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"resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es conocer los criterios de selección y preparación de los pacientes en las diferentes unidades de cirugía mayor ambulatoria (UCMA) españolas y su impacto en los resultados de éstas; también se comparan dichos resultados según el tipo de estructura funcional de las unidades (autónoma o integrada).</p> <span class="elsevierStyleSectionTitle">Material y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal mediante encuesta postal. Encuesta con los siguientes apartados: tipo de unidad, cartera de servicios, criterios de selección, evaluación, manejo preoperatorio e indicadores cualitativos y cuantitativos de la actividad realizada en el año 2000. Se incluyeron 123 unidades, con un nivel de respuesta del 39%.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Existe un alto grado de consenso en los criterios de selección. En el 97,9% de las unidades se utiliza la consulta de anestesia para la evaluación preoperatoria. La solicitud sistemática de las pruebas de laboratorio es elevada (89% para la hemostasia y el hemograma, 72,9% para la bioquímica), mientras que para la radiografía de tórax (33,3%) y el ECG (35,4%) se utilizan criterios más selectivos. La implantación de protocolos para el manejo de afecciones asociadas está poco extendida (25-64,6%). El índice de cancelaciones es ventajoso para las unidades que utilizan la consulta de anestesia en todos los pacientes (el 1,5 frente al 4,4%). Existe una significativa aceptación de pacientes de mayor riesgo quirúrgico-anestésico en las unidades de tipo autónomo respecto a las integradas, así como una significativa disminución del número de ingresos (el 1,2 frente al 1,9%; p = 0,003) de las estancias (240 frente a 367 min; p = 0,002), y del tiempo de recuperación (150 frente a 212 min; p = 0,001). Las diferencias en el resto de los indicadores analizados no revisten significación.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Es necesario profundizar en la consecución de protocolos basados en evidencias científicas para la se-lección de los pacientes, la evaluación preoperatoria y el manejo perioperatorio de las diferentes enfermedades, así como para la utilización racional de las pruebas de laboratorio. Se constata la necesidad de la consulta anestésica para la evaluación preoperatoria. Los resultados de nuestra encuesta apuntan hacia unos mejores resultados en los indicadores de funcionamiento en las UCMA autónomas frente a las integradas. Existe la posibilidad de definir estándares de calidad y validarlos, para lo cual serán necesarios futuros estudios multicéntricos.</p>"
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"en" => array:2 [
"titulo" => "Abstract"
"resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated).</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9%) and to a lesser extent chest X-ray (33.3%) and electrocardiogram (35.4%). The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%). Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%). Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003), mean stay (240 min vs 367 min, p = 0.002), and recovery time (150 min vs 212 min, p = 0.001) than integrated units. No statistically significant differences were found in the remaining parameters.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Scientifically based protocols for patient selection, preoperative assessment and perioperative management of distinct processes and for the rational use of laboratory tests should be more widely used. The need for an outpatient anesthesia clinic for preoperative assessment was notable. The results of our survey indicate that better results in performance indexes are achieved in autonomous ambulatory surgery units than in integrated units. Given the possibility of defining and validating quality standards, further multicenter studies should be performed.</p>"
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