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Valoración de la eficiencia de la profilaxis antiemética farmacológica en diferentes grupos de riesgo tras anestesia general en la población quirúrgica de Cataluña
Evaluation of the efficiency of pharmacological antiemetic prophylaxis in different risk groups after general anaesthesia in the surgical population of Catalonia
V. Mazoa,
Autor para correspondencia
vmazo54@gmail.com

Autor para correspondencia.
, P. Vilaa, S. Sabatéb, C. Orregoc, J. Caneta, en nombre del Grupo PONVICAT
a Servicio de Anestesiología y Reanimación, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
b Servicio de Anestesiología y Reanimación, Fundació Puigvert, Barcelona, España
c Institut Universitari Avedis Donabedian-UAB, Barcelona, España
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retrasan el alta de las unidades de recuperaci&#243;n posquir&#250;rgica y son una de las causas m&#225;s frecuentes de reingreso no previsto en la cirug&#237;a ambulatoria<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Su prevenci&#243;n implica la identificaci&#243;n de los factores de riesgo y el seguimiento de protocolos encaminados a disminuir su incidencia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; M&#225;s de 1&#46;000 ensayos cl&#237;nicos han sido realizados con f&#225;rmacos antiem&#233;ticos&#44; siendo los m&#225;s com&#250;nmente utilizados en profilaxis&#44; los neurol&#233;pticos&#44; los corticoides y los antagonistas del receptor 5-HT<span class="elsevierStyleInf">3</span><a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;15</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Est&#225;n disponibles diferentes gu&#237;as cl&#237;nicas y recomendaciones para adultos basadas en la escala de riesgo de Apfel<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; pero la prescripci&#243;n de profilaxis difiere ampliamente entre los distintos hospitales debido a las diferencias en el juicio cl&#237;nico de los profesionales&#44; el deficiente cumplimiento de las gu&#237;as<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> y a la controversia que persiste en cuanto a la generalizaci&#243;n de dicha profilaxis a todos los pacientes sometidos a AG<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue conocer la incidencia de las NVPO en la poblaci&#243;n quir&#250;rgica de Catalu&#241;a sometida a AG y valorar la eficiencia de la profilaxis antiem&#233;tica farmacol&#243;gica realizada en los diferentes grupos de riesgo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se proyect&#243; un estudio observacional&#44; prospectivo y multic&#233;ntrico de una cohorte aleatoria de pacientes sometidos a cirug&#237;a con AG&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Marco de referencia</span><p id="par0025" class="elsevierStylePara elsevierViewall">Participaron en el estudio 26 hospitales de Catalu&#241;a&#46; A cada centro se le asignaron de manera aleatoria 10 d&#237;as entre los meses de septiembre- noviembre de 2007&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Criterios de inclusi&#243;n y exclusi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">En los d&#237;as asignados&#44; cada centro participante consider&#243; para incluir a todos los pacientes programados para cirug&#237;a electiva con AG&#46; Los criterios de exclusi&#243;n fueron&#58; <span class="elsevierStyleItalic">1&#41;</span> Pacientes menores de 18 a&#241;os&#59; <span class="elsevierStyleItalic">2&#41;</span> Cirug&#237;a de urgencias&#59; <span class="elsevierStyleItalic">3&#41;</span> Procedimientos con anestesia local o regional&#59; <span class="elsevierStyleItalic">4&#41;</span> Cirug&#237;a oft&#225;lmica<span class="elsevierStyleItalic">&#59; 5&#41;</span> Pacientes sin posibilidad de seguimiento en las 24<span class="elsevierStyleHsp" style=""></span>h posteriores a la cirug&#237;a&#59; <span class="elsevierStyleItalic">6&#41;</span> Pacientes que pasaron intubados a la sala de recuperaci&#243;n&#44; y <span class="elsevierStyleItalic">7&#41;</span> Cirug&#237;a cardiaca&#46; La elecci&#243;n de la premedicaci&#243;n&#44; la profilaxis antiem&#233;tica y la t&#233;cnica anest&#233;sica fueron responsabilidad del anestesi&#243;logo implicado en el procedimiento&#46; El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Hospital Germans Trias i Pujol&#44; y fue aceptado por cada uno de los hospitales participantes&#46; El consentimiento de cada paciente no fue considerado necesario por dicho comit&#233; al tratarse de un estudio observacional en el que se siguieron los cuidados m&#233;dicos habituales en cada hospital&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Variables recogidas</span><p id="par0035" class="elsevierStylePara elsevierViewall">Un coordinador en cada centro recogi&#243; la informaci&#243;n cumplimentada y la transfiri&#243; a una base de datos centralizada&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogi&#243; informaci&#243;n referente a caracter&#237;sticas de los pacientes &#40;edad&#44; sexo&#44; e &#237;ndice de masa corporal &#91;IMC&#93;&#41;&#44; estado f&#237;sico &#40;clasificaci&#243;n de la <span class="elsevierStyleItalic">American Society of Anesthesiologists</span> &#91;ASA&#93;&#41;&#44; presencia de factores de riesgo seg&#250;n la escala de Apfel<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> simplificada &#40;historia de NVPO o cinetosis previas&#44; condici&#243;n de no fumador&#44; mujer y tratamiento postoperatorio con opioides&#41;&#44; profilaxis antiem&#233;tica farmacol&#243;gica&#44; tipo de f&#225;rmaco administrado&#44; tipo y duraci&#243;n de la cirug&#237;a&#44; t&#233;cnica y duraci&#243;n de la anestesia&#44; presencia o no de eventos hemodin&#225;micos significativos durante la cirug&#237;a &#40;m&#225;s del 30&#37; de variaci&#243;n respecto a las cifras basales de frecuencia cardiaca y presi&#243;n arterial que requirieron intervenci&#243;n farmacol&#243;gica&#41;&#44; fluidoterapia administrada&#44; inserci&#243;n de sonda nasog&#225;strica &#40;SNG&#41; y registro de episodios de NVPO&#46; Se consider&#243; que el paciente padeci&#243; NVPO cuando acontec&#237;a un episodio &#250;nico o m&#250;ltiple de n&#225;usea o v&#243;mito dentro de las primeras 24<span class="elsevierStyleHsp" style=""></span>h postoperatorias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos los datos fueron introducidos en una base de datos Acces<span class="elsevierStyleSup">&#174;</span> &#40;Acces<span class="elsevierStyleSup">&#174;</span>&#44; Microsoft Corporation&#44; 2002&#44; Redmon&#44; WA&#44; EE&#46; UU&#46;&#41; para ulterior an&#225;lisis y fueron reunidos en una web creada para el estudio&#58; <a href="http://www.seguretatpacient.org/cuestionarios/ponv/">http&#58;&#47;&#47;www&#46;seguretatpacient&#46;org&#47;cuestionarios&#47;ponv&#47;</a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tama&#241;o de la muestra</span><p id="par0050" class="elsevierStylePara elsevierViewall">En funci&#243;n de los hallazgos de la encuesta ANESCAT 2003<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#44; se estim&#243; que la cirug&#237;a electiva llevada a cabo en los 26 hospitales participantes representaba aproximadamente el 40&#37; de la cirug&#237;a realizada en Catalu&#241;a&#46; Teniendo en cuenta una prevalencia de NVPO de un 25&#37;&#44; un error de precisi&#243;n de un 3&#37; y una poblaci&#243;n diana de 300&#46;000 pacientes por a&#241;o en Catalu&#241;a&#44; el tama&#241;o muestral fue de 810 pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas de los pacientes y de los diferentes procedimientos realizados&#46; Asimismo&#44; se calcularon la incidencia de NVPO y las proporciones de pacientes que recibieron profilaxis con relaci&#243;n a todas las caracter&#237;sticas y procedimientos descritos&#44; expres&#225;ndose los resultados en porcentajes para las variables categ&#243;ricas y en medias<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar para las variables continuas&#46; Se realiz&#243; una estratificaci&#243;n de la muestra por grupos de riesgo de NVPO &#40;escala reducida de riesgo de Apfel&#58; riesgo bajo&#58; 0-1 factores&#59; riesgo moderado&#58; 2 factores&#59; riesgo alto&#58; 3-4 factores&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cada uno de los estratos se procedi&#243; por separado al mismo an&#225;lisis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dado el alto n&#250;mero de variables potenciales de confusi&#243;n y con el fin de evitar un sobreaajuste &#40;<span class="elsevierStyleItalic">overfitting</span>&#41;&#44; se evalu&#243; la asociaci&#243;n entre la administraci&#243;n de profilaxis antiem&#233;tica y la incidencia de NVPO mediante un modelo multivariable de regresi&#243;n log&#237;stica en 2 pasos&#46; El primero consisti&#243; en el c&#225;lculo de un <span class="elsevierStyleItalic">propensity score</span> &#40;PS&#41; mediante un modelo de regresi&#243;n log&#237;stica no parsimonioso&#44; con profilaxis como variable dependiente y con la inclusi&#243;n como independientes de todas las variables potencialmente relacionadas con la prescripci&#243;n de profilaxis y de todas aquellas susceptibles de generar confusi&#243;n por su posible relaci&#243;n con el resultado de NVPO&#46; Fueron incluidas&#58; edad&#44; sexo&#44; IMC&#44; ASA&#44; tipo de cirug&#237;a&#44; tipo y duraci&#243;n de la anestesia&#44; presencia de eventos hemodin&#225;micos durante la intervenci&#243;n&#44; SNG y volumen de fluidos peroperatorios&#46; El poder de discriminaci&#243;n del modelo fue cuantificado mediante el <span class="elsevierStyleItalic">c-index</span> o proporci&#243;n del &#225;rea bajo la curva ROC <span class="elsevierStyleItalic">&#40;Receiver Operating Characteristic&#41;</span> y la calibraci&#243;n del modelo se realiz&#243; mediante la prueba de bondad de ajuste de Hosmer-Lemeshow&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Posteriormente&#44; en un segundo paso&#44; usamos el PS&#58; <span class="elsevierStyleItalic">1&#41;</span> como una variable en una regresi&#243;n log&#237;stica destinada a ajustar la relaci&#243;n entre cada una de las variables enumeradas y el hecho de recibir o no profilaxis&#44; con la finalidad de evaluar la comparabilidad de los 2 grupos &#40;tratados y no tratados&#41;&#59; y <span class="elsevierStyleItalic">2&#41;</span> caso de confirmarse la comparabilidad&#44; se us&#243; para ajustar&#44; en un nuevo an&#225;lisis de regresi&#243;n&#44; la magnitud de asociaci&#243;n entre profilaxis e incidencia de NVPO&#44; expresada en t&#233;rminos de <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; con intervalo de confianza del 95&#37;&#46; A partir de las OR obtenidas se calcul&#243; el n&#250;mero de pacientes que es necesario tratar &#40;NNT&#41; para evitar un episodio de NVPO mediante el programa de c&#225;lculo del <span class="elsevierStyleItalic">Centre for Evidence-Based Medicine</span> de Toronto &#40;<a href="http://www.ktklearinghouse.ca/cebm/">http&#58;&#47;&#47;www&#46;ktklearinghouse&#46;ca&#47;cebm&#47;</a>&#41;&#46; El resto del an&#225;lisis estad&#237;stico fue realizado con PASW<span class="elsevierStyleSup">&#174;</span> software package &#40;IBM SPSS<span class="elsevierStyleSup">&#174;</span> 18&#44; Chicago IL&#44; EE&#46; UU&#46;&#41;&#46; Fueron considerados significativos los valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Un total de 1&#46;259 pacientes fueron incluidos en el estudio&#46; Veinte fueron excluidos por datos incompletos&#46; El error de precisi&#243;n recalculado para esta muestra respecto a la estimaci&#243;n de NVPO en la poblaci&#243;n quir&#250;rgica de Catalu&#241;a fue del 2&#44;5&#37;&#46; La proporci&#243;n de mujeres fue del 55&#44;9&#37;&#44; la tasa de fumadores del 24&#44;6&#37;&#44; las intervenciones m&#225;s frecuentes fueron las digestivas &#40;25&#44;3&#37;&#41;&#44; ortop&#233;dicas-traumatol&#243;gicas &#40;13&#44;3&#37;&#41; y ginecol&#243;gicas &#40;12&#37;&#41;&#46; El tipo de anestesia mayoritario&#44; la balanceada &#40;84&#37;&#41;&#46; La incidencia global de NVPO durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h de postoperatorio fue del 26&#44;1&#37;&#44; siendo superior al 30&#37; en el caso de las mujeres&#44; antecedentes de NVPO&#44; cirug&#237;a ginecol&#243;gica y cirug&#237;a urol&#243;gica&#46; Se administr&#243; profilaxis antiem&#233;tica a un 51&#44;9&#37; de los pacientes&#59; 47&#37; ondansetr&#243;n&#44; 39&#37; dexametasona m&#225;s ondansetr&#243;n&#44; y el 14&#37; restante otros f&#225;rmacos &#40;haloperidol&#44; dexametasona en monoterapia o metoclopramida&#41;&#46; Esta proporci&#243;n fue superior al 60&#37; en el caso de las mujeres&#44; de los pacientes con antecedentes de NVPO y en las cirug&#237;as digestiva&#44; ginecol&#243;gica&#44; neurocirug&#237;a&#44; operaciones de mama y endocrinolog&#237;a&#46; La incidencia de NVPO fue mayor en los pacientes de menor ASA&#44; en los m&#225;s j&#243;venes&#44; en los que m&#225;s se infundi&#243; volumen y en las anestesias de mayor duraci&#243;n&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de estos datos y del resto de caracter&#237;sticas demogr&#225;ficas figuran reflejados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Los <span class="elsevierStyleItalic">c-index</span> de los 3 PS calculados&#44; fueron 0&#44;75 en el primer estrato&#44; 0&#44;77 en el segundo y 0&#44;75 en el tercero&#46; En ninguna de las pruebas de bondad de ajuste practicadas para cada una de las regresiones log&#237;sticas realizadas se encontr&#243; significaci&#243;n estad&#237;stica&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> pueden verse los resultados del an&#225;lisis en el estrato de bajo riesgo&#46; De un total de 381 pacientes&#44; 241 no recibieron profilaxis &#40;63&#44;3&#37;&#41; y 140 &#40;36&#44;7&#37;&#41; s&#237;&#46; Se reflejan las proporciones o las medias &#40;variables dicot&#243;micas o continuas&#44; respectivamente&#41; de pacientes con o sin profilaxis para cada una de las variables que sirvieron para construir el PS&#44; as&#237; como las OR del an&#225;lisis de regresi&#243;n entre cada una de las variables y la profilaxis&#44; que muestra diferencias significativas en cirug&#237;a digestiva&#44; neurocirug&#237;a&#44; SNG e incidencia de eventos hemodin&#225;micos&#46; Esas diferencias desaparecieron cuando se realiz&#243; una regresi&#243;n multivariable ajustada por el PS&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; con el mismo patr&#243;n de an&#225;lisis&#44; vemos los resultados referentes al estrato de riesgo moderado&#46; De los 466 pacientes&#44; 211 &#40;45&#44;3&#37;&#41; no recibieron profilaxis y 255 &#40;54&#44;7&#37;&#41; s&#237;&#46; En el an&#225;lisis sin ajustar&#44; hubo diferencias significativas en las proporciones de las variables edad&#44; sexo&#44; antecedentes de NVPO&#44; pacientes ASA III y IV&#44; cirug&#237;as ginecol&#243;gica&#44; traumatol&#243;gica y urol&#243;gica&#44; utilizaci&#243;n de &#243;xido nitroso y presencia de SNG&#46; Al ajustar por el PS no hubo diferencias entre los 2 grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> observamos que&#44; de los 392 pacientes de alto riesgo&#44; 144 &#40;33&#44;7&#37;&#41; no recibieron profilaxis frente a 248 &#40;66&#44;3&#37;&#41; que s&#237; la recibieron&#46; En este estrato&#44; el sexo y las cirug&#237;as ginecol&#243;gica&#44; tor&#225;cica&#44; urol&#243;gica y traumatol&#243;gica&#44; mostraron una dispar distribuci&#243;n entre pacientes con y sin profilaxis&#46; El an&#225;lisis multivariable ajustado por PS&#44; tampoco mostr&#243; diferencias significativas&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados observados en las <a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2&#8211;4</a> justificaron la evaluaci&#243;n de asociaci&#243;n entre pacientes con y sin profilaxis respecto a su efecto en la incidencia de NVPO&#44; ajustando igualmente por el PS de profilaxis calculado en cada estrato&#46; La fuerza de esta asociaci&#243;n queda reflejada en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> donde se observan unas diferencias de incidencia de NVPO entre los pacientes sin y con profilaxis de un 13&#44; 13&#44;7 y 13&#44;8&#37; en los estratos de bajo&#44; moderado y alto riesgo&#44; respectivamente&#46; Las respectivas OR y sus intervalos de confianza reflejan la significaci&#243;n estad&#237;stica en los 3 estratos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Los NNT y sus intervalos de confianza&#44; calculados a partir de cada una de las OR fueron 7 &#40;5-11&#41; en el estrato de bajo riesgo&#44; 7 &#40;5-13&#41; en el de riesgo moderado y 6 &#40;4-16&#41; en el de riesgo elevado&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">La profilaxis de NVPO debe abordarse desde una perspectiva multimodal&#44; y a pesar de que nuestro objetivo se centraba en la profilaxis famacol&#243;gica&#44; fueron tenidos en cuenta aquellos aspectos que podr&#237;an modificar el riesgo de dichos episodios&#44; con el f&#237;n de evitar al m&#225;ximo la confusi&#243;n derivada de factores escondidos y&#44; por lo tanto&#44; incontrolables&#46; Por ello&#44; se construy&#243; un modelo multivariable&#46; Los factores de riesgo m&#225;s aceptados en la literatura<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;23</span></a> fueron utilizados para estratificar el estudio de la muestra y para ser introducidos en el modelo descrito&#44; con el fin de garantizar la comparabilidad de los grupos tratado y no tratado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de la poblaci&#243;n quir&#250;rgica y los tipos de interveci&#243;n quir&#250;rgica realizada fueron muy similares a los observados en la encuesta ANESCAT 2003<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#44; lo que nos confirma la representatividad de la muestra que muy probablemente no difiere de otros contextos geogr&#225;ficos pr&#243;ximos&#46; La incidencia de NVPO &#40;26&#44;1&#37;&#41; hallada est&#225; en el rango medio o bajo en relaci&#243;n con lo publicado<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#44; as&#237; como que se administr&#243; profilaxis aproximadamente a la mitad de los pacientes anestesiados &#40;51&#44;9&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El hecho de que una proporci&#243;n muy importante de pacientes de riesgo alto y moderado no recibiera profilaxis nos alerta sobre la realidad de incumplimiento en nuestro entorno de lo que la mayor&#237;a de las gu&#237;as cl&#237;nicas propugnan&#46; Por otra parte&#44; que una importante proporci&#243;n de pacientes de bajo riesgo recibiese profilaxis&#44; podr&#237;a ser considerado por algunos como un exceso&#44; si bien el presente estudio lo desmiente&#46; Estos hallazgos&#44; preocupantes en cuanto a lo que podr&#237;a considerarse una cierta asignaci&#243;n aleatoria de la profilaxis&#44; nos permitieron&#44; no obstante&#44; comparar para los 3 estratos&#44; las diferencias de incidencia de NVPO entre pacientes con y sin profilaxis&#44; algo que podr&#237;a no considerarse &#233;tico en un ensayo cl&#237;nico&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Nos parece altamente significativo y relevante que no existiera pr&#225;cticamente diferencia entre los distintos grupos de riesgo&#44; en cuanto a la eficiencia de la profilaxis antiem&#233;tica&#46; El intervalo de confianza del NNT para los 3 estratos fue pr&#225;cticamente id&#233;ntico&#44; lo que avalar&#237;a la recomendaci&#243;n de una profilaxis universal que algunos autores preconizan<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; La incidencia superior a un 20&#37; de NVPO en la poblaci&#243;n de bajo riesgo no es despreciable y&#44; a su vez&#44; su disminuci&#243;n en los pacientes tratados en m&#225;s de 10 puntos porcentuales&#44; hay que tenerlo en cuenta&#46; Una posible explicaci&#243;n de la rentabilidad de la profilaxis en los pacientes de bajo riesgo puede ser que en este grupo nos encontramos m&#225;s cerca de rebajar el riesgo a un umbral m&#237;nimo&#44; mientras que en los pacientes de riesgo elevado&#44; el riesgo persiste a pesar de la profilaxis&#46; Con estos hallazgos y teniendo en cuenta el bajo coste y la relativa falta de contraindicaciones de los f&#225;rmacos disponibles&#44; recomendamos profilaxis para todos los pacientes que van a ser intervenidos con AG&#44; aunque se precisar&#237;an m&#225;s estudios en los grupos de bajo riesgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A pesar de no haber hecho menci&#243;n de costes&#44; el c&#225;lculo del NNT para evitar un evento&#44; nos permite hablar con propiedad de eficiencia&#46; Si tenemos en cuenta que los f&#225;rmacos utilizados en profilaxis oscilan en nuestro mercado entre 0&#44;5 y 2&#44;5 &#8364; y que el NNT oscila entre 5 y menos de 20&#44; podemos concluir&#44; que evitar un episodio de NVPO oscila en entre 2&#44;5 y 35 &#8364;&#44; muy alejado de los 250 &#36; que los pacientes pagar&#237;an seg&#250;n algunas encuestas por no padecer un episodio<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; En cualquier caso&#44; lo que este trabajo refleja es que los costes son similares para los diferentes grupos de riesgo y que una inhibici&#243;n en el grupo de bajo riesgo puede no estar justificada por criterios de coste-efectividad&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Empleamos el PS &#40;traducido por algunos de manera discutible como &#237;ndice de propensi&#243;n&#41;&#44; para minimizar los sesgos y los factores de confusi&#243;n inherentes a los estudios observacionales<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Hay que advertir&#44; que hay varias opciones a la hora de utilizar este par&#225;metro<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; La m&#225;s com&#250;n es utilizarlo para un posterior apareamiento <span class="elsevierStyleItalic">&#40;matching&#41;</span> de la muestra entre pacientes del grupo control y pacientes del grupo tratamiento con valores similares de su PS&#46; Esta aproximaci&#243;n&#44; aunque instructiva a efectos expositivos&#44; desecha una importante parte de la muestra y conlleva una p&#233;rdida de potencia estad&#237;stica&#46; En nuestro an&#225;lisis&#44; elegimos el uso del PS como una variable continua&#44; en un modelo multivariable de regresi&#243;n log&#237;stica&#44; para ajustar la asociaci&#243;n entre la profilaxis &#40;tratamiento&#41; y las NVPO &#40;resultado&#41;&#46; Este proceder permite condensar en esta variable los posibles confusores&#44; sin restricciones&#44; que de otra manera tendr&#237;an que introducirse en una regresi&#243;n cl&#225;sica con demasiados par&#225;metros conducentes a posibles resultados espurios<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;28</span></a>&#46; Su utilidad est&#225; respaldada<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n del estudio es su condici&#243;n de observacional&#46; Aunque las t&#233;cnicas de an&#225;lisis m&#225;s depuradas&#44; como la empleada&#44; permiten una aproximaci&#243;n estimable a la evidencia&#46; Cuentan con la ventaja de trabajar con supuestos reales&#44; mientras que en el caso de los ensayos cl&#237;nicos&#44; las condiciones ideales de ejecuci&#243;n pueden hacer dif&#237;cil la extrapolaci&#243;n de las conclusiones&#46; La desventaja&#44; ya conocida&#44; es el posible sesgo impuesto por factores no investigados&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n podr&#237;a ser la escasa informaci&#243;n aportada respecto a los diferentes f&#225;rmacos empleados&#44; si bien&#44; dada la evoluci&#243;n hist&#243;rica del mercado hasta la fecha de ejecuci&#243;n del presente estudio&#44; se sigui&#243; un proceder bastante uniforme&#44; de tal forma que una amplia mayor&#237;a recibi&#243; ondansetr&#243;n como profilaxis&#44; y menos dexametasona&#46; A d&#237;a de hoy&#44; la situaci&#243;n puede haber cambiado con la reintroducci&#243;n del droperidol&#46; De todas formas&#44; esta nueva opci&#243;n terap&#233;utica es equipotente a las empleadas&#44; ya que todos reducen en un 26&#37; el riesgo relativo para la NVPO<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; y los 3 se consideran de elecci&#243;n indistintamente para la profilaxis en las gu&#237;as<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Teniendo en cuenta estas consideraciones de equipotencia&#44; las conclusiones del estudio son claramente extrapolables a todos los f&#225;rmacos antiem&#233;ticos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; una posible insuficiencia del presente trabajo es la limitada exploraci&#243;n del efecto hospital&#44; por las diferentes maneras de proceder en los distintos centros&#44; auque al centrarnos en factores que podr&#237;an confundir el efecto&#44; como son las caracter&#237;sticas de los pacientes y los procedimientos realizados&#44; el centro no a&#241;ad&#237;a confusi&#243;n&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Este an&#225;lisis multivariable ajustado por un PS de las variables registradas en este estudio observacional nos permite ratificar la eficiencia de la profilaxis farmacol&#243;gica en una poblaci&#243;n quir&#250;rgica estratificada por niveles de riesgo para las NVPO&#46; Estos resultados sugieren la utilizaci&#243;n de profilaxis farmacol&#243;gica en cualquier grupo de riesgo de NVPO&#46; La propuesta de una profilaxis universal deber&#237;a considerarse en las pr&#243;ximas ediciones de gu&#237;as de pr&#225;ctica cl&#237;nica&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">Financiado en parte por la Alianza Catalana para la Seguridad del Paciente bajo los auspicios del Departament de Salut de la Generalitat de Catalu&#241;a&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Marco de referencia"
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              "titulo" => "Criterios de inclusi&#243;n y exclusi&#243;n"
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              "identificador" => "sec0030"
              "titulo" => "Variables recogidas"
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              "titulo" => "Tama&#241;o de la muestra"
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              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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    "fechaRecibido" => "2011-06-03"
    "fechaAceptado" => "2012-03-27"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec101646"
          "palabras" => array:3 [
            0 => "N&#225;useas y v&#243;mitos"
            1 => "Postoperatorio"
            2 => "Profilaxis farmacol&#243;gica"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:3 [
            0 => "Nausea and vomiting"
            1 => "Postoperative"
            2 => "Pharmacological prophylaxis"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Valorar la eficiencia de la profilaxis antiem&#233;tica farmacol&#243;gica en pacientes sometidos a una intervenci&#243;n quir&#250;rgica&#44; bajo anestesia general&#44; en diferentes grupos de riesgo de n&#225;useas y vomitos postoperatorios &#40;NVPO&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio multic&#233;ntrico aleatorio prospectivo observacional de cohortes&#46; Se estudiaron 1&#46;239 pacientes procedentes de 26 hospitales sometidos a cirug&#237;a programada con anestesia general&#46; Fueron registradas las caracter&#237;sticas poblacionales&#44; los factores de riesgo de NVPO&#44; la t&#233;cnica anest&#233;sica&#44; el tipo de cirug&#237;a&#44; la duraci&#243;n&#44; la fluidoterapia&#44; la profilaxis antiem&#233;tica administrada y la incidencia de NVPO en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46; Se realiz&#243; un an&#225;lisis estratificado &#40;riesgo bajo&#44; moderado y alto&#41; encaminado a evaluar la asociaci&#243;n entre profilaxis y NVPO mediante un modelo de regresi&#243;n log&#237;stica ajustado por <span class="elsevierStyleItalic">propensity score</span>&#46; Posteriormente&#44; se calcul&#243; en cada uno de los estratos el n&#250;mero de pacientes que es necesario tratar &#40;NNT&#41;&#44; para evitar un episodio de NVPO&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La incidencia de NVPO en el estrato de bajo riesgo fue del 21&#44;6&#37; sin profilaxis y del 8&#44;6&#37; con profilaxis&#44; en el de riesgo moderado fue del 31&#44;3&#37; frente al 17&#44;7&#37; y en el de alto riesgo del 46&#44;5&#37; frente al 32&#44;7&#37;&#46; Hubo un efecto protector de la profilaxis de forma significativa en los 3 estratos &#40;<span class="elsevierStyleItalic">odds ratio</span> entre pacientes tratados y no tratados&#41; y el NNT &#40;IC del 95&#37;&#41; fue de 7 &#40;5-11&#41; en el estrato de bajo riesgo&#44; 7 &#40;5-13&#41; en el de riesgo moderado y 6 &#40;4-16&#41; en el de riesgo elevado&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La eficiencia de la profilaxis antiem&#233;tica farmacol&#243;gica en pacientes sometidos a cirug&#237;a con anestesia general fue similar en todos los grupos de riesgo&#46; La privaci&#243;n de profilaxis antiem&#233;tica en los pacientes de bajo riesgo puede no estar justificada por criterios de coste-efectividad&#46; Las futuras gu&#237;as cl&#237;nicas para la mejora de la calidad asistencial&#44; de los pacientes intervenidos con anestesia general deber&#225;n considerar la conveniencia de una profilaxis universal de las NVPO&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the efficiency of pharmacological antiemetic prophylaxis in patients subjected to surgery under general anaesthetic in different postoperative nausea and vomiting &#40;NVPO&#41; risk groups&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A randomised&#44; observational&#44; prospective and multicentre cohort study was conducted&#46; The study included 1239 patients from 26 hospitals who were subjected to elective surgery under general anaesthesia&#46; The data collected included&#44; demographic characteristics&#44; the NVPO risk factors&#44; anaesthetic technique&#44; type of surgery&#44; the duration&#44; fluid therapy&#44; antiemetic prophylaxis administered&#44; and the incidence of NVPO in the first 24<span class="elsevierStyleHsp" style=""></span>h after surgery&#46; A stratified analysis &#40;low&#44; moderate and high risk&#41; was performed with the intention of evaluating the relationship between prophylaxis and NVPO using a logistic regression model adjusted for propensity score&#46; The number of patients needed to treat &#40;NNT&#41; to prevent an NVPO episode was then calculated for each of the strata&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The incidence of NVPO in the low risk stratum was 21&#46;6&#37; without prophylaxis and 8&#46;6&#37; with prophylaxis&#44; 31&#46;3&#37; compared to 17&#46;7&#37; in the moderate risk&#44; and 46&#46;5&#37; compared to 32&#46;7&#37; in the high risk group&#46; There was a significant protective effect in the three strata &#40;odds ratio between treated and untreated patients&#41; and in the NNT &#40;95&#37; CI&#41; was 7 &#40;5-11&#41; in the low risk stratum&#44; 7 &#40;5-13&#41; in that of the moderate risk&#44; and 6 &#40;4-16&#41; in the high risk&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The efficiency of pharmacological antiemetic prophylaxis in patients subjected to surgery under general anaesthesia was similar in all risk groups&#46; Not providing antiemetic prophylaxis in low risk patients may not be justified due to the cost-effectiveness criteria&#46; Future clinical guidelines to improve the quality of health care of patients operated on under general anaesthesia should consider the advantages of a universal NVPO prophylaxis&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Datos presentados en parte al&#58; VI Congreso de la Sociedad Catalana de Anestesiolog&#237;a &#40;SCARTD&#41;&#44; noviembre de 2008&#44; Bellaterra&#59; XXIX Congreso de la Sociedad Espa&#241;ola de Anestesiolog&#237;a &#40;SEDAR&#41;&#44; 26-29 de mayo 2009&#44; Salamanca&#59; Euroanesthesia 2009&#44; junio 2009&#44; Mil&#225;n&#44; Italia&#59; Euroanesthesia 2010&#44; junio 2010&#44; Helsinki&#44; Finlandia&#46;</p>"
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            "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Pinar Santos &#40;Hospital Cl&#237;nic&#44; Barcelona&#41;&#59; Antoni Perez &#40;Hospital Matar&#243;&#41;&#59; Valent&#237;n Mazo &#40;Hospital Germans Trias i Pujol&#41;&#59; Roser Aloma &#40;Hospital General de l&#8217;Hospitalet&#41;&#59; Jordi Torras &#40;Hospital General de Vic&#41;&#59; M&#46; Ant&#242;nia Dalmau &#40;Hospital de Bellvitge&#41;&#59; Tomeu Cantallops &#40;Hospital de Sant Pau&#41;&#59; Francesca Reguant &#40;Hospital Althaia Manresa&#41;&#59; Gregorio Marco &#40;GSS-H&#46; Sta&#46; Mar&#237;a&#41;&#59; Helena M&#233;ndez &#40;Hospital de Sabadell&#41;&#59; Vicente Serrano &#40;Hospital Joan XXIII&#41;&#59; Eduard Esteva &#40;Hospital Municipal&#41;&#59; Maite Robles &#40;Hospital General Granollers&#41;&#59; Xavier Miret &#40;Hospital de l&#8217;Alt Penedes&#41;&#59; Emili Le&#243;n &#40;Hospital Trueta&#41;&#59; Nuria Baldom&#225; &#40;Hospital del Mar&#41;&#59; Francesca Barbal &#40;Hospital Sant Rafael&#41;&#59; Eduardo Rojas &#40;Fundaci&#243; Puigvert&#41;&#59; Gloria Mart&#237;nez &#40;Hospital Arnau Vilanova&#41;&#59; Ferran Manen &#40;Hospital San Joan de D&#233;u&#41;&#59; Carme Mart&#237;n &#40;Hospital de Terrassa&#41;&#59; Joaquim Sabater &#40;Hospital de Igualada&#41;&#59; Jorge Castillo &#40;Hospital de la Esperanza&#41;&#59; J&#46;M&#46; Corominas &#40;Hospital de Olot&#41;&#59; Lluis Sanjuan &#40;Hospital de Valls&#41;&#44; y Elisenda Izquierdo &#40;Hospital de Viladecans&#41;&#46;</p>"
            "etiqueta" => "Anexo 1"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IMC&#58; indice de masa coporal&#59; NVPO&#58; n&#225;useas y vomitos postoperatorios&#59; SNG&#58; sonda nasog&#225;strica&#59; TIVA&#58; anestesia total intravenosa&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#42;</span>Valores expresados en media &#40;&#177; desviaci&#243;n estandar&#41;&#46; Resto de variables expresadas en n&#250;mero de pacientes y porcentaje dentro de su grupo de tratamiento &#40;con o sin profilaxis&#41;&#46; Factores de Apfel&#58; mujer&#44; antecedentes de NVPO&#44; opioides en postoperatorio y condici&#243;n de no fumador&#47;a&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia de NVPO o cinetosis</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " colspan="4" align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Opioides en postoperatorio</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&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  " 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
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                  \t\t\t\t  " align="char" valign="\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  " colspan="4" align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ASA</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;5&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;1&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de cirug&#237;a</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Digestiva&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="char" valign="\n
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                  \t\t\t\t">313 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">60&#44;7&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traumatolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165 &#40;13&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ginecolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;12&#44;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="char" valign="\n
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                  \t\t\t\t">37&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">77&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">32&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mama&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="char" valign="\n
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                  \t\t\t\t">130 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;7&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="char" valign="\n
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                  \t\t\t\t">60&#44;0&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ORL&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="char" valign="\n
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                  \t\t\t\t">74 &#40;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&#44;5&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Endocrino&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">28&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tor&#225;cica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">54 &#40;4&#44;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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurocirug&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;3&#44;8&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;3&#44;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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pl&#225;stica&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;3&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;0&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maxilofacial&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;1&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otras&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;0&#44;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="" 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="" 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="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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de anestesia</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>TIVA&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">192 &#40;15&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Balanceada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1047 &#40;84&#44;5&#41;&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">27&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Utilizaci&#243;n de &#243;xido nitroso</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">240 &#40;19&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;0&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  " 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">999 &#40;80&#44;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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;1&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
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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  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Portadores de SNG</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">411 &#40;33&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;0&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  " 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">828 &#40;66&#44;8&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Eventos hemodin&#225;micos</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">504 &#40;40&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;5&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  " 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">735 &#40;59&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;7&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total muestra</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;239 &#40;100&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;1&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab202315.png"
              ]
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            1 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Variables continuas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sin NVPO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Con NVPO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sin profilaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Con profilaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad &#40;a&#241;os&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;5 &#40;16&#44;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;2 &#40;16&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;6 &#40;16&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;2 &#40;16&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;8 &#40;16&#44;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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9 &#40;5&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0 &#40;5&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9 &#40;5&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9 &#40;4&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9 &#40;5&#44;9&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fluidos intraoperatorios &#40;ml&#41;&#42;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;371 &#40;1&#46;610&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;304 &#40;928&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;563 &#40;2&#46;744&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;460 &#40;2&#46;132&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;328 &#40;869&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n &#40;min&#41;&#42;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145 &#40;82&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139 &#40;75&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160 &#40;87&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;79&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab202313.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero&#44; porcentaje de pacientes&#44; incidencia de NVPO y porcentaje de pacientes con profilaxis en funci&#243;n de las caracter&#237;sticas de los pacientes y de los procedimientos realizados</p>"
        ]
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      1 => array:7 [
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">IMC&#58; &#237;ndice de masa coporal&#59; NVPO&#58; n&#225;useas y vomitos postoperatorios&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio</span>&#59; PS&#58; <span class="elsevierStyleItalic">propensity score</span>&#59; SNG&#58; sonda nasog&#225;strica&#59; TIVA&#58; anestesia total intravenosa&#46;</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"><td 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">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Profilaxis No&nbsp;\t\t\t\t\t\t\n
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                  \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" style="border-bottom: 2px solid black">Profilaxis S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Bruto</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ajustado por PS</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">54&#44;21&#40;17&#44;02&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;02 &#40;16&#44;21&#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="char" valign="\n
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                  \t\t\t\t">0&#44;99 &#40;0&#44;98-1&#44;00&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;22&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;99 &#40;0&#44;98-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;10&#44;4&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;13&#44;6&#37;&#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
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                  \t\t\t\t">1&#44;36 &#40;0&#44;72-2&#44;56&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;35&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;18 &#40;0&#44;59-2&#44;38&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26&#44;16 &#40;4&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;26 &#40;4&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00 &#40;0&#44;95-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fumador&#47;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126 &#40;52&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traumatolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maxilofacial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de anestesia</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIVA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pl&#225;stica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurocirug&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Duraci&#243;n &#40;min&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sueroterapia &#40;ml&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estrato de alto riesgo &#40;3-4 factores de Apfel&#41;&#58; comparaci&#243;n de las caracter&#237;sticas de los pacientes y de los procedimientos entre pacientes con y sin profilaxis</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#59; NNT&#58; n&#250;mero de pacientes necesarios a tratar&#59; NVPO&#58; n&#225;useas y v&#243;mitos postoperatorios&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio</span>&#59; PS&#58; <span class="elsevierStyleItalic">propensity score</span>&#46;</p>"
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                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">NVPO sin profilaxis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR bruto &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR ajustado por PS &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">NNT &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Grupo de bajo riesgo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;341&#40;0&#44;175-0&#44;664&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&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">0&#44;252&#40;0&#44;120-0&#44;529&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;471&#40;0&#44;305-0&#44;727&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&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">0&#44;416&#40;0&#44;253-0&#44;685&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&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">7 &#40;5-13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Grupo de alto riesgo&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">67 &#40;46&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81 &#40;32&#44;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">0&#44;557&#40;0&#44;366-0&#44;850&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;007&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">0&#44;479&#40;0&#44;298-0&#44;770&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;4-16&#41;&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Which clinical anesthesia outcomes are important to avoid&#63; The perspective of patients"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46; Macario"
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                        "paginaFinal" => "658"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10475299"
                            "web" => "Medline"
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              "identificador" => "bib0010"
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                  "contribucion" => array:1 [
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                      "titulo" => "A survey of postoperative nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Koivuranta"
                            1 => "E&#46; Laara"
                            2 => "L&#46; Snare"
                            3 => "S&#46; Alahuhta"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "1997"
                        "volumen" => "52"
                        "paginaInicial" => "443"
                        "paginaFinal" => "449"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9165963"
                            "web" => "Medline"
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The postoperative interview&#58; assessing risk factors for nausea and vomiting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;M&#46; Cohen"
                            1 => "P&#46;G&#46; Duncan"
                            2 => "D&#46;P&#46; DeBoer"
                            3 => "W&#46;A&#46; Tweed"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "1994"
                        "volumen" => "78"
                        "paginaInicial" => "7"
                        "paginaFinal" => "16"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8267183"
                            "web" => "Medline"
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rational approach to the control of postoperative nausea and vomiting&#58; evidence from systematic reviews&#46; Part I&#46; Efficacy and harm of antiemetic interventions&#44; and methodological issues"
                      "autores" => array:1 [
                        0 => array:2 [
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
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                            "web" => "Medline"
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                          "etal" => false
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                            1 => "E&#46; Laara"
                            2 => "M&#46; Koivuranta"
                            3 => "C&#46;A&#46; Greim"
                            4 => "N&#46; Roewer"
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Información del artículo
ISSN: 00349356
Idioma original: Español
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