio&#46; El uso de Vancomicina t&#243;pica ha ganado inter&#233;s para el uso en cirug&#237;a de columna por su bajo costo&#44; disponibilidad y uso f&#225;cil<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#44; adem&#225;s de ser segura por su pobre absorci&#243;n sist&#233;mica&#46; La aplicaci&#243;n de vancomicina t&#243;pica var&#237;a de acuerdo con el tipo de cirug&#237;a y su duraci&#243;n&#44; se han descrito estudios con aplicaci&#243;n de 1 gramos versus 2 gramos&#44; pero esto no ha mostrado ninguna diferencia&#46; La gu&#237;a del segundo Consenso Internacional sobre las infecciones musculoesquel&#233;ticas &#40;ICM por sus siglas en ingl&#233;s&#41; recomienda el uso de vancomicina bas&#225;ndose en diferentes estudios reunidos en una revisi&#243;n sistem&#225;tica realizada por Xie et al&#46; en donde revisaron 19 estudios cohorte retrospectivos y 1 estudio prospectivo&#44; con resultados a favor del uso de la vancomicina&#44; con un riesgo de 2&#46;83 veces m&#225;s riesgo de infecci&#243;n para el grupo sin vancomicina &#40;IC 95&#37;&#58; 2&#46;03&#8211;3&#46;95&#41;&#44; I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#46;2&#37;&#44; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;083<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En Colombia&#44; no se dispone de literatura que hable sobre la incidencia de infecciones del sitio operatorio en pacientes a quienes se les aplic&#243; esta terap&#233;utica&#46; Por tanto&#44; el objetivo de este estudio es determinar la incidencia de ISO en pacientes llevados a cirug&#237;a de columna en quienes se aplic&#243; vancomicina entre enero 2014 a enero 2018 en una instituci&#243;n de alta complejidad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional de tipo cohorte &#250;nica y retrospectiva en pacientes que fueron llevados a cirug&#237;a de columna y se les aplic&#243; vancomicina t&#243;pica previo al cierre&#44; entre enero 2014 a enero 2018 en una instituci&#243;n de tercer nivel&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El seguimiento inici&#243; al finalizar el procedimiento quir&#250;rgico y continu&#243; hasta los tres meses postoperatorios&#46; Se defini&#243; ISO &#40;desenlace principal&#41; como la presencia de drenaje purulento&#44; dolor intenso&#44; enrojecimiento por la herida qurir&#250;rgica que ocurr&#237;a hasta 30 d&#237;as o un a&#241;o si existiese implantes&#46; Adem&#225;s&#44; con niveles elevados de Prote&#237;na C reactiva la cual se considera la prueba m&#225;s sensible&#44; que se encuentra elevada en m&#225;s del 98&#37; de los casos reportados<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron todos los pacientes mayores de 18 a&#241;os&#44; con cirug&#237;a de columna electiva&#44; por trauma o para manejo de patolog&#237;a oncol&#243;gica&#44; con instrumentaci&#243;n &#40;cervical&#44; dorsal o lumbosacra&#41; y operados en la instituci&#243;n por el grupo de columna de Ortopedia y Traumatolog&#237;a de la instituci&#243;n y por el mismo cirujano&#44; de forma consecutiva y a conveniencia&#46; Se excluyeron pacientes con re-intervenci&#243;n al primer mes de cirug&#237;a&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En todos los casos se recolect&#243; informaci&#243;n sobre datos demogr&#225;ficos &#40;edad y sexo&#41;&#44; presencia de comorbilidades como diabetes&#44; hipertensi&#243;n arterial e hipotiroidismo&#59; informaci&#243;n cl&#237;nica sobre peso&#44; talla e &#205;ndice de Masa Corporal &#40;IMC&#41; y gramos usados de vancomicina t&#243;pica&#59; informaci&#243;n del procedimiento en relaci&#243;n al volumen de sangrado calculado por medio de la estimaci&#243;n de la p&#233;rdida sangu&#237;nea seg&#250;n consenso del personal de la sala de operaciones &#40;estimaci&#243;n visual y contabilizando el recolector&#47;compresas&#41;&#44; tiempo quir&#250;rgico en minutos&#44; abordaje anterior o posterior&#44; instrumentaci&#243;n y localizaci&#243;n de segmento a operar&#44; complicaciones intra y postoperatorias&#44; presencia de ISO y pat&#243;geno aislado en caso de infecci&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los pacientes fueron identificados a partir de los registros de programaci&#243;n de cirug&#237;a &#40;en caso de programados&#41; y las descripciones quir&#250;rgicas de los pacientes con procedimiento de urgencia con los siguientes c&#243;digos&#58; 810812 artrodesis posterolateral e intercorporal &#40;PLIF&#41;&#44; artrodesis transforaminal e intercorporal &#40;TLIF&#41; de columna vertebral con instrumentaci&#243;n&#59; 793952 reducci&#243;n abierta de fractura de columna tor&#225;cica&#44; lumbar o sacra&#41; v&#237;a posterior o posterolateral con instrumentaci&#243;n simple&#59; correcci&#243;n de escoliosis v&#237;a anterior y posterior&#46; De los pacientes seleccionados&#44; se revisaron las historias cl&#237;nicas electr&#243;nicas con el fin de documentar las variables de inter&#233;s&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Por protocolo institucional&#44; todos los pacientes recibieron antibi&#243;tico profil&#225;ctico sist&#233;mico &#40;cefazolina 1 gramo IV o en caso de presentar alergia documentada&#44; clindamicina 600<span class="elsevierStyleHsp" style=""></span>mg IV&#41; antes de realzar incisi&#243;n y cada 8 horas hasta completar tres dosis&#46; A su vez&#44; la preparaci&#243;n del campo est&#233;ril fue con jab&#243;n clorhexidina y soluci&#243;n clorhexina y campo de IOBAN&#46; Previo al cierre&#44; de acuerdo al tiempo estimado de cirug&#237;a y tama&#241;o de incisi&#243;n&#44; se les coloc&#243; 1 o 2 gramos de vancomicina t&#243;pica sobre la fascia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lsis descriptivo de la informaci&#243;n recolectada&#46; Las variables cualitativas se reportar&#225;n como frecuencias absolutas y relativas&#46; Las variables cuantitativas se presentan a trav&#233;s de medidas de tendencia central y dispersi&#243;n&#46; La normalidad de estas variables se evalu&#243; con el test de Shapiro-Wilks&#46; La incidencia de ISO se reporta como proporci&#243;n en conjunto con Intervalo de Confianza del 95&#37; &#40;IC95&#37;&#41;&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n de la Fundaci&#243;n Universitaria Sanitas&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se incluyeron 130 pacientes y en uno de ellos&#44; se realizaron dos procedimientos independientes&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; se describen las variables demogr&#225;ficas del estudio&#46; La mayor&#237;a de los pacientes fueron mujeres&#44; la edad mediana del grupo fue de 64 a&#241;os &#40;54-73 a&#241;os&#41;&#46; El peso promedio fue de 68&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#44; con un IMC de 25&#46;7&#44; de los cuales el 40&#37; de los pacientes presentaron sobrepeso&#46; Dentro de las comorbilidades encontradas en las historias cl&#237;nicas&#44; m&#225;s del 50&#37; de los pacientes ten&#237;an hipertensi&#243;n arterial y menos del 10&#37; ten&#237;an Diabetes Mellitus&#46; Por otra parte&#44; el 17&#46;7&#37; report&#243; hipotiroidismo y un paciente report&#243; el antecedente de Virus de Inmunodeficiencia Humana &#40;VIH&#41; en manejo con antirretrovirales&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">El 95&#46;4&#37; fueron intervenidos por v&#237;a posterior para realizaci&#243;n de laminectom&#237;a&#44; artrodesis e instrumentaci&#243;n y colocaci&#243;n de aloinjerto&#46; Del total de pacientes&#44; el 18&#37; se reintervino&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En relaci&#243;n a la informaci&#243;n del procedimiento quir&#250;rgico&#44; el tiempo en promedio de cirug&#237;a fue de 207<span class="elsevierStyleHsp" style=""></span>min&#44; con un sangrado aproximado de 400<span class="elsevierStyleHsp" style=""></span>mL &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Al al 80&#46;9&#37; se le aplic&#243; 1 gramo de vancomicina en polvo previo al cierre de la incisi&#243;n&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">El segmento vertebral que m&#225;s se intervino fue columna lumbar &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">La incidencia de ISO fue de 3&#46;8&#37; &#40;IC95&#37; 1&#46;5&#37; - 8&#46;9&#37;&#41; y en todos los casos fue profunda y localizada a nivel lumbar&#46; As&#237; mismo&#44; en solo dos casos se aisl&#243; el microorganismo responsable &#40;E&#46; coli y P&#46; mirabili&#41;&#46; Dos de estas infecciones se identificaron a las 6 semanas postoperatorias</p><p id="par0080" class="elsevierStylePara elsevierViewall">En cuanto a la presencia de otras complicaciones&#44; solo 1 paciente present&#243; ruptura de duramadre&#44; que se resolvi&#243; con parche hem&#225;tico y reposo durante la hospitalizaci&#243;n&#44; sin presentar complicaciones durante el postoperatorio mediato o tard&#237;o&#46; Se document&#243; en una paciente infecci&#243;n del sitio de toma de injerto ajeno al sitio intervenido&#44; con una osteomielitis del il&#237;aco que requiri&#243; lavados posteriores&#46; Los pacientes reconsultaron al servicio de urgencias por presentar dolor radicular en miembros inferiores&#44; sin documentar infecci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Finalmente&#44; se evalu&#243; el tiempo quir&#250;rgico y sangrado de acuerdo a la incidencia de ISO encontr&#225;ndose que la mediana de tiempo quir&#250;rgico en quienes presentaron la infecci&#243;n fue de 195 minutos &#40;RIQ 180 - 265&#41; y 208 minutos &#40;RIQ 165 - 250&#41; en los dem&#225;s pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto al sangrado&#44; la mediana fue de 400cc &#40;RIQ 400 &#8211; 900&#41; en quienes presentaron infecci&#243;n y 400cc &#40;200 &#8211; 500&#41; en los dem&#225;s pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; se encontr&#243; que el 4&#46;7&#37; de los pacientes infectados&#44; previamente se les hab&#237;a aplicado 1 gramo de vancomicina &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio determin&#243; la incidencia de ISO en pacientes a quienes se les aplic&#243; vancomicina t&#243;pica previa al cierre de incisi&#243;n en procedimiento quir&#250;rgicos de columna&#46; En comparaci&#243;n con la literatura disponible&#44; la incidencia en esta poblaci&#243;n es similar e incluso m&#225;s baja a lo reportado previamente &#40;hasta el 10&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Tubaki et al&#44; en un estudio ensayo cl&#237;nico aleatorizado controlado evalu&#243; el uso de vancomicina en 907 pacientes y no encontr&#243; diferencias en la tasa de infecci&#243;n entre el grupo que recibi&#243; vancomicina comparado con el grupo control &#40;1&#46;61&#37; versus 1&#46;68&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#46; Por su parte&#44; Sweet et al&#46;&#44; en su estudio comparativo de tipo cohorte retrospectiva con 1732 pacientes llevados a instrumentaci&#243;n posterior con o sin fusi&#243;n en la regi&#243;n toracolumbar&#44; les administr&#243; 1 gramo de vancomicina y adem&#225;s se mezcl&#243; vancomicina &#40;1<span class="elsevierStyleHsp" style=""></span>g&#41; en los injertos &#40;grupo con fusi&#243;n&#41;&#46; Se demostr&#243; una reducci&#243;n significativa de infecci&#243;n de sitio operatorio cuando se a&#241;adi&#243; vancomicina&#44; de 2&#46;6&#37; a 0&#37;&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&#46; Strom et al&#44; realiz&#243; un estudio retrospectivo donde observ&#243; la reducci&#243;n de ISO en 253 pacientes llevados a laminectom&#237;a lumbar y fusi&#243;n posterior &#40;11&#37; vs 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000018&#41;&#44; adem&#225;s de observar el riesgo de infecci&#243;n en los grupos&#44; evalu&#243; el riesgo con los grupos llevados a instrumentaci&#243;n y observ&#243; que ten&#237;an mejores resultados el grupo que se complementaba la instrumentaci&#243;n con el uso de vancomicina t&#243;pica &#40;12&#37; vs 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000806&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&#46; Molinari et al&#46;&#44; en un estudio retrospectivo de 1512 pacientes&#44; de los cuales 849 pacientes no ten&#237;an instrumentaci&#243;n comparado con 478 cirug&#237;as de instrumentaci&#243;n posterior como anterior&#44; en quienes se aplic&#243; 1 gramo de vancomicina previo al cierre&#44; encontr&#243; que el pat&#243;geno m&#225;s com&#250;nmente aislado era S&#46; aureus y de la muestra&#44; solo 15 pacientes se infectaron&#46; Comparando con la literatura&#44; Molinari demostr&#243; que con el uso de vancomicina existi&#243; una disminuci&#243;n de la tasa de infecci&#243;n de 1&#46;14&#37; a 0&#46;33&#37;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se han encontrado factores de riesgo para ISO como la presencia de obesidad&#44; ser adultos mayores&#44; tener antecedente de diabetes mellitus&#44; tabaquismo&#44; instrumentaci&#243;n&#44; tiempo quir&#250;rgico largo y hemorragias voluminosas<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#8211;22</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Varios estudios reportan que el uso de vancomicina como una terapia de bajo costo&#44; con seguridad para el paciente sin mostrar efectos secundarios y que sirve para prevenir la ISO&#46; Ghobrial et al&#46; en una revisi&#243;n sistem&#225;tica con un total de 6701 pacientes encontr&#243; una tasa de infecci&#243;n de 1&#46;36&#37;&#44; y reportaron 23 eventos adversos para una tasa de 0&#46;3&#37;&#44; conluyendo as&#237; que el uso de vancomicina parece ser seguro y efectivo para disminuir las ISO con una tasa baja de morbilidad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ning&#250;n estudi&#243; a la fecha ha evaluado si la dosis de vancomicina afecta a los resultados&#44; pero s&#237; se ha demostrado que el uso t&#243;pico tiene gran importancia en cuanto a disminuci&#243;n de ISO sobretodo las profundas&#46; Texakalidis et al&#44; en un metaan&#225;lisis y revisi&#243;n sistem&#225;tica encontr&#243; diferencias en el grupo de ISO profundas &#40;OR&#58;0&#46;31&#58; 95&#37; IC&#58; 0&#46;22-0&#46;45&#58; P &#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#59; I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a>&#46; A pesar de que los estudios han demostrado su seguridad y eficacia&#44; la mayor&#237;a son evidencia clase III&#44; por lo que se requieren m&#225;s estudios que demuestren su eficacia<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones de este estudio&#44; el componente retrospectivo pudiese hacer pensar la restricci&#243;n en el acceso a la informaci&#243;n disponible as&#237; como en una posible p&#233;rdida de sujetos durante el periodo de observaci&#243;n&#59; sin embargo&#44; las historias cl&#237;nicas presentaron una baja frecuencia de datos perdidos para las variables de inter&#233;s y se dio un seguimiento completo y apropiado a todos los pacientes&#44; seg&#250;n las recomendaciones del CDC que son 3 meses postoperatorio&#46; El tama&#241;o de muestra puede considerarse como peque&#241;o pero es un grupo heterog&#233;neo y pueden extrapolarse los resultados a la poblaci&#243;n de la instituci&#243;n&#46; Pese a que la mayor&#237;a de estudios sobre este tema son nivel III de evidencia&#44; el uso de vancomicina t&#243;pica ha tomado fuerza en campos de cirug&#237;a ortop&#233;dica&#44; m&#225;s en concreto en cirug&#237;a de columna&#44; as&#237; como en gu&#237;as cl&#237;nicas como ICM&#44; quienes recomiendan su uso&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La incidencia de ISO en pacientes con cirug&#237;a de columna y uso de vancomicina t&#243;pica fue similar e incluso m&#225;s baja que lo reportado por otros estudios&#46; Sin embargo&#44; se requieren estudios de tipo ensayos cl&#237;nicos o estudios prospectivos&#44; para medir la dosis ideal as&#237; como la seguridad de la vancomicina t&#243;pica previa al cierre de la incisi&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fuentes de Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">Recursos propios de los autores&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de Inter&#233;s</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores no refieren alg&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Background"
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            1 => array:2 [
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        7 => array:2 [
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          "titulo" => "Discusi&#243;n"
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    "fechaRecibido" => "2019-07-09"
    "fechaAceptado" => "2021-04-04"
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          "palabras" => array:4 [
            0 => "Columna vertebral"
            1 => "Artrodesis"
            2 => "Vancomicina"
            3 => "Infecci&#243;n sitio operatorio"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Spinal column"
            1 => "Arthrodesis"
            2 => "Vancomycin"
            3 => "Surgical site infection"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La incidencia de infecci&#243;n en cirug&#237;a de columna puede ser hasta el 12&#37;&#59; con el uso de vancomicina t&#243;pica&#44; previo al cierre&#44; se ha logrado disminuir el riesgo de esta condici&#243;n&#46; El objetivo del estudio es determinar la incidencia de infecci&#243;n en cirug&#237;a de columna a quienes se aplic&#243; vancomicina t&#243;pica previo al cierre de incisi&#243;n en una instituci&#243;n de alta complejidad</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional de tipo cohorte retrospectiva&#46; Se incluyeron pacientes intervenidos en cirug&#237;a de columna con aplicaci&#243;n de vancomicina t&#243;pica previa al cierre entre el 2014 al 2018 en una instituci&#243;n de tercer nivel&#46; Los pacientes fueron seguidos desde el momento de la cirug&#237;a hasta 3 meses postquir&#250;rgico Se recolect&#243; informaci&#243;n sobre edad&#44; comobilidades&#44; &#237;ndice masa corporal&#44; tiempo quir&#250;rgico&#44; sangrado intraoperatorio&#44; complicaciones&#44; uso de drenajes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 130 pacientes&#44; 81 mujeres y 49 hombres con una edad pomedio de 64 a&#241;os&#46; 95&#46;4&#37; se les realiz&#243; v&#237;a posterior con laminectom&#237;a&#44; artrodesis e instrumentaci&#243;n&#46; El tiempo promedio fue de 207 minutos&#44; con un sangrado de 400<span class="elsevierStyleHsp" style=""></span>mL&#46; Solo un paciente present&#243; ruptura de duramadre&#46; Cinco pacientes presentaron infecci&#243;n del sitio operatorio para una incidencia de 3&#46;8&#37; &#40;IC95&#37; 1&#46;5&#37; - 8&#46;9&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El uso de vancomicina parece reducir el riesgo de infecci&#243;n en cirug&#237;a de columna seg&#250;n la incidencia de esta infecci&#243;n reportada en la literatura&#59; sin embargo&#44; hacen falta estudios prospectivos o ensayos cl&#237;nicos controlados que prueben las dosis ideales de esta terap&#233;utica&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">NIVEL DE EVIDENCIA&#58; III</p></span>"
        "secciones" => array:4 [
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materiales y M&#233;todos"
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          2 => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The incidence of infection in spine surgery can be up to 12&#37;&#59; With the use of topical vancomycin&#44; prior to closure&#44; the risk of this condition has been reduced&#46; The aim of the study is to determine the incidence of infection in spinal surgery to which topical vancomycin was applied prior to the closure of an incision in a highly complex institution&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">An observational retrospective cohort study was conducted&#46; Patients undergoing spinal surgery with application of topical vancomycin prior to closure between 2014 and 2018 in a third-level institution were included&#46; The patients were followed from the moment of surgery until 3 months post-surgery&#46; Information was collected on age&#44; comorbilities&#44; body mass index&#44; surgical time&#44; intraoperative bleeding&#44; complications&#44; use of drainages&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">130 patients were included&#44; 81 women and 49 men with an average age of 64 years&#46; 95&#46;4&#37; were performed posteriorly with laminectomy&#44; arthrodesis and instrumentation&#46; The average time was 207<span class="elsevierStyleHsp" style=""></span>minutes&#44; with a bleeding of 400<span class="elsevierStyleHsp" style=""></span>mL&#46; Only one patient presented a dura mater rupture&#46; Five patients presented surgical site infection for an incidence of 3&#46;8&#37; &#40;95&#37; CI 1&#46;5&#37; - 8&#46;9&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The use of vancomycin seems to reduce the risk of infection in spinal surgery according to the incidence of this infection reported in the literature&#59; however&#44; prospective studies or controlled clinical trials are needed to prove the ideal doses of this therapy&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">EVIDENCE LEVEL&#58; III</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC&#44; mediana &#40;RIQ&#41;</span>&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\ttable-entry\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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;4&#46;1&#41;&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
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                  \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>No&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \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 registra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\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">12 &#40;24&#46;5&#41;&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
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                  \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\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>Bajo peso&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">3 &#40;2&#46;3&#41;&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 &#40;2&#46;0&#41;&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 &#40;4&#46;7&#41;&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>Normal&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">46 &#40;35&#46;4&#41;&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 &#40;32&#46;6&#41;&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">30 &#40;37&#46;0&#41;&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>Sobrepeso&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">52 &#40;40&#46;0&#41;&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">23 &#40;46&#46;9&#41;&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 &#40;35&#46;8&#41;&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>Obesidad I&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">15 &#40;11&#46;5&#41;&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 &#40;8&#46;2&#41;&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 &#40;13&#46;6&#41;&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>Obesidad II&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 &#40;1&#46;5&#41;&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">-&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 &#40;2&#46;5&#41;&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>Sin registro&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">12 &#40;9&#46;2&#41;&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 &#40;10&#46;2&#41;&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">7 &#40;8&#46;6&#41;&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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hipotiroidismo&#44; n &#40;&#37;&#41;</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>Si&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">23 &#40;17&#46;7&#41;&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">6 &#40;12&#46;2&#41;&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">17 &#40;20&#46;9&#41;&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&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">84 &#40;64&#46;6&#41;&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">31 &#40;63&#46;3&#41;&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">53 &#40;65&#46;4&#41;&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 registra&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">23 &#40;17&#46;7&#41;&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">12 &#40;24&#46;5&#41;&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 &#40;13&#46;6&#41;&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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Otros antecedentes&#44; n &#40;&#37;&#41;</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="elsevierStyleItalic">Artritis reumatoidea</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 &#40;9&#46;09&#41;&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">-&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 &#40;18&#46;2&#41;&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="elsevierStyleItalic">Ca de pr&#243;stata</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">1 &#40;4&#46;55&#41;&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 &#40;9&#46;10&#41;&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">-&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="elsevierStyleItalic">Ca endometrio</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">Ca mama</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">Dislipidemia</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">6 &#40;27&#46;2&#41;&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">3 &#40;27&#46;7&#41;&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">3 &#40;27&#46;7&#41;&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="elsevierStyleItalic">Enf&#46; Coronaria</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">3 &#40;13&#46;64&#41;&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">3 &#40;27&#46;7&#41;&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">-&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="elsevierStyleItalic">Fibromialgia</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">Hiperparatiroidismo</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">HIV</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">1 &#40;4&#46;55&#41;&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 &#40;9&#46;10&#41;&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">-&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="elsevierStyleItalic">Polio</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">SAHOS</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 &#40;9&#46;09&#41;&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 &#40;18&#46;2&#41;&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">-&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="elsevierStyleItalic">Sd Sjogren</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">1 &#40;4&#46;55&#41;&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">-&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 &#40;9&#46;10&#41;&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="elsevierStyleItalic">Trombocitopenia idiop&#225;tica</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">1 &#40;4&#46;55&#41;&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 &#40;9&#46;1&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Caracter&#237;sticas demogr&#225;ficas de los pacientes incluidos</p>"
        ]
      ]
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            0 => array:2 [
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                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">Informaci&#243;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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>131n &#40;&#37;&#41;&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">Procedimiento</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">125 &#40;95&#46;4&#41;&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="elsevierStyleBold">Artrodesis e instrumentaci&#243;n &#43; injerto &#243;seo v&#237;a posterior &#40;dorsal&#44; dorsolumbar&#44; lumbar&#41;</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">3 &#40;2&#46;3&#41;&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="elsevierStyleBold">Corpectom&#237;a &#43; artrodesis e instrumentaci&#243;n v&#237;a anterior &#40;cervicales&#41;</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">3 &#40;2&#46;3&#41;&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="elsevierStyleBold">Correcci&#243;n escoliosis</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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Reintervenci&#243;n&#44; n &#40;&#37;&#41;</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>Si&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">18 &#40;13&#46;7&#41;&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&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">113 &#40;86&#46;3&#41;&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="elsevierStyleBold">Tiempo quir&#250;rgico&#44; &#40;min&#41; mediana &#40;RIQ&#41;</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">207 &#40;165 &#8211; 250&#41;&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="elsevierStyleBold">Sangrado&#44; &#40;ml&#41; mediana &#40;RIQ&#41;</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">400 &#40;200 &#8211; 600&#41;&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">Vancomicina</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>1 gr&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">106 &#40;80&#46;9&#41;&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>2 gr&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">25 &#40;19&#46;1&#41;&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="elsevierStyleVsp" style="height:0.5px"></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="elsevierStyleBold">Drenaje</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>Si&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">12 &#40;9&#46;2&#41;&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&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">119 &#40;90&#46;8&#41;&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="elsevierStyleVsp" style="height:0.5px"></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="elsevierStyleBold">Ruptura de duramadre&#44; n &#40;&#37;&#41;</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>Si&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 &#40;0&#46;8&#41;&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&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">130 &#40;99&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaci&#243;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">Frecuencian<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&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">Porcentaje&#40;&#37;&#41;&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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Intraquir&#250;rgica&#58;</span></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"><span class="elsevierStyleHsp" style=""></span>Ruptura de duramadre&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">1&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&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Postquir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteomielitis &#40;toma injerto ajena a zona intervenida&#41;&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">1&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">11&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#46;77&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "CDC&#47;NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting"
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                        0 => array:2 [
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                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1016/j.ajic.2008.03.002"
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                        "tituloSerie" => "Am J Infect Control"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "309"
                        "paginaFinal" => "332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18538699"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0135"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Surgical site infections"
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                          "autores" => array:2 [
                            0 => "P&#46;S&#46; Barie"
                            1 => "S&#46;R&#46; Eachempati"
                          ]
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "Surg Clin North Am"
                        "fecha" => "2005"
                        "volumen" => "85"
                        "paginaInicial" => "1115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16326197"
                            "web" => "Medline"
                          ]
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              "etiqueta" => "3"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Infection after spinal fusion for pediatric spinal deformity&#58; thirty years of experience at a single institution"
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                          "autores" => array:3 [
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                            2 => "M&#46;J&#46; Lee"
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                        "fecha" => "2010"
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                        "paginaInicial" => "1211"
                        "paginaFinal" => "1217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20445480"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0145"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient comorbidities and complications after spinal surgery&#58; a societal-based cost analysis"
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                          "etal" => false
                          "autores" => array:9 [
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                            2 => "S&#46;C&#46; Stein"
                            3 => "P&#46;G&#46; Campbell"
                            4 => "S&#46; Yadla"
                            5 => "J&#46;S&#46; Harrop"
                            6 => "A&#46;D&#46; Sharan"
                            7 => "M&#46;G&#46; Maltenfort"
                            8 => "J&#46;K&#46; Ratliff"
                          ]
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                        "link" => array:1 [
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                            "web" => "Medline"
                          ]
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              ]
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              "identificador" => "bib0150"
              "etiqueta" => "5"
              "referencia" => array:1 [
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                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "S&#46;L&#46; Trivette"
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                            4 => "D&#46;J&#46; Sexton"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1086/501572"
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                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "1999"
                        "volumen" => "20"
                        "paginaInicial" => "725"
                        "paginaFinal" => "730"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10580621"
                            "web" => "Medline"
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                    0 => array:2 [
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                          ]
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                      ]
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                    0 => array:2 [
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                        "fecha" => "2008"
                        "volumen" => "6"
                        "paginaInicial" => "238"
                        "paginaFinal" => "245"
                        "link" => array:1 [
                          0 => array:2 [
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                            4 => "B&#46; Wang"
                            5 => "H&#46; Meng"
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                            7 => "N&#46; Su"
                            8 => "Y&#46; Yang"
                          ]
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "World Neurosurgery"
                        "fecha" => "2016 Nov"
                        "volumen" => "95"
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                      "titulo" => "Early surgical site infections in adult spinal trauma&#58; a prospective&#44; multicentre study of infection rates and risk factors"
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                            5 => "P&#46; Bonnevialle"
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                    0 => array:2 [
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                        "fecha" => "2012"
                        "volumen" => "98"
                        "paginaInicial" => "788"
                        "paginaFinal" => "794"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Postoper- ative wound infection after instrumentation of thoracic and lumbar fractures"
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                    0 => array:2 [
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                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "paginaInicial" => "566"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11733673"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "paginaInicial" => "350"
                        "paginaFinal" => "358"
                        "link" => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Hospital Infection Control Practices Advisory Committee&#46; Guideline for prevention of surgical site infection&#44; 1999"
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                          "etal" => false
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                            0 => "R&#46;G&#46; Strom"
                            1 => "D&#46; Pacione"
                            2 => "S&#46;P&#46; Kalhorn"
                            3 => "Frempong-Boadu AK&#58;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clineuro.2013.04.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lumbar laminectomy and fusion with routine local application of vancomycin powder&#58; decreased infection rate in instrumented and non-instrumented cases&#58; Clin Neurol Neurosurg"
                        "fecha" => "2013"
                        "volumen" => "115"
                        "paginaInicial" => "1766"
                        "paginaFinal" => "1769"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23622935"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection&#59; 1&#44;512 consecutive surgical cases over a 6-year period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;W&#46; Molinari"
                            1 => "O&#46;A&#46; Khera"
                            2 => "W&#46;J&#46; Molinari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-011-2104-z"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2012 Jun"
                        "volumen" => "21"
                        "numero" => "Suppl 4"
                        "paginaInicial" => "S476"
                        "paginaFinal" => "S482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22160172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infection in spinal instrumentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Gerometta"
                            1 => "J&#46;C&#46; Rodriguez Olaverri"
                            2 => "F&#46; Bitan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00264-011-1426-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Orthop&#46;"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "457"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22218913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of Powdered Vancomycin on Preventing Surgical Site Infections in Neurosurgery&#58; A Systematic Review and Meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "Pavlos Texakalidis"
                            1 => "M&#46; Victor"
                            2 => "Lu"
                            3 => "Yagiz Yolcu"
                            4 => "Panagiotis Kerezoudis"
                            5 => "Mohammed Ali Alvi"
                            6 => "F&#46; Ian"
                            7 => "Parney"
                            8 => "L&#46; Jeremy"
                            9 => "Fogelson"
                            10 => "Mohamad Bydon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/neuros/nyy288"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "2019"
                        "volumen" => "84"
                        "paginaInicial" => "569"
                        "paginaFinal" => "580"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29982615"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A meta-analysis of spinal surgical site infection and vancomycin powder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "Khan NR1"
                            1 => "C&#46;J&#46; Thompson"
                            2 => "M&#46; DeCuypere"
                            3 => "J&#46;M&#46; Angotti"
                            4 => "E&#46; Kalobwe"
                            5 => "M&#46;S&#46; Muhlbauer"
                            6 => "F&#46;X&#46; Camillo"
                            7 => "P&#46; Klimo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2014.8.SPINE1445. Epub 2014 Sep 26"
                      "Revista" => array:5 [
                        "tituloSerie" => "Journ Neurosurg Spine&#46;"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "974"
                        "paginaFinal" => "983"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for surgical site infection in the patient with spinal injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46;G&#46; Blam"
                            1 => "A&#46;R&#46; Vaccaro"
                            2 => "J&#46;S&#46; Vanichkachorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.BRS.0000067109.23914.0A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "2003"
                        "volumen" => "28"
                        "paginaInicial" => "1475"
                        "paginaFinal" => "1480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12838110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical site infections following spinal surgery at a tertiary care center in Lebanon&#58; incidence&#44; microbiology&#44; and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Z&#46;A&#46; Kanafani"
                            1 => "G&#46;K&#46; Dakdouki"
                            2 => "O&#46; El-Dbouni"
                            3 => "T&#46; Bawwab"
                            4 => "S&#46;S&#46; Kanj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/00365540600606440"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Infect Dis&#46;"
                        "fecha" => "2006"
                        "volumen" => "38"
                        "paginaInicial" => "589"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16857600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for surgical site infections following spinal fusion procedures&#58; a case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;B&#46; Rao"
                            1 => "G&#46; Vasquez"
                            2 => "J&#46; Harrop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cir506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis&#46;"
                        "fecha" => "2011"
                        "volumen" => "53"
                        "paginaInicial" => "686"
                        "paginaFinal" => "692"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21890772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications from the use of intrawound vancomycin in lumbar spinal surgery&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Ghobrial"
                            1 => "D&#46;W&#46; Cadotte"
                            2 => "K&#46; Williams"
                            3 => "M&#46;G&#46; Fehlings"
                            4 => "J&#46;S&#46; Harrop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2015.7.FOCUS15258"
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurosurgical Focus"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "E11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26621409"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical-site infection in spinal injury&#58; incidence and risk factors in a prospective cohort of 518 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Dubory"
                            1 => "H&#46; Giorgi"
                            2 => "A&#46; Walter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-014-3523-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "543"
                        "paginaFinal" => "554"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25148864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "French Orthopaedic Surgery Traumatology Society&#46; Early surgical site infections in adult spinal trauma&#58; a prospective&#44; multicentre study of infection rates and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Lonjon"
                            1 => "C&#46; Dauzac"
                            2 => "E&#46; Fourniols"
                            3 => "P&#46; Guigui"
                            4 => "F&#46; Bonnomet"
                            5 => "P&#46; Bon- nevialle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Orthop Trau- matol Surg Res"
                        "fecha" => "2012"
                        "volumen" => "98"
                        "paginaInicial" => "788"
                        "paginaFinal" => "794"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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